Anxiety

Question 1

What are the 6 main groups of anxiety disorder?

Answer 1

GAD
Panic disorder
Social anxiety
OCD
PTSD
Agoraphobia

Question 2

Give some psychological symptoms of anxiety.

Answer 2

Worrying thoughts
Fearful anticipation
Poor memory
Insomnia
Avoidance
Irritability
Poor concentration
Sensitivity to noise/lights

Question 3

Give some physical symptoms of anxiety.

Answer 3

Palpitations
Shortness of breath
Tremor
Fatigue
Sexual difficulties
Dizziness
Headache
Dry mouth

Question 4

What is GAD?

Answer 4

Excessive worry about a number of issues most of the time for at least 6 months

Question 5

What is panic disorder?

Answer 5

Worrying thoughts and fearful anticipation

Panic attack followed by one month of persistent worry about recurrence

Question 6

What is social anxiety?

Answer 6

Persistent and overwhelming fear of social situations that is out of proportion for at least 6 months

Question 7

What is the first line psychological therapy for GAD?

Answer 7

Self help and group education

Question 8

What is the second line psychological therapy for GAD?

Answer 8

High intensity intervention such as CBT or applied relaxation

Question 9

What is the first line pharmacological therapy for GAD?

Answer 9

SSRIs

Sertraline is not licensed

Question 10

What is the second line pharmacological therapy for GAD?

Answer 10

Alternative SSRI or SNRI

Question 11

What is the third line pharmacological therapy for GAD?

Answer 11

Pregabalin

Question 12

What is the first line psychological therapy for panic disorder?

Answer 12

Individualised CBT

2 hours weekly for up to 4 months

Question 13

What is the first line pharmacological therapy for panic disorder?

Answer 13

SSRI

Question 14

What is the second line pharmacological therapy for panic disorder?

Answer 14

Imipramine or clomipramine

Question 15

What is the first line pharmacological therapy for social anxiety disorder?

Answer 15

SSRI- sertraline or escitalopram

Question 16

What is the second line pharmacological therapy for social anxiety disorder?

Answer 16

Alternative SSRI or SNRI

Venlafaxine or fluvoxamine

Question 17

What is the third line pharmacological therapy for panic disorder?

Answer 17

MAOI- moclobemide or phenelzine

Question 18

What is the first line psychological therapy for social anxiety disorder?

Answer 18

Individualised CBT

Or CBT self help

Question 19

When may BZDs be used in anxiety?

Answer 19

Short term use in GAD crisis

Question 20

What ADRs must be considered for antidepressants in anxiety?

Answer 20

Anxiety

Suicidal thoughts

Question 21

What is the indication for propranolol in anxiety?

Answer 21

Used in physical symptoms

Good for situational stress

Question 22

When is buspirone used in anxiety? What is its MoA?

Answer 22

GAD

Partial agonist at 5-HT1

Question 23

Give examples of BZDs with a short half life.

Answer 23

Lorazepam

Oxazepam

Question 24

Give examples of BZDs with a long half life.

Answer 24

Diazepam

Clonazepam

Question 25

Which BZD is most appropriate for use in anxiety?

Answer 25

Diazepam

Question 26

Which BZDs are not used in anxiety? Why?

Answer 26

Lorazepam and clonazepam | Potency, increased risk of tolerance and dependence

Question 27

What major interaction must be considered with antidepressant used in anxiety?

Answer 27

Fluvoxamine and warfarin

Question 28

What are the withdrawal symptoms of BZDs?

Answer 28

Flu like symptoms Agitation Muscle weakness

Question 29

What are the dependence symptoms of BZDs?

Answer 29

Unsteadiness Drowsiness Speech disorder Nystagmus

Question 30

Describe the site of action of anxiolytics.

Answer 30

Attention focussed on limbic system, particularly to hippocampus and amygdala Bilateral destruction of amygdala results in calm and tranquil animal in some species Studies suggest BZDs selectively impair discharges from amygdala and amygdalo-hippocampal transmission

Question 31

Describe the action of GABA receptors.

Answer 31

Ionotropic GABA is most prevalent receptor subtype and demonstrate ubiquitous distribution in the brain Five subunits to form integral transmembrane ion channel When open, channel predominantly conducts chloride ions causing hyperpolarisation Two alpha subunits and two beta subunits, particular composition vaires among brain regions and species Apart from binding site for GABA, receptor possesses sites of action for clinically important drugs

Question 32

Describe the mechanism of action of BZDs.

Answer 32

Binds to BZD site on GABA receptors, not GABA binding site Increases affinity for GABA Channel is more likely to open with BZD bound, increasing chloride flux and hyperpolarisation- inhibition BZD potency limited by availability of GABA

Question 33

How does the action of anxiolytics differ between different GABA receptors?

Answer 33

BZDs with high activity at alpha 1 are associated with amnesia, sedation, ataxia Those with greater activity at alpha 2/3 subunits show greater anxiolytic activity