Anxiety & Stress - Physiology & Pharmacology Flashcards
What is anxiety and fear?
Preparation for fight or flight behaviour
What is the difference between fear, anxiety and stress?
Fear: acute response to an ACTUAL stressor (amygdala)
Anxiety: towards a PERCIEVED/POTENTIAL stressor (anticipation/unease) (BNST)
Stress: feeling overwhelmed by situations, REAL OR PERCIEVED
When do problems occur with anxiety, fear and stress?
When responses are occurring to non-threatening situations as this can cause secondary displacement and complications
What disorder group is anxiety, fear and stress a part of?
Part of the neurotic, stress-related and somatoform disorders group (ICD-10, F40-48)
Give some examples of phobias.
Ailurophobia
Arachnophobia
Arachibutyrophobia
Coulrophobia
What are the different types of anxiety and fear disorders?
- Generalised anxiety (often with depression)
- Phobias (simple vs complex)
- OCD
What disorders are included in the branch of phobias?
Specific phobias
Social anxiety disorder (SAD)/social phobia
Panic disorder
PTSD
What disorders are included in the branch of OCD?
Starts with GAD then becomes obsessive E.G:
- Body dysmorphic disorder
- Anorexia/bulimia nervosa
How common is anxiety, fear and stress disorders?
Amongst the most common of psychiatric disorders (e.g. 5% suffer from GAD) where most common anxiety disorders are phobias and there are only increasing numbers of outpatient appointments related to these disorders
What is stress?
A feeling of being overwhelmed or an inability to cope by current situational, environmental or perceived pressures (can be +ve and -ve)
What are the effects of stress?
- Emotional e.g. depression
- Psychological e.g. irritability
- Physical e.g. high BP + fatigue
What CNS areas are involved in anxiety and fear?
- Amygdala
- Higher cognitive centres e.g. pre-frontal cortex
- Insula
- Other limbic system areas
- Associations areas e.g. frontal + parietal
- Sensory, motor + autonomic regions
What is the amygdala and how is it involved in the anxiety and fear response?
Multinucleated area with huge connectivity that is responsible for fear, olfaction and social recognition
How is the insula involved in anxiety and fear?
Threshold for emotions
What fissure does the left insular cortex sit behind?
Lateral (Sylvian) fissure
What input feeds into the relevant areas to influence anxiety and fear?
Hormonal Proprioceptive Contextual Auditory Visual Olfactory
What areas are involved in integration, assimilation and then finally anxiety and stress behaviours?
Hypothalamus Basal ganglia Cerebellum Brainstem Spinal efferents
What brainstem region controls defence behaviours?
Periaqueductal gray as it contains a high number of opioid receptors so it increases descending inhibition reducing the ascending pain signal
What mechanisms are involved in anxiety and fear?
- Increased CNS activity (decrease in primary sensory areas)
- Increased neuronal synchrony
- Firing frequency changes
- Morphological changes and genetic/epigenetic changes (perhaps)
What types of psychotherapy (behavioural therapy) are available for anxiety and fear?
- Conscious avoidance
- Relaxation courses
- Hypnotherapy
- Bibliotherapy
What medications are available for anxiety?
Only for severe cases:
- ADs (SSRI, SNRI + atypicals)
- BZDs
- AEDs
- Other drugs for symptom reduction
What treatments are used for Generalized Anxiety Disorder (GAD)?
Sertraline (SSRI)
Venlafaxine (SNRI)
Pregabalin (AED)
Buspirone (atypical)
What treatments are used for specific phobias?
Sertraline (SSRI)
Propanolol (β-blocker to relieve anxiety SYMPTOMS)
What treatment is used for panic disorders?
Sertraline (SSRI)
What treatment is used for Post-Traumatic Stress Disorder (PTSD)?
Sertraline (SSRI)
Venlafaxine (SNRI)
Amitriptyline (TCA)
What treatment is used for Obsessive Compulsive Disorders (OCD)?
Sertraline (SSRI)
Olanzapine (antipsychotic)
Buspirone (atypical)
What treatments can be given in a short-term crises?
Lorazepam (BDZ)
Zolpidem (Z-drug)
What are the main classes of antidepressants (AD)?
- SSRI - Sertraline
- SNRI - Venlafaxine
- TCA - Amitriptyline
- Atypical - Buspirone + Mirtazepine
What does the evidence-base have to say about all these disorders and there best treatments?
UNCLEAR
What are the theories surrounding what psychotherapy is doing to the brain?
New learning
Overwriting/depressing old learning
Altered brain activity frequencies
Desensitizing
What could predict the outcome of psychotherapy?
MRI imaging
What have recent studies shown about false memories and fear removal?
Optogenic studies have shown it is possible to implant a false memory so we may be able to overwrite a bad memory or change it to a positive if specific pathways and activity patterns are identified and activated
