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Block 3: Pathophysiology and pharmacology > Anxiety and stress > Flashcards

Anxiety and stress Flashcards

1
Q

What is an anxiety disorder?

A

Abnormal and pathological fear and anxiety

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2
Q

What are the psychological features of Generalised Anxiety Disorder?

A

Difficult to control worry
Interrupted sleep
Poor concentration
Increased sensitivity to noise

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3
Q

What are the physiological features of Generalised Anxiety Disorder?

A 
Sweating 
Dry mouth
Urinary frequency 
Hyperventilation 
Palpitations
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4
Q

What features must be present for a diagnosis of GAD?

A

Excessive anxiety/ worry occurring more days than not for at least 6 months about a number of events/ activities
3+ symptoms including: restlessness, fatigue, difficulty concentrating, irritability, muscle tension, sleep disturbance

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5
Q

What impact can GAD have on daily living?

A

Co-morbidities with physical conditions (e.g. chronic pain)
Affects work, social interactions, relationships
Increased suicidal ideation

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6
Q

What factors can predispose an individual to GAD?

A

Combination of biological, psychological and social factors

Neural activity associated with abnormal cognitions and increased attention to threat

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7
Q

What treatments can be used to manage anxiety?

A

Pharmacological treatments
Mindfulness
CBT (establishing links between physiological and psychological changes)
Thought diary

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8
Q

What is selective attention?

A

Seeing only the negative features in events

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9
Q

What is magnification?

A

Exaggerating the importance of undesirable events

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10
Q

What is overgeneralisation?

A

Drawing broad negative conclusions on the basis of a single insignificant event

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11
Q

What behaviours do anxiety treatments aim to target?

A

Selective attention
Magnification
Overgeneralisation

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12
Q

What are the 4 classes of the effects of stress?

A

Affective
Behavioural
Cognitive
Physiological

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13
Q

What behaviours or emotions are affective effects of stress?

A 
Shock 
Distress
Anger
Low self-esteem 
Guilt 
Depression 
Anxiety/ fear
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14
Q

What are the behavioural effects of anxiety?

A 
Smoking 
Alcohol 
Help seeking delay
Poor adherence
Social withdrawal 
Illicit drugs 
Sexual function
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15
Q

What are the cognitive effects of anxiety?

A 
Poor attention 
Poor decision making 
Hypervigilance to threats
Memory loss
Learning difficulties
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16
Q

What are the physiological effects of anxiety?

A 
Nervous system activation 
Hormone production 
Metabolic function 
Immune function 
Fatigue
Disease/ illness
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17
Q

How can the physiological effects of anxiety impact patients on the ward?

A 
Poor wound healing 
Post-surgery complications 
Longer in-patient stays
More staff time 
More analgesia use
Poor adherence/ less satisfaction with treatment
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18
Q

How can the physiological effects of anxiety impact patients after discharge?

A

Longer recovery (e.g. return to work)
More service use
Less use of rehabilitation services
Increased risk of co-morbidity and early mortality

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19
Q

What 3 perspectives should be used to understand stress?

A

Stimulus (cause/ stressor)
Response (effect e.g. physiological)
Process (person-environment interaction)

20
Q

What is stress?

A

A non-specific physiological response to a threat to one’s physical or emotional wellbeing

21
Q

What are the 3 stages of a physiological response to stress?

A
  1. Alarm (fight or flight response - nervous, endocrine and immune systems activated for defence against threat)
  2. Resistance (conservation response initiated to return homeostasis) becomes counterproductive if alarm continues
  3. Exhaustion (depletion of physiological resources - collapse of adaptive responses, immune failures and disease outcomes)
22
Q

What is the transactional model of stress?

A

A causal chain of influence involving a stimulus event and and outcome influenced by intervening processes:

  1. Primary appraisal (determines significance of event)
  2. Secondary appraisal (evaluation of available response options)
  3. Response (coping - cognitive and behavioural activities initiated in order to manage demands of event)
23
Q

What does problem-focused coping involve?

A

Attempts to manage or change concrete aspects of the stressor

24
Q

What does emotion-focused coping involve?

A

Attempts to remove or reduce the emotional distress

25
Q

What is the most effective coping strategy?

A

Flexible (mix of problem-focused and emotion-focused coping)
Dependent on whether it is possible to change stressor

26
Q

What is the difference between fear and anxiety?

A

Fear is an acute response to an actual stressor whilst anxiety is a response to a perceived or potential stressor (anticipation or unease)

27
Q

What drug is commonly used to alleviate the physical symptoms of anxiety?

A

Propanolol (a Beta blocker)

28
Q

Define fear

A

Acute response to an actual stressor - preparation for fight or flight behaviour

29
Q

Define anxiety

A

Preparation for fight or flight behaviour in response to a perceived or potential stressor (e.g. anticipation or unease)

30
Q

Define stress

A

A feeling of being overwhelmed by current situational, environmental or perceived pressures
Effects can be emotional (e.g. depression), psychological (e.g. irritability) and physical (raised BP, fatigue)

31
Q

How are anxiety and fear disorders classified?

A

Generalised Anxiety Disorder (often accompanied by Depression)
Phobias (can be simple or complex) - including specific phobias, social anxiety, panic disorder and PTSD
Obsessive Compulsive Disorders (inc. body dysmorphia)

32
Q

Which areas of the CNS are involved in anxiety and fear?

A

Amygdala
Higher cognitive centres (pre-frontal cortex)
Insula (located within the lateral fissure)
+ other limbic system areas, association areas and sensory/ motor/ autonomic regions

33
Q

Which brainstem region controls defence behaviours?

A

Periaqueductal Gray - contains high number of opioid receptors

34
Q

What non-pharmacological management is available for anxiety and fear disorders?

A

Psychotherapy (behavioural) including conscious avoidance, relaxation, hypnotherapy and bibliotherapy

35
Q

What pharmacological options are typically used to manage GAD?

A

SSRIs (Sertraline)
SNRIs (Venlafaxine)
Anti-epileptics (Pregabalin)
Atypical antidepressants (Buspirone)

36
Q

What is the MoA of Sertraline?

A

SSRI - selectively inhibits Serotonin reuptake on the presynaptic membrane increasing synaptic concentration of Serotonin in the CNS

37
Q

What is the MoA of Venlafaxine?

A

SNRI - selectively inhibits Serotonin and Norepinephrine reuptake on the presynaptic membrane increasing synaptic concentration of 5HT and NE in the CNS

38
Q

What is the MoA of Pregabalin?

A

AED - inhibition of voltage-gated calcium channels on the pre-synaptic membrane (thus modulating release of several excitatory NTs into the synapse)

39
Q

What is the MoA of Buspirone?

A

Atypical - binds to 5HT 1A receptors on presynaptic membrane increasing NT levels in synaptic cleft
Suppressed serotonergic action and enhanced firing of noradrenaline and dopamine

40
Q

What pharmacological options are typically used to manage specific phobias?

A

SSRIs (Sertraline)

Beta-blockers (Propanolol)

41
Q

What is the MoA of Propanolol?

A

Competetively binds to beta1-adrenergic receptors inhibiting sympathetic stimulation by preventing catecholamines (norepinephrine, epinephrine, dopamine etc.) from binding - results in reduced HR, cardiac output, BP etc.

42
Q

What pharmacological options are typically used to manage panic disorders?

A

SSRIs (Sertraline)

43
Q

What pharmacological options are typically used to manage PTSD?

A

SNRIs (Venlafaxine)
SSRIs (Sertraline)
Antipsychotics (Risperidone)

44
Q

What is the MoA of Risperidone?

A

2nd Gen antipsychotic - inhibition of D2 (dopaminergic) and 5HT2A (serotonergic) receptors (5HT and D2 anatagonist)

45
Q

What pharmacological options are typically used to manage OCD (inc. body dysmorphia)?

A

SSRIs (Sertraline)
+ TCA (Clomipramine)
+ Atypicals (Buspirone)

46
Q

What pharmacological options are used acutely to manage crises?

A

Benzodiazepines (e.g. Lorazepam)

‘Z-drug’ (Zolpidem)

Block 3: Pathophysiology and pharmacology (16 decks)

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