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Mental Health > Anxiety Disorder Pathophysiology > Flashcards

Anxiety Disorder Pathophysiology Flashcards

1
Q

Anxiety as an emotion is…

A

Normal under circumstances of threat, and thought to be part of the evolutionary fight/flight reaction of survival

Normal reaction to a stressful situation

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2
Q

Anxiety becomes a disorder when it is…

A

Overwhelming, and affecting function + quality of life

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3
Q

Anxiety disorders share features of…

A

Excessive fear and anxiety, and related behavioural disturbances

Fear = emotional response to real/perceived imminent threat
Anxiety = anticipation of future threat

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4
Q

Core symptoms of anxiety can be split into two groups, of…

A

Psychological
Somatic (physical)

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5
Q

Psychologial anxiety symptoms can include…

A

Feelings of fear/anxiety
Worry + apprehension
Difficulty concentrating

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6
Q

Somatic symptoms of anxiety can include…

A

Increased HR
Tremor
Sweating
GI upset

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7
Q

Common anxiety disorders include…

A

Generalized anxiety
Panic
Social anxiety
Post-traumatic stress
Obessive-compulsive

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8
Q

Each anxiety disorder has a great deal of overlap with other anxiety disorders, but the 2 core symptoms remain the same…

A

Anxiety/fear and worry

…One could question if anxiety disorders are distinctly different, or just different aspects of the same illness

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9
Q

For majority of anxiety disorders, most 1st line medications…

A

Are effective, and are the same medications used for depression

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10
Q

Fear is associated with this brain region…

A

Amygdala-centered circuit

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11
Q

Worry is associated with this brain region…

A

Cortico-striato-thalamo-cortical (CSTC) circuit

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12
Q

The amygdala interprets sensory and cognitive information, and determines…

A

If there will be a fear response, both an affect response (feeling) and motor response (fight/flight/freeze)

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13
Q

The motor response of fear can include other physical symptoms involved with respiratory and CV symptoms, such as…

A

Respiratory sx’s - increased rate, SOB
Cardiovascular sx’s - increased BP, atherosclerosis, ischemia, HR issues

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14
Q

Activation of the amygdala-centered circuit and the CSTC-circuit involves some neurotransmitters, such as…

A

5HT
GABA
Glutamate
NE
Voltage-gated ion channels

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15
Q

GABA is a principle neurotransmitter that…

A

Is inhibitory - plays a role in decreasing activity of neurons, slowing down activity of amygdala and CSTC circuits

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16
Q

GABA is stored and released in…

A

Presynaptic vesicles, and released in synapse when needed

Then transported back to vesicles or metabolized + inactivated

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17
Q

These subtypes of voltage-sensitive calcium channels (VSCC) are relevant in psychopharmacology…

A

N and P/Q

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18
Q

Gabapentin and pregabalin MOA involves VSCC by…

A

Binding to subunit of presynaptic N and P/Q VSCC, blocking release of glutamate when neurotransmission is excessive to decrease fear + worry

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19
Q

The symptoms, circuits, and neurotransmitters for anxiety disorders overlap closely with…

A

Major depressive disorder

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20
Q

5-HT is a key NT that innervates…

A

The amygdala and CSTC - assisting with regulation of fear and worry

Hence SSRI/SNRI are effective, blocking reuptake

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21
Q

Buspirone is unique in that it is a…

A

5-HT partial agonist, effective only in GAD and to potentiate antidepressants

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22
Q

Norepinephrine is involved in anxiety via…

A

Regulator of amygdala + CSTC circuits, via attatching to alpha+beta receptors; autonomic activity triggers fear, panic, and anxiety

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23
Q

SNRI MOA may increase NE and interact with anxiety via…

A

Worsening symptoms at initial dosing, but improve fear/worry longterm as beta-receptors down-regulate

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24
Q

GAD stands for…

A

Generalized anxiety disorder

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25
Q

GAD often coincides with…

A

Other mental health disorders

Can also co-occur with physical leaht problems and exacerbate/interfere with management

26
Q

Onset of GAD is usually…

A

In late adolescents/early adulthood

Cases have been seen in older adults as well

27
Q

GAD etiology is unknown, but is likely to be…

A

The combined effect of biological (neurotransmitters) and psychological factors (thought processes, conflicts)

28
Q

Cognitive behaviour theory describes the influences of…

A

Emotions, behaviours, and thoughts - and how they affect each other

29
Q

Other suspected causes of GAD that we as pharmacists should be aware of include…

A

Medications/natural products
Medical conditions

Consider withdrawal of medications that may increase anxiety (alcohol, sedatives, BZD’s)

30
Q

Common classes of drugs associated with anxiety symptoms include…

A

Corticosteroids
Stimulants
Sympathomimetics (pseudoephedrine, phenylephrine)

31
Q

Psychological/cognitive symptoms of GAD include…

A

Excessive anxiety + worries that are difficult to control
Poor concentration
Restlessness + irritability
Sleep disturbances

32
Q

Physical symptoms of GAD include…

A

Fatigue
Muscle tension
Trembling or shaking
Sweating
Feeling of fullness in throat/chest

33
Q

GAD standardized rating scales include…

A

GAD-7
HAM-A

34
Q

A panic attack is a distinct period of intense fear/discomfort when 4 or more symptoms develop suddenly. Some of these symptoms include…

Think of hyperactivity

A

Palpitations, increased HR
Sweating, trembling
Chest pain, nausea, abdominal distress
Feeling SOB, choking, dizziness, faint,
Feeling of unreality, or going crazy
Numbness, tingling sensation

35
Q

Panic disorder is classified as…

A

Recurrent unexpected panic attacks, with at least 1 of the attacks followed by 1 of the following for month or longer:

Concern about having another attack
Anxiety over implications of attack/its consequences
Maladaptive change in behaviour to avoid panic attacks

36
Q

Rates of panic disorder increase during… and peak during…

A

Increase during adolescence
Peak during adulthood

37
Q

Identifiable stressors of panic disorder include…

A

Interpersonal stressors
Stressors related to physical well being
Unpredictable/uncontrolable life stressors

38
Q

Psychological comorbidities with panic disorder include…

A

Other anxiety disorders
Depression
Bipolar
AUD

39
Q

Some medical comorbidities that coincide with panic disorder may include…

Anything that may cause instability of catecholamines

A

Cardiac arrythmias
Hyperthyroidism
Asthma, COPD
IBS
Cushing’s

40
Q

Most patients with panic disorder require ____ to achieve…

A

Long-term treatment, to achieve remission, prevent relapse, and reduce risks associated with co-morbidity

41
Q

Predictors of chronic course of panic disorder include…

A

Long duration of illness
Comorbidity with personality, mood, or other anxiety disorders
Excessive sensitivity to physical symptoms of anxiety

42
Q

Standardized rating scales for panic disorder include…

Can be referenced to help with monitoring

A

Panic disorder severity scale
Panic and agoraphobia scale

43
Q

Social anxiety disorder is defined by intense anxiety/fear of…

A

Being judged, negatively evaluated, or rejected in a social/performance situation

44
Q

Median age of onset of social anxiety disorder is…

A

13 years

45
Q

Risk factors for SAD often include…

A

Temperamental - fear, behavioural inhibition
Environmental - life stressors, adverse experiences
Genetics - dopamine, serotonin

46
Q

SAD often has comorbidities which are…

A

Concurrent anxiety
Depression
Substance use disorder

47
Q

SAD fears include…

A

Scrutiny by others
Embarassment
Humiliation

Public speaking, eating/drinking with others, talking with strangers…

48
Q

Physical symptoms of SAD may include…

A

Blushing
Diarrhea
Sweating
Tachycardia
Trembling
“Butterflies in stomach”

49
Q

Generalized SAD refers to…

A

Fear and avoidance of a wide range of social situations

50
Q

Standardized rating scales for SAD include…

A

All the ones used for GAD
Social phobia inventory
Liebowitz social anxiety scale

Help with monitoring

51
Q

PTSD is when your body experiences anxiety, fear, and panic in response to…

A

A traumatic event that happened in the past

52
Q

In PTSD, neuotransmitters that are overexpressed include ____, which causes…

A

Dopamine and Norepinephrine; cause persistent hyperarousal

These affect amygdala which activates SNS

53
Q

In PTSD, fear memories often become ____, which leads to…

A

Reconsolidated; long-term fear memories

54
Q

The 3 dimensions of PTSD involve…

A

1) Re-experiencing event with distressing recollections, dreams, flashbacks, psychological, and physical distress
2) Persistent avoidance of stimuli that might invite memories or experiences of trauma
3) Increased arousal

55
Q

Co-morbid psychiatric conditions that often coincide with PTSD include…

A

MDD
SUD/AUD
Other anxiety disorders
Bipolar
Psychosis

56
Q

PTSD patients often have higher rates of these medical co-morbidities…

A

CVD
Respiratory disorders
Autoimmune disorders

57
Q

Pathophysiology of OCD is ____, and is possibly related to abnormalities in…

A

Serotonin neurotransmission
Dopamine transmission
Glutamate

58
Q

OCD symptoms are usually ____ onset, occurring after…

A

Sudden onset, occurring after a stressful event

Treatment is usually delayed - waxing + waning symptoms

59
Q

Co-morbidities with OCD include…

A

MDD
Bipolar
Other anxiety disorders
Tic disorder, ADHD

60
Q

Indicators of poor OCD prognosis include…

A

Acting on compulsions
Childhood onset
Bizarre compulsions
Comorbid depression/personality disorder
Delusional beliefs/need for hospitalization

61
Q

The two core symptoms of OCD are…

A

Obessessions
Compulsions

62
Q

A good OCD standardized rating scale that could be used for monitoring response to treatment is…

A

Yale-brown obsessive compulsive scale

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