Anxiety and stress pharmacology Flashcards
1
Q
What are the definitions of:
Fear
Anxiety
Stress
A
- Fear –> the acute reponse to an actual stressor (physiological and psychological response)
- Anxiety –> anticipation or feeling of unease towards a percieved or potential stressor
- Stress –> feeling overwhelmed by situations, real or percieved
2
Q
What are the problems of fear/ stress/ anxiety
A
- Fear/ stress/ anxiety are all normal responses that prepare us for the fight or flight response
- Problems arise when this fear/ anxiety/ stress behaviour becomes chronic:
- Can lead to avoidance behaviours
- Secondary displacement (taking out frustration/ feeling/ impulse on objects or people seemed to be less threatening).
- Secondary complications –> effect on heart rate variability:
- Normally heart able to vary its rate and respond to ANS by increase/decrease HR
- Chronic stress inhibits heart rate variability, heart less plastic and less able to respond
3
Q
What are the primary areas involved in fear and anxiety?
A
- Suggested primary area for fear is the amygdala, and the primary area for anxiety is the BNST (Bed nucleus stria terminalis). More likely both are involved in both regions
4
Q
What are the three main classifications of anxiety disorders?
What subclassifications exist for these main classifications?
A
- Generalised anxiety disorder –> often coincides with depression
- Phobic disorder: simple vs complex
- Specific (spider etc.)
- social anxiety disorder –> begins in early adulthood/ adolescence, feeling of anxiety in any social situation
- panic disorder –> booting up of autonomic NS
- post traumatic stress disorder (PTSD) –> often associated with ex forces but any kind of trauma can lead to this, ingrained and can be reactivated, difficult to treat.
- obsessive complusive disorder: (anxiety unless tasks completed in specific order).
- Body dysmorphic disorder
- Anorexia/ bulimia nervosa
5
Q
What are the symptoms and defining features of generalised anxiety disorder?
A
- Period of at least 6 months with prominent tension, worry and feelings of apprehension about everyday events and problems.
- Behavioural symptoms:
- Inability to relax or concentrate, restlessness
- avoidance/ putting things off
- Physical symptoms:
- fatigue
- headache
- Gi disturbance
- Dysponea
- trembling/ fidgeting
- Sweating
- Insomnia
- muscle tension
- Psychological:
- Depression
- Irritability
6
Q
What are the symptoms of specific phobia?
A
- In response to the trigger:
- imminent feeling of danger/ doom and need to escape
- Heart palpitations
- sweating
- trembling
- SOB
- Chest pain/ discomfort/ choking feeling
7
Q
What are the symptoms of social anxiety disorder?
A
- Typically begins in adolescence or early adulthood
- Everday interactions cause significant anxiety, fear and self conciousness/ embarassment
- Avoidance behaviours, excessive anxiety and fear in anticipation and during social situations, unable to interact with strangers
- Physical symptoms –> Tachycardia, sweating, blushing, GI disturbance, muscle tension, SOB, dizziness
8
Q
What are the symptoms of PTSD?
A
- Person must experience symptoms for at least 1 month following a traumatic event, however symptoms may not appear until months later.
- Characterised by:
- re-experiencing trauma through intrusive recollections of the event, flashbacks or nightmares
- Emotional numbness, avoidance of places/ people/ situations that are reminders of trauma
- Increased arousal, insomnia, difficulty concentrating, easily startled, irritated or angered.
9
Q
What is panic disorder?
How is it diagnosed?
What are the symptoms of a panic attack?
A
- Diagnosed on the basis of recurrent panic attacks, and at least one attack being followed by a month in which the individual fears another attack.
- Panic attack = sudden onset intense physical and cognitive symptoms, may be triggered or unexpected. May lead to avoidance behaviour.
- Panic attack symptoms:
- palpitations and tachycardia
- SOB
- Sweating
- Chest pain
- Nausea and GI disturbance
- Trembling/ shaking
- Fear of dying/ losing control
10
Q
What are the diagnostic criteria and symptoms for OCD? (Obsessive compulsive disorder)
A
- Diagnostic criteria –> Essential feature is recurrent or obessional thoughts or compulsive acts
- Obsessional thoughts are involuntary, repeated and often distressing.
- Compulsive acts/ rituals are stereotyped behaviours repeated again and again.
- Function of compulsive acts is to prevent an unlikely event from occuring.
- Accompanied by anxiety if the behaviour is not done.
11
Q
What is anorexia and bulimia nervosa?
A
- Anorexia – >
- persistent restriction of energy intake leading to significantly low body weight
- intense fear of gaining weight
- persistent behaviour that interferes with weight gain
- lack of recognition of low body weight.
- Bulimia –>
- Recurrent episodes of binge eating, lack of control and intake in excess within 2 hour period
- recurrent episodes self induced behaviours to prevent weight gain, self induced vomiting, misuse laxative, fasting, over exercising
- Behaviours occur at least 1/ week for 3 months
12
Q
What is body dysmorphic disorder?
A
- Anxiety disorder in which a person is abnormally preoccupied with imagined defect in physical appearance that is unobservable or slight to others
- Routinely engage in compulsive rituals and behaviours (mirror checking, excessive grooming, skin picking, reassurance seeking).
- Individual must also be severely impacted in occupational and social functioning.
13
Q
What are the general symptoms of all the anxiety disorders?
A
- Physical:
- Fatigue
- SOB
- Tense muscles
- dizziness
- Psychological:
- Insomnia
- panic
- fear
- Depression
- Irritability
- Autonomic:
- Tachycardia
- High BP
- Sweating and cold peripheries
- Dry mouth
14
Q
What is the most common psychiatric disorder?
A
- Anxiety disorders are the most common of the psychiatric disorders
15
Q
What is the most common type of anxiety disorder?
A
- Most common type of anxiety disorder are the phobias
17
Q
Describe the inputs into the amygdala
Where is this information fed into?
Where does this information flow out to?
A
- Visual input , olfactory input and auditory input
- Hormonal responses and proprioceptive input (where the body is in space)
- Contextual input about the environment ( escape routes, distance etc)
- Added inputs from the limbic system, association cortexes and frontal cortex
- All this information is processed in the amygdala, fed int the cnetral nucleus that feeds out into brainstem regions to generate a response.
18
Q
What are the outputs from the amygdala when it is stimulated?
A
- Information is sent to the sensory regions for storage and integration
- Also sent to the frontal regions for higher cognitive response and decision
- It is also sent to the limbic system and stored for further experiences and the hypothalamus for the autonomic response
- Motor:
- motor system to control the limbs
- basal ganglia and cerebellum for fine tuning
- down to the brainstem to modulate autonomic outflow from cardiorespiratory centres
- spinal efferents to control spinal circuitry
19
Q
What are some of the specific nuclei activated in the amygdala response and what is the effect?
A
- Periaqueductal gray (PAG)–> is the Defence region, freeze and conflict reponses. Also descending inhibition of pain.
- Lateral hypothalamus –> tachycardia, vasoconstriction, ocular dilation and pressor responses
- Paraventricular nucleus of hypothalamus –> stress response, corticosteroid release
- Ventromedial nucleus –> fear
- Nucleus ambiguus –> parasympthetic to the heart, bradycardia, defeacation and micturition
- Locus coeruleus –> NA projections, arousal
20
Q
Describe the changes shown in the functional scans of different disorders
A
- PTSD large hypoactivation in the septal nuclei that deal with pleasure, in the region of the cingulate gyrus.
- Large increase in activity of the amygdala
- Social anxiety, specific phobia and learned fear also shows a large increase in the amygdala
