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SGUL - Physiology 2 > Anxiety > Flashcards

Anxiety Flashcards

1
Q

Define anxiety

A

A feeling of unease (worry or fear) which can range from mild to severe

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2
Q

What type of response can anxiety be?

A

Can be a normal adaptive response and in some cases, can be beneficial:
- An innate adaptive response
- A learned adaptive response

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3
Q

Describe Anxiety as an innate adaptive response

A
  • Fear is an adaptive response to a threatening stimuli
  • Fear response comprises several components (defensive behaviour, autonomic reflexes, increased alertness)
  • Many fears are innate and species specific
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4
Q

Describe anxiety as a learned adaptive response

A
  • Fear can also be learned through life experiences
  • However fear is not an appropriate response in all circumstances
  • Fear response can occur in an anticipatory manner, sometimes independently of stimuli
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5
Q

When does anxiety become a problem?

A

Due to the intensity (Intermittent Chronic) or source Certain events or situations (Irrational) come together causing:
- Social disturbances
- Avoidance behaviours
- Incessant worry
- Concentration/Memory problems

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6
Q

What is some psychological symptoms of anxiety?

A
  • Stress
  • Suspense
  • Worry
  • Foreboding
  • Uneasiness
  • Nervous
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7
Q

What are some physiological symptoms of anxiety?

A
  • Tachycardia
  • Shortness of breath
  • Excessive sweating
  • Tremble or shaking
  • Nausea
  • Fatigue
  • Insomnia
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8
Q

What can cause some symptoms of anxiety?

A
  • Past experiences: Difficult experiences in childhood
  • Everyday life and habits: Current issues or problems in everyday life
  • Diet: Some types of food and drink
  • Physical and mental health:
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9
Q

How can alcohol cause symptoms of anxiety?

A
  • Alcohol is a central nervous system depressant, increases GABAergic neurotransmission and can block glutamatergic neurotransmission
  • Balance between GABA and glutamate crucial for optimal brain function, alcohol disrupts its balance
  • Our brain adapts to counteract this imbalance, leads to low levels of GABA and high levels of glutamate can trigger anxiety symptoms
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10
Q

What else can trigger symptoms of anxiety?

A

Recreational drugs

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11
Q

How can genetics be a cause for the symptoms of anxiety?

A
  • Research has linked genetic factors to several anxiety disorders
  • However the only clear result can be derived from genetic studies is that anxiety disorders are not based on a single gene but likely have a complex genetic basis which can be affected by the environmental factors
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12
Q

What is the pathophysiology of anxiety?

A

Hallmark of anxiety disorders is an inappropriate stress response either when a stressor is present or not immediately threatening

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13
Q

What is the coordination of a stress response to a threatening stimuli?

A
  • The stress response is regulated by the hypothalamus pituitary adrenal (HPA) axis
  • The HPA axis regulate the release of cortisol which contributes to the body’s physiological response to stress
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14
Q

What evidence suggests that activation of CRH releasing hormones of the hypothalamus play a key role in regulating stress response?

A
  • Over-expressing CRH in rodent models lead to increased anxiety like behaviours
  • Knocking out CRH receptors in rodent models leads to less anxiety like behaviours
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15
Q

What role does the amygdala play in terms of anxiety?

A
  • Amygdala: Role in emotion and fear response
  • Stimulates HPA axis to promote cortisol release
  • Amygdala hyperactivity linked to anxiety disorders
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16
Q

What role does the hippocampus play in terms of anxiety?

A
  • Hippocampus has a role in learning and memory
  • Suppresses HPA axis to prevent excessive cortisol release
  • Hippocampus under activity linked to anxiety disorders
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17
Q

What book is universally used for the classification of anxiety disorders?

A
  • DSM 5 2013
  • Anxiety disorders
  • Obsessive compulsive disorders
  • Trauma and stressor related disorders
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18
Q

List some anxiety disorders found in the DSM-5 2013

A
  • Generalised anxiety disorder
  • Specific phobias
  • Social phobias
  • Panic disorders
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19
Q

List some obsessive compulsive disorders found in the DSM-5 2013

A
  • Obsessive compulsive disorders
  • Body dysmorphic disorder
  • Hoarding disorder
  • Trichotillomania
20
Q

List some Trauma and stressor related disorders found in the DSM-5 2013

A

Post traumatic stress syndrome

21
Q

Define generalised anxiety disorder (GAD)

A

Characterised by an ongoing state of excessive anxiety lacking clear reason or focus

22
Q

Describe generalised anxiety disorder

A
  • Excessive anxiety and worry occurring for at least 6 months which is difficult to control and impairs activities of daily life
  • Associated with 3 or more symptoms
  • Not associated to a substance or medical condition or better explained by another type of anxiety disorder
  • GAD sufferers symptoms likely to be different from another persons experience with GAD
23
Q

Define the term “specific phobias”

A

Extreme fears or anxieties provoked by exposure to a particular situation or object. Often leads to avoidance behaviours

24
Q

Describe specific phobias

A
  • Phobic object or situation almost always provokes immediate fear or anxiety
  • This is out of proportion to the actual danger posed by the object or situation
  • Phobia is persistent and typically persists for at least 6 months, impairing daily life activities
  • Not attributable to a substance or medical condition or better explained by another type of anxiety disorder
25
Q

Define the term “Social phobias”

A

Characterised by significant anxiety provoked by exposure to certain types of social or performance situations

26
Q

Describe social phobias

A
  • May relate to one or more social situations in which individual is exposed to possible scrutiny by others
  • Includes social interactions, being observed and in front of others
  • Social situations almost always provoke immediate fear or anxiety, out of proportion to the actual danger posed by object or situation
  • The phobia is persistent and typically persists at least 6 months, impairing activities of daily living
  • Not attributable to a substance or medical condition
27
Q

Define the term “Panic disorders”

A

Characterised by reoccurring panic attacks without a seemingly clear cause or trigger

28
Q

Describe panic disorders

A
  • A panic attack is an abrupt surge of intense fear or discomfort, reaching a peak within minutes
  • Associated with four or more of thirteen symptoms in accordance to DSM 5
  • Includes increased heart rate, sweating, trembling, shortness disorder and fear of dying
  • Individual worries about further panic attacks, can lead to a panic cycle
  • Panic attacks can occur spontaneously or be a feature of number of anxiety disorders
29
Q

What is an Obsessive compulsive disorder (OCD)?

A

Characterised by compulsive, ritualistic behaviour driven by irrational anxiety

30
Q

List the 2 types of OCD

A
  • Obsessions: Recurrent, Intrusive thoughts, images, ideas or impulses
  • Compulsions: Repetitive behaviours or mental acts that are performed to reduce anxiety associated with the obsessions
31
Q

Describe OCD briefly

A
  • Obsessions and compulsions are time consuming, impairing activities of daily living
  • Not attributable to a substance or medical condition or better explained by another type of anxiety disorder
32
Q

Define PTSD

A

Post traumatic stress disorder is characterised by distress triggered by the recall of past traumatic experiences

33
Q

Describe PTSD in more detail

A
  • Triggered by exposure to certain situations, actual or threatened death, serious injury
  • Exposure may be direct as a witness or learning that a close family member experience the traumatic event
  • Associated with one or more intrusion symptoms
  • Include Recurrent intrusive memories, nightmares, dissociative reactions
  • Disturbances persist for at least one month, impairing activities of daily life
  • Not attributable to a substance or medical condition
34
Q

List the 2 anxiety disorder treatments

A
  • Psychological: cognitive behavioural therapy
  • Pharmacological: Anxiolytics
35
Q

State one pharmacological anxiolytics used to treat anxiety disorder

A

Benzodiazepines which are a class of GABAA receptor positive allosteric modulators

36
Q

Describe the mechanism of action of a Benzodiazepines

A
  • Benzodiazepines bind to a distinct regulatory site on GABAA receptors
  • Benzodiazepines stabilise the GABAA affinity for its binding site and produces a general enhancement of its neuroinhibitory actions
  • Benzodiazepines are therefore classed as positive allosteric modulators
  • Benzodiazepines are cleaner compounds compared to the barbiturates, don’t activate other receptors
37
Q

List the different types of benzodiazepines
List their duration of action

A
  • Midazolam: Ultrashort (< 6 hours)
  • Larazepam: Short (12-28 hours)
  • Alprazolam Medium (24 hours)
  • Diazepam: Long (24-48 hours)
38
Q

Describe the general duration of action of benzodiazepines

A

Act quickly and are useful for patients who need acute treatment that can be taken as needed

39
Q

What is the problem with barbiturates and benzodiazepines?

A

Associated with unwanted side effects and can induce tolerance and withdrawal symptoms

40
Q

Briefly describe what serotonin is

A

Serotonin (5-HT) is a neurotransmitter in the peripheral nervous system (PNS) and in the central nervous system (CNS)

41
Q

Briefly Describe how serotonin works

A

Serotonin activates G protein coupled receptor subtypes with the exception of a ligand gated ion channel

42
Q

List the function of serotonin

A

Important role in sleep and wakefulness, in addition to mood and emotional behaviours

43
Q

Describe Serotonin as a Drug target

A

A key drug target for depression and anxiety disorders

44
Q

What are 5 HT1A receptor agonists?

A

5 HT1A receptor agonists are a class of drugs primarily used to treat generalised anxiety disorder

45
Q

Describe 5 HT1A receptor agonists

A
  • Buspiromes side effects are less troublesome than benzodiazepines, include dizziness, nausea, headache
  • Buspirome activates 5 HT1A auto receptors which inhibits 5 HT release
  • Buspirone also inhibits the activation of noradrenergic neurons, decreases arousal reactions
  • However a delay of several days before anxiolytic effects are seen
46
Q

Compare between the functions of Buzpirone and SSRI’S

A
  • Buspirone Activates 5 HT1A auto receptors, decrease 5 HT release (Generalised anxiety disorder)
  • SSRI’s block serotonin re-uptake transporter (SERT) More 5 HT available (Long term anxiety and depression)
47
Q

Describe the mechanism of action for Buspirone

A
  • Buspirone is a 5-HT1A receptor agonist
  • 5-HT1A receptors are auto-inhibitory and, therefore, buspirone initially inhibits 5-HT release
  • However, if buspirone is taken over a period of time (e.g. weeks), buspirone can induce desensitisation of auto-inhibitory 5-HT1A receptors - this can lead to downregulation of 5-HT1A receptors
  • The desensitisation and downregulation of 5-HT1A receptors ultimately results in heightened excitation of serotonergic neurons and enhanced 5-HT release
  • Supresses the symptoms of anxiety in generalised anxiety disorder (GAD) – not effective against phobias

SGUL - Physiology 2 (37 decks)

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