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S3 Case 2 - Mental Health > Anxiety + Insomnia: Pathophysiology + Pharmacology > Flashcards

Anxiety + Insomnia: Pathophysiology + Pharmacology Flashcards

1
Q

Are anxiety + insomnia interlinked?

A

YES

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2
Q

What is anxiety?

A

Worried, tense or afraid about things that are about to happen, or which could happen

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3
Q

What’s the difference between anxiety + fear?

A

Anxiety = unknown threat
Fear = definite threat

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4
Q

How can anxiety be experienced?

A

Thoughts, feelings and physical sensations

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5
Q

What is an example of physical sensations of anxiety?

A

Increased HR
Increased BP

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6
Q

What is anxiety often a comorbidity of?

A

Mental health disorders
eg. schizophrenia

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7
Q

What are the psychological symptoms of anxiety?

A

Restlessness
Difficulty concentrating
Irritability

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8
Q

What are the physical symptoms of anxiety?

A

Fatigue
Muscle aches + tension
Insomnia

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9
Q

What are the behavioural symptoms of anxiety?

A

Avoidance
Engaging in unhealthy, risky or self-destructive behaviours
Becoming overly attached

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10
Q

What are the different types of anxiety disorders?

A

General anxiety disorder (GAD)
Panic disorder
Specific phobias
Social anxiety disorder
PTSD
OCD

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11
Q

What is panic disorder?

A

Scared of something - eg. an exam
BUT goes away after the exam has finished

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12
Q

How do you diagnose anxiety?

A

Has to be most days for at least 6 months
Significant distress in social, occupational or important areas
NOT due to medical condition or substance

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13
Q

How does stress happen?

A

Hypothalamus releases CRH
Acts on pituitary gland
Pituitary gland releases ACTH
Acts on adrenal gland
Releases cortisol
STRESS

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14
Q

What is the response to stress?

A

Increased cardiovascular tone
Suppression of digestion
Suppression of growth
Suppression of reproduction
Alter immune system
Sharpening of cognition

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15
Q

What is the overall treatment for anxiety?

A

Changes in lifestyle
Self-help
Psychotherapy
Pharmacotherapy

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16
Q

What is the 1st line treatment for anxiety?

A

SSRIs (selective serotonin reuptake inhibitors)
SNRIs (serotonin + norepinephrine reuptake inhibitors)

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17
Q

What is the 2nd line treatment for anxiety?

A

Tricyclic antidepressants
5-HTA agonist
Monoaminoxidase inhibitors

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18
Q

What is the 3rd line treatment for anxiety?

A

Benzodiazepines

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19
Q

What are examples of SSRIs?

A

Citalopram
Fluoxetine
Paroxetine

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20
Q

What are the advantages of SSRIs?

A

Effective against various types of anxiety disorders
Long lasting
Less addictive than benzodiazepines
Potent
Fewer side effects

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21
Q

What are disadvantages of SSRIs?

A

Delay period (2-6 weeks)
Health issues if taken with other drugs

22
Q

Why is there a delay period in SSRIs?

A

Receptors on pre-synaptic
Binds
= inhibits further release of serotonin
BUT after weeks auto-receptors desensitise

23
Q

What are the side effects of SSRIs?

A

Insomnia
Nausea
Dizziness
Sexual dysfunction
Serotonin syndrome

24
Q

What does SNRIs do?

A

Increase both serotonergic + noradrenergic transmission

25
Q

Does SNRIs have more or less side effects than SSRIs?

A

LESS

26
Q

What are examples of SNRIs?

A

Duloxetine
Venlafaxine

27
Q

What are TCAs antagonists of?

A

5-HT receptors
Alpha1 adrenergic receptor
Histamine receptor
Muscarinic cholinergic receptor

28
Q

What does it mean that TCAs are antagonists of lots of receptors?

A

Have LOTS of side effects

29
Q

What are examples of TCAs?

A

Clomipramine
Imipramine

30
Q

What are side effects of TCAs?

A

Dry mouth
Sedation
Weight gain
Constipation
Dizziness
Heart rhythm problems

31
Q

What is the mechanism of action of SSRIs + SNRIs?

A

Promote neuroplasticity
= promotes flexibility + make the brain more capable of changing
= brain resists anxiety

32
Q

What are benzodiazepines mechanism of action?

A

Activate GABA
= hyperpolarisation
= inhibits neurone
= sedative drug

33
Q

What are the advantages of benzodiazepines?

A

Quick onset

34
Q

What are the disadvantages of benzodiazepines?

A

Highly addictive
Withdrawal symptoms
Impaired cognitive function

35
Q

What criteria needs to be considered when choosing an anxiety drug?

A

Particular symptoms
Side effects
Whether one worked for a close relative
Interaction with other medications
Pregnancy
Other health conditions

36
Q

What is insomnia?

A

Difficulty falling asleep or staying asleep

37
Q

What is short term insomnia?

A

Less than 3 months

38
Q

What is long term insomnia?

A

3 months or longer

39
Q

What are the cause of insomnia?

A

Stress
Psychiatric conditions (depression, schizophrenia)
Other medical conditions (Alzheimer’s)
Medications (SSRIs)

40
Q

What sets the clock for your brain?

A

Suprachiasmatic nucleus (SCN)

41
Q

What also influences your sleep?

A

Light exposure
= tells you if night/day based on light let into eye

42
Q

What is the sleep-wake cycle?

A

Arousal
REM
Timing
Consolidation

43
Q

What happens in wake promoting circuits?

A

Neurons release serotonin, noradrenaline, dopamine, Ach + histamine

44
Q

Why is it significant that serotonin is released in the wake promoting circuit?

A

SSRIs can cause insomnia

45
Q

What happens in NREM promoting circuits?

A

GABA is released in forebrain

46
Q

What happens in REM promoting circuits?

A

GABA released into brainstem
= stays asleep

47
Q

What is the treatment for insomnia?

A

Changes in sleep pattern/lifestyle
Tackle stress/anxiety
Psychotherapy
Pharmacotherapy

48
Q

Which hypnotic was originally used to treat insomnia?

A

Barbiturates

49
Q

Why aren’t barbiturates not used to treat insomnia anymore?

A

Narrow therapeutic window
Easy to overdose
Fatal if combined with antidepressants, alcohol + other drugs

50
Q

What were barbiturates replaced with?

A

Benzodiazepines

51
Q

What are examples of benzodiazepines?

A

Diazepam
Loprazolam
Midazolam

52
Q

What are the other drugs that can be used to treat insomnia?

A

Z drugs - eg. Zolpidem
Antihistamines - eg. diphenhydramine
Melatonin

S3 Case 2 - Mental Health (15 decks)

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