Lecture 9: Affective disorders 2 - Anxiety Flashcards
What are the symptoms of anxiety?
Adrenaline acts on organs to produce the following effects:
- Shortness of breath, choking
- Palpitatins, chest pains, flushes
- Trembling, sweating
- Dry mouth, butterflies, nasea, belching
- feeling dizzy and light headed
- Damaging cognition and fear
What is healthy anxiety?
Anxiety experienced by most people under unaccustomed stress. Normal response to an unusual situation eg exams, sports etc
What is pathological anxiety?
An unadaptive response - no useful purpose. Anixiety is experienced both in the prsence of, or absence of, what can be seen to be obvious stimuli. The patients know that their fears are irrational and groundless, but this is of no help to them in allaying their anxiety eg heights, spiders
What are the key clinical points for diagnosing generalised anxiety disorders?
- Gerneralized anxiety disorder is characterized by persistent anxiety and uncontrolled worry that occurs consistently for at least 6 months.
- The disorder is commonly associated with depression, alcohol and substance abuse, physical health problems, or all of these
- In primary care, patients with this disorder often present with physical symptoms such as headaches, muscle tension, GI symptoms, back pain and insomnia
- Brief validated screening tools such as genealised anxiety disorder 7 (GAD-7) scale should be used to assess the severity of symptoms and response to treatment
What are the social signs of anxiety disorder?
- Depression or suicidal thoughts
- Family or relationship problems
- Changes in personality
- Extreme, unwanted fear of partitucular situation or things
- Fear of leaving the house, social withdrawal
- Compulsive or repetitive behaviours
- Trouble on the job or in school
- Alcohol or drug abuse
- Frequent emotional and physical health issues
What is the diferrence between generelaizsed and major depression?
Patients with generalised anxiety disorder often describe a sense of helplessness, whereas patients with major depression may feel hopeless
What are the types of anxiety disorders in the DSM 5 classification?
- Social anxiety
- Specific phobia
- Panic disorders
- Agaraphobia
- Generalized anxiety
- Anxiety due to another medical condition
- Substance/ medication induced anxiety disorder
- Selective mutism
- Separation anxiety
- Other sepcified anxiety disorder
- Unspecified anxiety disorder
OCD and PTSD and no longer included in anxiety disorder due to the prevelence
What are the types of anxiety in ICD 10?
- Phobia anxiety disorders
- Other anxiety disorders
- OCD
- Reaction to severe stress and adjustment disorders
- Dissociative and conversion disorders
- Somatoform disorders
- Other nonpsychotic mental disorders
What are the symptoms of specific phobias?
- Triggers may be animals, natural environemnt, blood injection injury; fear of blood, fear of injections and transfusins, fear of other types of medical care, fear of injury
What is the GAD 7 questionare?
- feeling nervous, anxiety or on edge
- Not being able to stop or control worrying
- Worrying too much about different things
- Having trouble relaxing
- Being so restless that it is hard to sit still
- Becoming eaily annoyed or irritable
- Feeling afraid, as if something awful might happen.
Not at all - 0
Several days - 1
More than half the days - 2
Nearly every day - 3
5 = mild
10 = moderate
15 = severe
What is the pathiophysiology of anxiety?
- The limbic system of the brain is thought to play central role in anxiety disorders
- The neurotransmitter systems may have an altered sensitivity of the GABA system; May be reduced GABA sensitivity
- Seratonergic system may also be involved
What are the neural circuits for anxiety?
There are pathways that promote anxiety and also pathways that dampen anxiety.
The bilateral amygdala going to the hippocampus, is a forward loop which causes and promotes anxiety.
All the brain regions are interconnected so them all interacting is what causes anxiety.
What are the treatment for anxiety?
Drugs used to treat anxiety are called anxiolytics; bemzodiazapines, SSRIs, TCAs, 5-HT agonists
What are benzodiazepines?
One of the most heavily presecibed psychoactive drugs, with alprazolam, clonazepam, diazepam and lorazepam. Also used in other CNS disorders. Generally produce almost immediate effects so may be prescibed for short term, intermittent, as needed use. Not to be give if self medicating with alcohol.
They work on GABAnergic neurotransmission. BZD act on GABAa receptors. They increase the affinity/ affect of GABA on the receptor. BZDs increase the frequency of opening of GABAa channels
Specific mutation of alpha2 subunit in GABA leads to loss of anxiolytic effect of BZDs
What is the metabolism and elimination of BZDs and side effects
- Midazolam - rapid half life: <5 hours
- Lorazepam, Temazepam: Short half life 5-20 hours
- Nitrazepam: intermediate half life 20-40 hours
- Diazepam, chlordiazepoxide: Slow half life >40 hours
Long half lifes usually means the genretion of active metabolites
Side effects include overdose, drug interaction, tolerance and dependance
