Anxiety Disorders

Question 1

What is the definition of anxiety?

Answer 1

• A feeling of unease, such as worry or fear, that can be mild or severe.
• A diagnosis is made if feeling of anxiety occurs all the time.

Question 2

What is a panic disorder?

Answer 2

• Unexpected panic attacks that may not be restricted to a specific situation or stimuli
• Charachterised by intense and abrupt feeling of fear or discomfort.

Question 3

What are symptoms of anxiety disorders?

Answer 3

• Palpitation or inc HR
• Sweating
• Trembling
• Sensations or shortness of breath
• Feelings of choking
• Chest pain
• Nausea or abdominal stress
• Feelings of dizziness/light-headed
• Chills or hot flushes
• Tingling or lack of sensation in extremitites
• Depersonalisation or derealisation
• Fear of losing control or going mad
• Fear of imminent death

Question 4

What is OCD?

Answer 4

• Combination of obsessive thoughts and compulsive activity
• Obsession: Unwanted/unpleasant thoughts that cause anxiety e.g. being burgled.
• Person tries to supress these thoughts through compulsions.
• Compulsion:Repititve behaviour a person undertakes to relieve the unpleasant feeling
• Diagnosis: Both the obsessions and compulsions must be time consuming and result in sig impact on day-day function.

Question 5

What is PTSD?

Answer 5

• Develops after experiencing threatening or horrific event/series of events
• Charachterised by:
  1.Re-experiencing traumatic event
  2.Avoidance of thoughts and mem attributed to the event
  3.Persistent perceptions of heightened threat

Question 6

What are some additional symptoms of PTSD?

Answer 6

• Insomnia
• Nightmares
• Flashbacks
• Isolation

Question 7

What is a specific phobia?

Answer 7

• An intense fear of something that, in reality, is of little or no actual danger.

Question 8

What is social phobia/social anxiety disorder?

Answer 8

• Fear of social or performanc situations resulting from thoughts of neg judgement, embarassment or humiliation.
• Person ‘tolerates’ with dread or avoids situation.

Question 9

What is Generalised anxiety disorder?

Answer 9

• Excessive, uncontrollable worry about every day things, such as:
  1. Job
  2. Finances
  3. Health
  4. Family
  5. Chores
  6. Car repairs
  7. Late for things
• The intenity, duration and freq of the worry are disproportionate to the issue.
• May also be present with physical symptoms e.g. palpitations, sweating, trembling etc.

Question 10

Why is the prefrontal cortex important?

Answer 10

• Intellectual function AND emotional behaviour(suppresses aggro behaviou)

Question 11

Why is the amygdala important?

Answer 11

• Involved in processing emotional behaviour?

Question 12

Why are the amygdala and prefrontal cortex linked?

Answer 12

• A decrease in the connectivity between them leads to GAD.

Question 13

How much do genes and the environment contribute to GAD?

Answer 13

• Genes-30-50%
• Environment-50-70%

Environment is more important.

Question 14

How does GABA affect GAD?

Answer 14

• Dysregulation of GABA inhibitory neurotransmission
• GABAa receptor downregulation observed in GAD patients
• Symptoms of GAD are effectively treated with GABAa agonsits

Question 15

How does 5-HT affect GAD?

Answer 15

• SSRIs have efficacy for GAD

Question 16

How does Corticotrophin-releasing factor affect GAD?

Answer 16

• No effect in clinical trial

Question 17

How do neuropeptides affect GAD?

Answer 17

• GAD patients are hypersensitive to cholecystokinin (CCK) agonists
• Unsuccessful trials investigating CCK-antagonists.

Question 18

What is the mechanism of GAD and neuroendocrine?

Answer 18

• Cortisol is a stress hormone
• Adrenaline and Noradrenaline fight or flight
• Neg feedback loop stops this chain(HPA) (see below)
  1. Hypothalamus, Anterior pituitary, Adrenal cortex->cortisol.
• In GAD and depression this neg feedback loop that leads to cortisol is compromised and therefore more cortisol is produced.

Question 19

What are the considerations during an anxiety assessment?

Answer 19

• Mental health history
• Environmental stressors
• Medical and drug history
• Degree of distress and func impairment
• Risk of suicide

Question 20

What are non-pharmacological methods of treatment?

Answer 20

• Self-help
• Meditation and relaxation techniques
• Excercise
• Lifestyle changes

Question 21

How do you manage GAD?

Answer 21

Interventions:
* Autonomic symptoms:
1. B-adrenoreceptors antagonists (propranolol)

• • 1. Reduces autonomic effect
• 2. Do not withdraw abruptly to provent rebound effects
• Anxiety symptoms:
  1. Psychological interventions
• 1. Offer SSRIs- sertraline as first option
• 2. Do not offer benzodiazepine except for short term use during a crisis

Question 22

What are Benzodiazepines used for?

Answer 22

• Muscle relaxation
• Insomnia
• Pre-medication
• Epilepsy
• Alcohol withdrawal
• Anxiety

Question 23

How do benzodiazepines work?

Answer 23

• BDZ occupy site on GABAa receptor
• BDZ binding->conformational change which allows GABA to bind
• GABA binding->conformational change in GABAa receptor chloride channel
• Greater flow of Cl- ions into the neurone
• Hyperpolarisation=Inhibition