Week 3 - Anxiety and Sleep Disorders

Question 1

Anxiety primary and secondary

Answer 1

Primary: no underlying cause
secondary: caused by another condition/drug therapy

Question 2

1st line for all anxiety treatment

Answer 2

psychological therapy and support
- healthy coping mechanisms
- stress reduction
- counselling to determine underlying cause
- breathing control

Question 3

Benzodiazepines

Answer 3

Short term

act to POTENTIATE (increase) effects of GABA on the GABA receptors
- GABA is an inhibitory neurotransmitter found throughout the CNS - inhibits neuronal firing

when activated:
- anxiolyctic
- sedative
- hypnotic
- muscle relaxant
- antiepileptic

always start low and go slow
patient needs to be withdrawn slowly
highly addictive

Question 4

OCD

Answer 4

durgs with best efficacy = have an effect on the serotonergic system

SSRIs and TCAs increase the amount of serstonin

Question 5

Anxiety specific phobias

Answer 5

5 subtypes:
- animals
- natural environment
- blood/injury
- situational
- other

if cognitive therapy isnt sufficient and a situation cannot be avoived - can have benzodiazepine 30 mins before trigger

Question 6

Insomnia

Answer 6

pathophysiology = not well understood
invovles: physiological mechanism, cognitive mechanisms and cortical arousal

Sleep cycles are distruped leading to clinically SIGNIFICANT EFFECTS ON LIFESTYLE FOR AT LEAST 1 MONTH

Question 7

Sleep disorder - 1st line therapy

Answer 7

non-pharmaological thereapy ALWATS be tried first
- remove underlying factors: drugs/alcohol/prescriptions
- CBT/meditation/stress management
- Sleep hygiene
consistent sleep/wake times
reduce caffeine intake
remove stimuli from bedroom
regular exercise during the day
no eating/exercise close to bedtime
meditation/breathing/stretching before bed
get out of bed and do something relazing if no sleep within 20 mins of getting into bed

Question 8

if sleep hygiene = not enough

Answer 8

• benzodiazpeines - increases inhibitory effects of GABA
• zolpidem - increases inhibitory effects of GABA
• melatonin - resets the circadiam rhythm or sleep-wake cycle, melatonin produced in response to low light levels, useful for those suffering jetlag

Question 9

Dopamine

Answer 9

Increases alterness in the hypothalamus - promotes wakefullness

Question 10

Narcolepsy

Answer 10

fall asleep inappropriately - driving, spontaneously during activity (require stimulants)

Question 11

RLS

Answer 11

restless leg syndrome - reduced dopamine transmission in a specific area of the brain which control movement