Anxiety

Question 1

OCD

Answer 1

Obsession - unwanted thoughts that cause anxiety

Compulsion - Repetitive behaviour to relieve the unpleasant obsessive thoughts.

Diagnosed if it has a significant impact on day to day functioning.

Question 2

PTSD

Answer 2

Characterised by re-experiencing traumatic events, avoidance of thoughts/memories of event.

also insomnia, nightmares, flashbacks, isolation, etc…

Question 3

Generalised anxiety disorder (GAD) and its neurobiology

Answer 3

Excessive uncontrollable worry about every day things. can present with physical symptoms.

Neurobiology:
Amygdala processes emotions, e.g., anger, aggression, anxiety, etc…

Decreased connectivity between the amygdala and the prefrontal cortex

unable to properly and intellectually process emotions, e.g., anxiety/fear.

Question 4

Causes of GAD

Answer 4

30-50% genetic, 50-70% environmental

Dysregulation of GABA often seen: down regulation of GABAA.

GAD patients have been found to be hypersensitive to the neuropeptide cholecystokinin (CCK)

Neuroendocrine: dysregulation of HPA axis: negative feedback of cortisol is compromised. increased cortisol seen. overstimulation of the HPA axis.

Question 5

Non-pharmacological treatments

Answer 5

Meditation/relaxation - mindfulness
exercise
lifestyle changes

Question 6

Pharmacological treatments

Answer 6

Beta blockers to reduce the physical symptoms of anxiety

SSRI as first line option

Benzodiazapines given for short term use during especially stressful times

Question 7

Benzodiazapines

Answer 7

bind to the BZD site on GABAA (between alpha and gamma interface), and cause a conformational change to improve GABA binding. More Cl- mediated hyperpolarisation.