Anxiety Disorder Pathophysiology Flashcards by Mason Truong

Anxiety as an emotion is…

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

Normal reaction to a stressful situation

How well did you know this?

Not at all

Perfectly

Anxiety becomes a disorder when it is…

Overwhelming, and affecting function + quality of life

How well did you know this?

Not at all

Perfectly

Anxiety disorders share features of…

Excessive fear and anxiety, and related behavioural disturbances

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

How well did you know this?

Not at all

Perfectly

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

Psychological
Somatic (physical)

How well did you know this?

Not at all

Perfectly

Psychologial anxiety symptoms can include…

Feelings of fear/anxiety
Worry + apprehension
Difficulty concentrating

How well did you know this?

Not at all

Perfectly

Somatic symptoms of anxiety can include…

Increased HR
Tremor
Sweating
GI upset

How well did you know this?

Not at all

Perfectly

Common anxiety disorders include…

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

How well did you know this?

Not at all

Perfectly

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

Anxiety/fear and worry

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

How well did you know this?

Not at all

Perfectly

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

Are effective, and are the same medications used for depression

How well did you know this?

Not at all

Perfectly

Fear is associated with this brain region…

Amygdala-centered circuit

How well did you know this?

Not at all

Perfectly

Worry is associated with this brain region…

Cortico-striato-thalamo-cortical (CSTC) circuit

How well did you know this?

Not at all

Perfectly

The amygdala interprets sensory and cognitive information, and determines…

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

How well did you know this?

Not at all

Perfectly

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

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

How well did you know this?

Not at all

Perfectly

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

5HT
GABA
Glutamate
NE
Voltage-gated ion channels

How well did you know this?

Not at all

Perfectly

GABA is a principle neurotransmitter that…

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

How well did you know this?

Not at all

Perfectly

GABA is stored and released in…

Presynaptic vesicles, and released in synapse when needed

Then transported back to vesicles or metabolized + inactivated

How well did you know this?

Not at all

Perfectly

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

N and P/Q

How well did you know this?

Not at all

Perfectly

Gabapentin and pregabalin MOA involves VSCC by…

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

How well did you know this?

Not at all

Perfectly

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

Major depressive disorder

How well did you know this?

Not at all

Perfectly

5-HT is a key NT that innervates…

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

Hence SSRI/SNRI are effective, blocking reuptake

How well did you know this?

Not at all

Perfectly

Buspirone is unique in that it is a…

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

How well did you know this?

Not at all

Perfectly

Norepinephrine is involved in anxiety via…

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

How well did you know this?

Not at all

Perfectly

SNRI MOA may increase NE and interact with anxiety via…

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

How well did you know this?

Not at all

Perfectly

GAD stands for…

Generalized anxiety disorder

How well did you know this?

Not at all

Perfectly

GAD often coincides with...

Other mental health disorders ## Footnote Can also co-occur with physical leaht problems and exacerbate/interfere with management

Onset of GAD is usually...

In late adolescents/early adulthood | Cases have been seen in older adults as well

GAD etiology is unknown, but is likely to be...

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

Cognitive behaviour theory describes the influences of...

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

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

Medications/natural products Medical conditions Consider withdrawal of medications that may increase anxiety (alcohol, sedatives, BZD's)

Common classes of drugs associated with anxiety symptoms include...

Corticosteroids Stimulants Sympathomimetics (pseudoephedrine, phenylephrine)

Psychological/cognitive symptoms of GAD include...

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

Physical symptoms of GAD include...

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

GAD standardized rating scales include...

GAD-7 HAM-A

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

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

Panic disorder is classified as...

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

Rates of panic disorder increase during... and peak during...

Increase during adolescence Peak during adulthood

Identifiable stressors of panic disorder include...

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

Psychological comorbidities with panic disorder include...

Other anxiety disorders **Depression** Bipolar AUD

Some medical comorbidities that coincide with panic disorder may include... | Anything that may cause instability of catecholamines

Cardiac arrythmias Hyperthyroidism Asthma, COPD IBS Cushing's

Most patients with panic disorder require ____ to achieve...

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

Predictors of chronic course of panic disorder include...

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

Standardized rating scales for panic disorder include... | Can be referenced to help with monitoring

Panic disorder severity scale Panic and agoraphobia scale

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

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

Median age of onset of social anxiety disorder is...

13 years

Risk factors for SAD often include...

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

SAD often has comorbidities which are...

Concurrent anxiety Depression Substance use disorder

SAD fears include...

Scrutiny by others Embarassment Humiliation | Public speaking, eating/drinking with others, talking with strangers...

Physical symptoms of SAD may include...

Blushing Diarrhea Sweating Tachycardia Trembling "Butterflies in stomach"

Generalized SAD refers to...

Fear and avoidance of a wide range of social situations

Standardized rating scales for SAD include...

All the ones used for GAD Social phobia inventory Liebowitz social anxiety scale | Help with monitoring

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

A traumatic event that happened in the past

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

Dopamine and Norepinephrine; cause persistent hyperarousal | These affect amygdala which activates SNS

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

Reconsolidated; long-term fear memories

The 3 dimensions of PTSD involve...

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

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

MDD SUD/AUD Other anxiety disorders Bipolar Psychosis

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

CVD Respiratory disorders Autoimmune disorders

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

Serotonin neurotransmission Dopamine transmission Glutamate

OCD symptoms are usually ____ onset, occurring after...

Sudden onset, occurring after a stressful event ## Footnote Treatment is usually delayed - waxing + waning symptoms

Co-morbidities with OCD include...

MDD Bipolar Other anxiety disorders Tic disorder, ADHD

Indicators of poor OCD prognosis include...

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

The two core symptoms of OCD are...

Obessessions Compulsions

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

Yale-brown obsessive compulsive scale