Anxiety and Anxiolytics

Question 1

What is the difference between normal and pathological anxiety?

Answer 1

• Normal Anxiety: A protective response to threats.
• Pathological Anxiety: Overreactive fear response to non-threatening situations, often without an external trigger.

Question 2

Name the six types of anxiety disorders.

Answer 2

1. Generalised Anxiety Disorder (GAD).
2. Panic Disorder (PD).
3. Social Anxiety Disorder (SAD).
4. Post-Traumatic Stress Disorder (PTSD).
5. Obsessive-Compulsive Disorder (OCD).
6. Simple/Specific Phobia

Question 3

What are the key symptoms of Generalised Anxiety Disorder (GAD)?

Answer 3

Excessive worry, restlessness, fatigue, irritability, muscle tension, and sleep disturbances lasting ≥6 months.

Question 4

What brain regions are involved in the fear and anxiety response? (3)

Answer 4

• Thalamus: Sensory relay.
• Amygdala: Fear processing.
• Hypothalamus: Regulates autonomic and endocrine responses.

Question 5

Which neurotransmitter systems are involved in anxiety?

Answer 5

• GABA: Reduced inhibition.
• Serotonin (5-HT): Reduced activity.
• Noradrenaline (NA): Overactivity, leading to increased arousal.

Question 6

What is the role of the HPA axis in anxiety?

Answer 6

The hypothalamic-pituitary-adrenal axis triggers cortisol release, activating the “fight or flight” response.

Question 7

What is the mechanism of action of benzodiazepines?

Answer 7

They bind to an allosteric site on GABA-A receptors, enhancing GABA’s effect by increasing chloride ion influx, leading to neuronal hyperpolarisation.

Question 8

Name the clinical effects of benzodiazepines.

Answer 8

Anxiolytic, sedative, hypnotic, anticonvulsant, and muscle relaxant.

Question 9

What are the main subtypes of benzodiazepines based on metabolism? (3)

Answer 9

• 2-Keto compounds: Long half-lives (e.g., Diazepam)
• 3-Hydroxy compounds: Short half-lives (e.g., Lorazepam).
• Triazolo compounds: Few active metabolites (e.g., Alprazolam)

Question 10

What are the limitations of benzodiazepines?

Answer 10

Tolerance, dependence, withdrawal symptoms, sedation, memory loss, and addiction risk.

Question 11

What is the structure of the GABA-A receptor?

Answer 11

A pentametric complex with subunits (two α, two β, one γ), where GABA binds between α and β subunits and benzodiazepines bind at the α/γ interface.

Question 12

Name the types of benzodiazepine effects on GABA-A receptors. (4)

Answer 12

• Full Agonists: Enhance GABAergic inhibition (e.g., Diazepam).
• Partial Agonists: Moderate efficacy.
• Inverse Agonists: Decrease GABA activity.
• Antagonists: Block effects without intrinsic activity.

Question 13

What are the first-line treatments for anxiety disorders? (2)

Answer 13

1. SSRIs: Effective for GAD, PD, SAD, PTSD, and OCD.
2. CBT: High intensity psychological therapy.

Question 14

What is the NICE Stepped-Care Approach for anxiety? (3)

Answer 14

1. Low-intensity interventions (e.g., self-help).
2. High-intensity therapy (e.g., CBT).
3. Pharmacological treatment if needed.

Question 15

What is the role of beta-blockers in anxiety?

Answer 15

Used to manage physiological symptoms like palpitations and tremors, especially in social anxiety.

Question 16

How does alcohol affect anxiety? (3)

Answer 16

• Low doses: Reduce anxiety via GABAergic effects
• High doses: Cause sedation and impaired coordination
• Withdrawal can lead to hyperexcitability and increased anxiety.

Question 17

What is Buspirone and how does it work?

Answer 17

A partial agonist at 5-HT1A receptors, used for GAD with less risk of sedation and dependence compared to benzodiazepines.