Anxiety and Anxiolytics JB 🧠 Flashcards
physical symptoms of anxiety
heart pounding face flushing fast breathing pupils dilating tense muscles slow digestion
different types of anxiety disorders
short term(natural rrepsonse, drives performance and increases alertness)
or prolonged- becomes distressing and disabling
what is anxiety?
define
normal, protective, psychological response to an unpleasant or threatening situation.
Mild to
moderate anxiety can improve performance and ensure
appropriate action is taken
main function of anxiety?
act as signal for danger
trigger appropriate adaptive response (fight/flight)
what is the acute stress response?
fight/flight response
physiological resonse to stress.
how does brain and body systems respond to anxiety? what happens when stressed?
- amygdala reacts to threat
- hypothalamus activates SNS, Ad released
- Cortisol released from adrenal cortex for continued alertness
what 3 transmitters have an inter-relationship to affect behaviours during anxiety?
Nad
Dopamine
Serotonin
hen does anxiety occur?
when arousal systems in brain are disturbed
main inhib transmitter in CNS?
GABA
what does biochemical theory of MH conditions centre around?
neurotransmitters in areas of the brain
affects of GABA?
anti-seizure and anti-anxiety effects
tranquility and wellbeing
Strong associations have been identified
between anxiety disorders and ?
physical health
Risk Factors for anxiety?
- Family history
- Childhood adversity (trauma) even if not direct. just witnessed
- Stressful life events
- Certain personality traits
- Parenting styles(overprotective)
- Younger age
- Female, Unmarried or unemployed (societal expectations)
- Poor physical and/or mental health
Physical symptoms of anxiety
disorders
(part of fight/flight as body cant differentiate actual and mental)
SOB, sweaty palms,
palpitations, nausea, dizziness, hot flushes
Behaviour Symptoms of anxiety.
Coping strategies eg:
avoidance strategies, engaging in risky behaviour,
escaping anxiety producing situations
Emotional Symptoms of anxiety.
Worry, apprehension,
distress, nervousness, panic, feeling uneasy
Cognitive symptoms of anxiety.
Thoughts that we have
when we are anxious eg: “ What if….happens?”,
“People will laugh at me”,
6 Types of anxiety disorders
BDD body dysmorphic disorder GAD generalised anxiety Social anxiety PTSD Panic disorder OCD
diagnosis of anxiety
scale of severity of symptoms and duration- varies for individual disorder types
what to consider when making
diagnosis of anxiety?
physical conditions that mimic some symptoms e.g. thyrotoxicosis, stimulant drugs
GAD-2 scale: what score = anxiety likely?
usually 3 or more
how is anxiety treated? (2)
CBT- changing perceptions
or pharmacological therapy
Pharmacological treatment of anxiety- what does drug choice depend on?
diagnosis and
severity of symptoms
what drugs prescribed for physical symptoms?
beta blockers- tachycardia, sweating, tremor…
what drugs prescribed to increase GABA levels?
benzodiazepines
- give rapid relief of acute anxiety but have SEs
or pregabalin
- option in GAD
what drugs prescribed to increase Serotonin levels?
SSRIs, SNRI, TCAs, Buspirone
whats first line drug class for most anxiety disorders?
SSRIS- delay in effect
mechanism of action of benzodiazepines?
- interact w specific binding sites associated with GABA receptors in brain
- potentiate inhibitory action of GABA
- Cl channels open- allows Cl to enter cell = hyperpolarisation (inhibition) of neuron
whats the most important NT in CNS?
GABA
whats neural activity in CNS regulated by? (2)
inhibitory activity- GABA
and excitatory NTs e.g. glutamate
whats are GABAa receptors and what do they control?
multimolec. complexes- control a Cl ion channel link and control specific binding sites for GABA
how many subtypes of rec do benzodiazepines bind to?
2 or more.
combo of alpha 2 containing subtype mediates their antiepileptic effect
alpha 1: antiamnesic effect
how are benzodiazepine receptors diff in patients with anxiety?
reduced receptors in key areas that regulate anxiety response
all benzodiazepines undergo heptic metabolism via… (2)
oxidation/ conjugation
the diff benzodiazepines available differ in… (2)
potency and rate of elimination
whats the absorption and membrane permeability of benzodiazepines like?
most: well absorbed orally and rapidly penetrate brain
how long does it take to get clinical effect of benzodiazepines via penetration in brain post oral admin?
within 30 mins
what patients is the oxidation of benzodiazepines increased in? why?
elderly
patients w hepatic impairment
DDIs
alcohol
how are benzodiazepines metabolised?
in liver, CYP450
what may reduce levels of benzodiazepines?
enzyme inducers e.g. carbamazepine
what may increase levels of benzodiazepines?
enzyme inhibitors e.g. erythromycin, ciprofloxacin
clinical uses of benzodiazepines (actions)?
= immediate symptoms relief
CNS depressants- sedative, anxiolytic, amnesic, musclar relaxant, anticonvulsant actions
when are benzodiazepines most useful?
short term anxiety- fight/flight
need alternatives for long term
concerns with benzodiazepines and long term use?
dependance and tolerance.
restrict use to short term
most common benzodiazepines and action?
Diazepam- rapid onset of action
slow elimination
= steady blood concs
side effects of benzodiazepines
CNS depression
respiratory depression
Examples of benzodiazepines?
Alprazolam Chlordiazepoxide Clonazepam Diazepam Lorazepam Oxazepam Temazepam
what is pregabalin and its effect at GABA a and GABA b receptors?
structural analogue of GABA
no clinical effect at GABAa or b
how does pregabalin exert its effect?
Binds in a state-dependent manner to subunit of voltage-gated ca channels of ‘over excited’ pre-synaptic neurones
changes conformation of the channel
Reduces release of excitatory
neurotransmitters (glutamate,
substance P)
what anxiety is pregabalin useful in?
Useful in GAD as a more long term option
than benzodiazepines.
whats responsible for pregabalins long term: anxiolytic, anticonvulsant, analgesic effects?
reduction in stimulation of post synaptic neurones
SSRIs: Role in what type of Anxiety
Long term treatment option for anxiety disorders
how does response of SSRIs vary with use in anxiety vs depression
Response varies and less predictable than
when used for depression
Have broader anxiolytic effects
thus take care with licenced indications
SSRIs mechanism of action
Increase serotonin by limiting its reabsorption
into the presynaptic cell
Low levels of serotonin are associated with
anxiety (and depression)
examples of SSRIs?
Citalopram (Celexa) Escitalopram (Lexapro) Fluoxetine (Prozac) Paroxetine (Paxil, Pexeva) Sertraline (Zoloft)
Beta blockers: Role in Anxiety…
Used to manage/alleviate the physical symptoms eg:
palpitations, tremor, sweating, SOB
Betablockers mechanism of action in anxiety
Reduce adrenaline which is produced as part
of the fight or flight response
Useful in combination with CBT
help w rapid heart rate etc
beta blockers- take care in parients with..?
Care in people with cardiac conditions as will
lower BP and HR
Can precipitate bronchospasm
whats the recommended therapy for anxiety?
A combination of psychological and
pharmacological therapy is recommended
when may benzodiazepines only be used?
only be used for
short term immediate relief of symptoms
role of beta blockers in
