Anxiety Flashcards
Define anxiety
A feeling of unease (worry or fear) which can range from mild to severe
What type of response can anxiety be?
Can be a normal adaptive response and in some cases, can be beneficial:
- An innate adaptive response
- A learned adaptive response
Describe Anxiety as an innate adaptive response
- 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
Describe anxiety as a learned adaptive response
- 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
When does anxiety become a problem?
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
What is some psychological symptoms of anxiety?
- Stress
- Suspense
- Worry
- Foreboding
- Uneasiness
- Nervous
What are some physiological symptoms of anxiety?
- Tachycardia
- Shortness of breath
- Excessive sweating
- Tremble or shaking
- Nausea
- Fatigue
- Insomnia
What can cause some symptoms of anxiety?
- 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:
How can alcohol cause symptoms of anxiety?
- 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
What else can trigger symptoms of anxiety?
Recreational drugs
How can genetics be a cause for the symptoms of anxiety?
- 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
What is the pathophysiology of anxiety?
Hallmark of anxiety disorders is an inappropriate stress response either when a stressor is present or not immediately threatening
What is the coordination of a stress response to a threatening stimuli?
- 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
What evidence suggests that activation of CRH releasing hormones of the hypothalamus play a key role in regulating stress response?
- 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
What role does the amygdala play in terms of anxiety?
- Amygdala: Role in emotion and fear response
- Stimulates HPA axis to promote cortisol release
- Amygdala hyperactivity linked to anxiety disorders
What role does the hippocampus play in terms of anxiety?
- Hippocampus has a role in learning and memory
- Suppresses HPA axis to prevent excessive cortisol release
- Hippocampus under activity linked to anxiety disorders
What book is universally used for the classification of anxiety disorders?
- DSM 5 2013
- Anxiety disorders
- Obsessive compulsive disorders
- Trauma and stressor related disorders
List some anxiety disorders found in the DSM-5 2013
- Generalised anxiety disorder
- Specific phobias
- Social phobias
- Panic disorders
List some obsessive compulsive disorders found in the DSM-5 2013
- Obsessive compulsive disorders
- Body dysmorphic disorder
- Hoarding disorder
- Trichotillomania
List some Trauma and stressor related disorders found in the DSM-5 2013
Post traumatic stress syndrome
Define generalised anxiety disorder (GAD)
Characterised by an ongoing state of excessive anxiety lacking clear reason or focus
Describe generalised anxiety disorder
- 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
Define the term “specific phobias”
Extreme fears or anxieties provoked by exposure to a particular situation or object. Often leads to avoidance behaviours
Describe specific phobias
- 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
Define the term “Social phobias”
Characterised by significant anxiety provoked by exposure to certain types of social or performance situations
Describe social phobias
- 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
Define the term “Panic disorders”
Characterised by reoccurring panic attacks without a seemingly clear cause or trigger
Describe panic disorders
- 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
What is an Obsessive compulsive disorder (OCD)?
Characterised by compulsive, ritualistic behaviour driven by irrational anxiety
List the 2 types of OCD
- Obsessions: Recurrent, Intrusive thoughts, images, ideas or impulses
- Compulsions: Repetitive behaviours or mental acts that are performed to reduce anxiety associated with the obsessions
Describe OCD briefly
- 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
Define PTSD
Post traumatic stress disorder is characterised by distress triggered by the recall of past traumatic experiences
Describe PTSD in more detail
- 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
List the 2 anxiety disorder treatments
- Psychological: cognitive behavioural therapy
- Pharmacological: Anxiolytics
State one pharmacological anxiolytics used to treat anxiety disorder
Benzodiazepines which are a class of GABAA receptor positive allosteric modulators
Describe the mechanism of action of a Benzodiazepines
- 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
List the different types of benzodiazepines
List their duration of action
- Midazolam: Ultrashort (< 6 hours)
- Larazepam: Short (12-28 hours)
- Alprazolam Medium (24 hours)
- Diazepam: Long (24-48 hours)
Describe the general duration of action of benzodiazepines
Act quickly and are useful for patients who need acute treatment that can be taken as needed
What is the problem with barbiturates and benzodiazepines?
Associated with unwanted side effects and can induce tolerance and withdrawal symptoms
Briefly describe what serotonin is
Serotonin (5-HT) is a neurotransmitter in the peripheral nervous system (PNS) and in the central nervous system (CNS)
Briefly Describe how serotonin works
Serotonin activates G protein coupled receptor subtypes with the exception of a ligand gated ion channel
List the function of serotonin
Important role in sleep and wakefulness, in addition to mood and emotional behaviours
Describe Serotonin as a Drug target
A key drug target for depression and anxiety disorders
What are 5 HT1A receptor agonists?
5 HT1A receptor agonists are a class of drugs primarily used to treat generalised anxiety disorder
Describe 5 HT1A receptor agonists
- 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
Compare between the functions of Buzpirone and SSRI’S
- 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)
Describe the mechanism of action for Buspirone
- 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
