Anxiety & Stress - Physiology & Pharmacology

Question 1

What is anxiety and fear?

Answer 1

Preparation for fight or flight behaviour

Question 2

What is the difference between fear, anxiety and stress?

Answer 2

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

Question 3

When do problems occur with anxiety, fear and stress?

Answer 3

When responses are occurring to non-threatening situations as this can cause secondary displacement and complications

Question 4

What disorder group is anxiety, fear and stress a part of?

Answer 4

Part of the neurotic, stress-related and somatoform disorders group (ICD-10, F40-48)

Question 5

Give some examples of phobias.

Answer 5

Ailurophobia
Arachnophobia
Arachibutyrophobia
Coulrophobia

Question 6

What are the different types of anxiety and fear disorders?

Answer 6

1. Generalised anxiety (often with depression)
2. Phobias (simple vs complex)
3. OCD

Question 7

What disorders are included in the branch of phobias?

Answer 7

Specific phobias
Social anxiety disorder (SAD)/social phobia
Panic disorder
PTSD

Question 8

What disorders are included in the branch of OCD?

Answer 8

Starts with GAD then becomes obsessive E.G:

• Body dysmorphic disorder
• Anorexia/bulimia nervosa

Question 9

How common is anxiety, fear and stress disorders?

Answer 9

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

Question 10

What is stress?

Answer 10

A feeling of being overwhelmed or an inability to cope by current situational, environmental or perceived pressures (can be +ve and -ve)

Question 11

What are the effects of stress?

Answer 11

1. Emotional e.g. depression
2. Psychological e.g. irritability
3. Physical e.g. high BP + fatigue

Question 12

What CNS areas are involved in anxiety and fear?

Answer 12

1. Amygdala
2. Higher cognitive centres e.g. pre-frontal cortex
3. Insula
4. Other limbic system areas
5. Associations areas e.g. frontal + parietal
6. Sensory, motor + autonomic regions

Question 13

What is the amygdala and how is it involved in the anxiety and fear response?

Answer 13

Multinucleated area with huge connectivity that is responsible for fear, olfaction and social recognition

Question 14

How is the insula involved in anxiety and fear?

Answer 14

Threshold for emotions

Question 15

What fissure does the left insular cortex sit behind?

Answer 15

Lateral (Sylvian) fissure

Question 16

What input feeds into the relevant areas to influence anxiety and fear?

Answer 16

Hormonal
Proprioceptive
Contextual
Auditory
Visual 
Olfactory

Question 17

What areas are involved in integration, assimilation and then finally anxiety and stress behaviours?

Answer 17

Hypothalamus
Basal ganglia
Cerebellum
Brainstem
Spinal efferents

Question 18

What brainstem region controls defence behaviours?

Answer 18

Periaqueductal gray as it contains a high number of opioid receptors so it increases descending inhibition reducing the ascending pain signal

Question 19

What mechanisms are involved in anxiety and fear?

Answer 19

1. Increased CNS activity (decrease in primary sensory areas)
2. Increased neuronal synchrony
3. Firing frequency changes
4. Morphological changes and genetic/epigenetic changes (perhaps)

Question 20

What types of psychotherapy (behavioural therapy) are available for anxiety and fear?

Answer 20

1. Conscious avoidance
2. Relaxation courses
3. Hypnotherapy
4. Bibliotherapy

Question 21

What medications are available for anxiety?

Answer 21

Only for severe cases:

• ADs (SSRI, SNRI + atypicals)
• BZDs
• AEDs
• Other drugs for symptom reduction

Question 22

What treatments are used for Generalized Anxiety Disorder (GAD)?

Answer 22

Sertraline (SSRI)
Venlafaxine (SNRI)
Pregabalin (AED)
Buspirone (atypical)

Question 23

What treatments are used for specific phobias?

Answer 23

Sertraline (SSRI)

Propanolol (β-blocker to relieve anxiety SYMPTOMS)

Question 24

What treatment is used for panic disorders?

Answer 24

Sertraline (SSRI)

Question 25

What treatment is used for Post-Traumatic Stress Disorder (PTSD)?

Answer 25

Sertraline (SSRI)
Venlafaxine (SNRI)
Amitriptyline (TCA)

Question 26

What treatment is used for Obsessive Compulsive Disorders (OCD)?

Answer 26

Sertraline (SSRI)
Olanzapine (antipsychotic)
Buspirone (atypical)

Question 27

What treatments can be given in a short-term crises?

Answer 27

Lorazepam (BDZ)

Zolpidem (Z-drug)

Question 28

What are the main classes of antidepressants (AD)?

Answer 28

1. SSRI - Sertraline
2. SNRI - Venlafaxine
3. TCA - Amitriptyline
4. Atypical - Buspirone + Mirtazepine

Question 29

What does the evidence-base have to say about all these disorders and there best treatments?

Answer 29

UNCLEAR

Question 30

What are the theories surrounding what psychotherapy is doing to the brain?

Answer 30

New learning
Overwriting/depressing old learning
Altered brain activity frequencies
Desensitizing

Question 31

What could predict the outcome of psychotherapy?

Answer 31

MRI imaging

Question 32

What have recent studies shown about false memories and fear removal?

Answer 32

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