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Psychiatry > Anxiety > Flashcards

Anxiety Flashcards

1
Q

What part of the brain acts as the emotional filter of the brain to assess whether sensory material (coming via the thalamus) requires a stress or fear response?

A

Amygdala

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2
Q

In order for a diagnosis of generalised anxiety disorder to be made how long/often must the person have been suffering from symptoms for?

A

Most days for at least 6 months. Also must be non controllable and causing significant distress/functional impairment.

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3
Q

What is the usual age of onset for genarilised anxiety disorder?

A

20 - 40

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4
Q

A patient presents to the GP saying they have been having severe attacks of anxiety where they get chest pain, palpitations and feel dizzy. They also describe a feeling that they are not themselves and watching their lives at these times and are not in control.There doesn’t seem to have been a trigger any of the times. They say they are worried they are going mad.

A

Panic disorder.

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5
Q

What other anxiety condition is strongly associated with panic disorder?

A

Agoraphobia

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6
Q

Infusions of what compound can bring on a panic attack in susceptible individuals?

A

Lactate

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7
Q

During a panic attack; in what part of the brain is their increased metabolism?

A

Anterior pole of the temporal lobe (parahippocampal gyrus)

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8
Q

What are the three types of phobias?

A

Agorophbia
Social phobia
Specific phobia

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9
Q

What is agorophobia?

A

A fear of leaving home, being in crowds, travelling. Most try to avoid these phobic situations.

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10
Q

What conditions might agorophobia be secondary to?

A

Depression

Panic disorders

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11
Q

What is the brain activity like in a patient with social phobia?

A

Increased bilateral activation of the amygdala and increased rCBF to the amygdala (& related limbic areas) that normalizes on successful treatment (pharmacological of psychological)

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12
Q

Name 2 benxodiazepines

A

Lorazepam
Diazepam
Chlorodiazepoxide

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13
Q

How do benzodiazepines work pharmcologically?

A

Increase GABA mediated inhibition. This decreases the excitability of neurones and so relieves anxiety.

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14
Q

What are the effects of benzodiazepines?

A 
Reduces anxiety
Sedation
Muscle relaxation
Anticonvulsant 
Anterograde amnesia
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15
Q

What is the main inhibitory neurotransmitter in the brain?

A

GABA

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16
Q

What does GABA stand for?

A

Gamma amino butyric acid

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17
Q

What neurotransmitter is restricted to the brain and the spinal cord?

A

Glycine

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18
Q

Does GABA cause depolarisation or hyperpolarisation?

A

Hyperpolarisation

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19
Q

Where exactly do benzodiazepines act?

A

The GABA - A receptor but at a different site from where GABA binds, meaning it enhances the effect when GABA is already bound.

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20
Q

What drug can reverse the effects of benzodiazepine overdose?

A

Flumazenil. Also acts as GABA - A receptor

21
Q

What kind of receptor is the GABA - A channel?

A

Ligand gated ion channe;

22
Q

What kind of receptor in the GABA - B channel?

A

G protein coupled receptor

23
Q

How goes the GABA channel work?

A

GABA binds to GABA receptor
Causes the opening of ion channels causing chloride ions (-ve) to flow into the cell or pottassium (+ve) to flow out of the cell. This causes hyperpolarization

24
Q

What symptoms might you see in a patient withdrawing from benzodizapines?

A

Confusion, psychosis, convulsions, anxiety, insomnia, tremore

25
Q

At a cellular level what neuroadaptation occurs when their is chronic use of benzodiazepines?

A

Decreased response to GABA. This is probably why there is anxiety/convulsions on withdrawal

26
Q

What is the treatment for status epilepticus?

A

PR benzodiazepines

27
Q

What benzodiazepines should a patient be put on if they are trying to withdraw from benzodiazepines and when should these be taken?

A

Diazepam or Chlorodiazepoxide taken at night

28
Q

In a person trying to withdraw from benzodiazapines how often should the dose be reduced and by how much?

A

Reduce dose every 2–3 weeks in steps of 2 or 2.5mg; if withdrawal symptoms occur, maintain this dose until symptoms improve. Eventually, stop completely.

29
Q

What other drugs are used in the treatment of anxiety (not benzodiazepines)?

A

Antidepressents
Buspirone
Pregablin
Beta blockers

30
Q

What antidepressant drugs are used for generalised anxiety disorder?

A

SSRI

Venlafxine

31
Q

What antidepressant drugs are used in panic disorder?

A

SSRI

Tricyclics

32
Q

What antidepressant drugs are used in social anxiety disorder?

A

Moclobemide

33
Q

What antidepressant drugs are used in OCD?

A

SSRI

Tricyclics

34
Q

What is the mechanism of buspirone?

A

5 HT 1A agonist

35
Q

What drug is useful for the treatment of the symptoms of palpitation and tremor?

A

Beta blockers such as propranolol

36
Q

What kind of drug is pregabalin?

A

Calcium channel blocker, GABA enhancer

37
Q

When would you give pregabalin?

A

Anxiety that was unresponsive to other treatments.

38
Q

Where is their increased metabolism in the brain in OCD?

A

Orbitofrontal cortex, caudate nucleus

Cingulate cortex

39
Q

What is the main drug treatment for OCD?

A

SSRI

40
Q

What is the first line treatments for OCD?

A

CBT and/or SSRI

41
Q

If two SSRIs havent’t worked in OCD what in the next drug treatment?

A

Tricycline (clomopramine)

42
Q

What are the three domains of dysunctional beliefs in OCD?

A
  1. Overestimation of threat/inflated sense of responsibility.
  2. Beliefs about the importance of and the need to control intrusive thought.
    3, Perfectionism and intolerance of uncertainty
43
Q

What is the best form of therapy for OCD?

A

Exposure and response prevention

44
Q

What are the three components in becks cognitive triad in anxiety?

A
  1. Negative views of oneself
  2. Negative views of the world
  3. Negative views of the world
45
Q

Deep rooted unconditional basic beliefs that stem from childhood experiences. They are stable and more resistant to change and they shape and colour assumptions and automatic thoughts

A

Schemas

46
Q

Thoughts that pop into our minds automatically throughout the day. We are often unaware of them and have not planned or intended to think that way. They are consiously available and can be in the form of sensations, feelings or images.

A

Autonomic thoughts.

47
Q

Which drug class increases the frequency of chloride channels of GABA receptors? t

A

Benzodiazipines

48
Q

Which drug class increases the duration of chloride channel opening on the GABA receptor?

A

Barbiturates

Psychiatry (24 decks)

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