ANXIETY AS A DRUG TARGET

Question 1

What is anxiety?

Answer 1

an emotion characterised by apprehension and somatic symptoms of tension in which an individual anticipates impending danger, catastrophe, or misfortune

Question 2

How is anxiety characterised?

Answer 2

• future orientated
• long acting response
• broadly focused on a diffuse threat

Question 3

How is fear characterised?

Answer 3

appropriate, present-orientated,
- short lived
- clearly identifiable threat

Question 3

When does anxiety become a disorder?

Answer 3

• exaggerated
• inappropriate
• interferes with daily life
• debilitating for the individual

Question 4

What are signs?

Answer 4

Objective
Observed by others (doctor)
E.g. rapid heart rate, rash etc.

Question 5

What are symptoms?

Answer 5

Subjective
Apparent to the patient
E.g. fatigue, pain etc.

Question 6

What are symptoms of anxiety disorders?

Answer 6

Difficulty concentrating
Difficulty sleeping
Feeling very shaky
‘Racing heart’
Sweating excessively
Chest tightness
Dry mouth
Vomiting
Abdominal upset
Choking sensation/finding it hard to swallow

Question 7

What are the types of anxiety disorders? (5)

Answer 7

• panic disorder
• generalised anxiety disorder
• PTSD
• obsessive compulsive disorder
• phobia

Question 7

What are signs of anxiety disorders?

Answer 7

Tachycardia
Hypertension
Tachypnoea
Tremors
Sweating, ‘diaphoresis’
Appear restless
Weight loss

Question 8

What is GAD?

Answer 8

• Characterised by long-standing, free floating anxiety
• Patients will describe worry about minor matters & will be apprehensive on most days for about 6 months

Criteria:
- Apprehension
- Motor tension (restlessness, fidgeting, tension headaches, inability to relax)
- Autonomic overactivity

Question 9

What is panic disorder?

Answer 9

Characterised by the presence of panic attacks (short, discrete episodes of extremely severe anxiety, <15 minutes) that occur unpredictably (without warning)
Aren’t restricted to any specific situation or objective danger
Panic attacks are so distressing that patients develop a fear of having further attacks, known as anticipatory anxiety

Question 10

What is PTSD

Answer 10

Develops 1-6 months after an exceptionally stressful, life-threatening or catastrophic event or situation
Re-experiencing the event in vivid nightmares or flashbacks (intrusive, unwanted memories, vivid mental images) often with autonomic arousal (increased pulse, BP & sweating)
In children, this can present as re-enacting the experience, repetitive play or frightening dreams

Question 11

What can PTSD result in?

Answer 11

Avoidance of things associated with the event
Hypervigilance (increased startle reaction
Insomnia, poor concentration
Irritability & social withdrawal

Question 12

What is OCD?

Answer 12

Obsessions & compulsive actions present for at least 2 successive weeks & are a source of distress or interfere with the patient’s functioning
They are acknowledged as coming from the patient’s own mind (intrusive thoughts)
The obsessions are unpleasantly repetitive
A compulsive act is not itself pleasurable (excluding the relief of anxiety)

Question 13

What is the impact of anxiety disorders on the individual?

Answer 13

• reduced quality of life
• worsens other symptoms: headache, migraines, insomnia
• can lead to depression
• reduced independence

Question 14

What is the impact of anxiety disorders on the society?

Answer 14

• work absence
• more visits to healthcare
• increases inequality

Question 15

Lifestyle modification?

Answer 15

Diet
Regular exercise
Sleep hygiene improvement
Meditation & mindfulness
Good support network

Question 16

What is the principles of anxiety in CBT - cognitive behavioural therapy?

Answer 16

Problem is based on faulty or unhelpful ways of thinking
Problem is based on learned patterns of unhelpful behaviour
Individual has the potential to learn improved ways of coping

Question 17

What are the strategies used in cognitive behavioural therapy?

Answer 17

Learning to recognise & revaluate one’s distortions in thinking in light of reality
Gaining a better understanding of the behaviour & motivation of others
Using problem solving skills to cope with difficult situations
Learning to develop a greater sense of confidence in one’s own abilities

Question 18

What are the first line anxiolytics?

Answer 18

SSRI - selective serotonin reuptake inhibitors
Benzodiazepines
beta-blockers

Question 19

What are the second line anxiolytics?

Answer 19

SNRI- serotonin and noradrenaline reuptake inhibitors

• tricyclic antidepressants
• MAOIs - monoamine oxidase inhibitors

Question 20

What are examples of benzodiazepines and uses and side effects?

Answer 20

• diazepam
• lorazepam
• short term anxiety
• short term for acute panic attacks
• risk of dependcece
• GI upset
• reduced alertness

Question 21

How does SSRI’s work?
Fluoxetine

Answer 21

Fluoxetine

• selectively inhibit reuptake of serotonin = high conc of serotonin in the synaptic cleft

side effects:
- GI upset - diarrhoea
- sexual dysfunction
QT prolonging

Question 22

What is an example of a beta blocker
uses
MOA
side effects

Answer 22

bisoprolol

• relief of symptoms (palpitation)
• beta-adrenergic receptor blocker
• diarrhoea
• blurred vision
• fatigue
• nausea

Question 23

What is an example of SNRI?
use?
MOA
side effects

Answer 23

venlafaxine

• anxiety
• depression

blocks noradrenaline and serotonin reuptake = high levels of both in syanpse

• withdrawal
• sexual dysfuntion
• worsening of anxiety
• palpitations

Question 24

What are withdrawal side effects?

Answer 24

• fatigue
• insomnia/nightmares
• nausea/vomitting
• light headedness
• sensory disturbances
• irritability