Week 9: Anxiety disorders Flashcards
What is anxiety?
Anxiety is an individual’s specific internal reaction to a perceived threat or stress
Is anxiety ever normal?
Yes in some situations.
It can help to motivate individuals or to warn of danger
How long does anxiety have to persist for it to be considered a disorder?
6 months or more
What are the physical symptoms of anxiety disorder?
Sweating Breathing changes Hot flushes Blushing Dry mouth Shaking Hair loss Fast heartbeat Lack of energy Extreme tiredness Dizziness/fainting Stomach aches
Mental symptoms of anxiety?
Racing thoughts Uncontrollable overthinking Difficulty concentrating Feelings of dread, panic or impending doom Feeling irritable Heightened alertness Problems with sleep Changes in appetite Wanting to escape Dissociation
At what age can you be affected by anxiety?
At any age
Anxiety tends to appear…
Gradually
Are there any gender differences with anxiety?
Women are 2x as likely than men
Is anxiety genetic?
Yes there is some genetic link
What are the different types of anxiety disorders?
Generalised anxiety disorder Panic disorder Social anxiety disorder Specific phobia Separation anxiety disorder Selective mutism Agoraphobia
What does the DSM5 say about generalised anxiety disorder?
Excessive anxiety or worry occurring for more days than not for at least 6 months about a number of things - the person finds it difficult to control the worry
The worry causes clinically significant distress or impairment in important areas of functioning.
This disturbance is not attributable to the physiological effects of a substance or a medical condition
The DSM5 requires 3 or more of the six symptoms for more days than not, for 6 months - what are the symptoms?
Restlessness or feeling on edge
Being easily fatigued
Difficulty concentrating or mind going blank
Irritability
Muscle tension
Sleep disturbance (falling asleep, staying asleep or unsatisfying sleep)
What is no longer included in the DSM5 under anxiety disorders?
Obsessive-compulsive - now under OCD and related disorders
Acute stress disorder and PTSD - now under trauma and stress-related disorders
What does anxiety increase the risk of?
Developing depression, alcohol, or other drug dependence as well as comorbidity with other anxiety disorders
Treatment for anxiety targets…
Serotonin, noradrenaline and GABA neurotransmitter systems
What is an anxiolytic?
A medication or any other intervention that reduces anxiety
What treatments are used for anxiety?
Psychotherapy
Medication
Healthy lifestyle
What psychotherapy is used for anxiety?
CBT
Psychotherapy when used with…… enhances the effectiveness of treatment
pharmacotherapy
What kinds of medications are used for anxiety?
Anti-depressants (SSRI and SNRI)
Benzodiazepines
Barbiturates
Beta-blockers
How long do anti-depressants take to have an anxiolytic effect?
4-6 weeks
- Anxiety is often slower to respond to treatment
What is the first-line recommendation for anxiety? and why?
Anti-depressants
Little evidence of a dose-response curve and many patients do and continue to respond to standard doses
What are serotonin pathways?
They are widespread in the brain - starting in the raphe nuclei that send major projections into the forebrain, cerebellum and the cortex
What is buspirone?
It is a new drug that acts on the serotonergic system however it is a lot faster acting than SSRIs (acts partial post-synaptically on 5HTIA receptors, and full at pre-synaptic receptors)
What are benzodiazepines?
Reduce both physical and mental symptoms in anxiety
What is the disadvantage of benzodiazepines?
Their withdrawal symptoms are frequently mistaken as the anxiety returning (agitation, tension)
What else can benzodiazepines be used for (other than anxiety)?
Alcohol dependence, seizures, insomnia
Benzodiazepines are not….
the first line of treatment for anxiety
What are barbiturates?
They have a sedative effect on the CNS - can be used as a sedative, anxiety reduction, hypnotic, anti-convulsants and anaesthetic
What is the disadvantage of barbiturates?
They can be highly addictive and can be very dangerous if they are mismanaged
Barbiturates act…
externally on the opening and closing of the chlorine channels - typically increasing duration of the GABA Cl channels
Benzodiazepines act…
to increase the frequency of the GABA Cl channels opening
Why are benzodiazepines better than barbiturates?
They cause less dependence
Long term use is relatively safe
Sleep induced is refreshing on wakeup - barbs cause hangover effect after waking
What are beta-blockers?
They are used for blood pressure, heart conditions and extreme stage fright
What is the main beta-blocker?
Propanolol
How does propanolol work?
Acting on both post synaptic beta blocker 1 and 2 norepinephrine receptors - dampening down what causes us to be stressed
Why hasn’t there been more treatments and medications made for anxiety?
How anxiety disorders work in the brain is not fully understood
Progress in understanding the brain has not been reflected in…
improved clinical outcomes
How do clinicians judge whether therapy is working?
Through the degree that patients report feeling better
Is it possible to develop a pharmaceutical treatment that specifically targets anxiety?
Because of the diverse effects of the medications, this may be difficult to do so without producing effects on other phenomena
What is the innate fear system?
Threat - sensory system - fear circuit - behaviour and physiological response (and conscious feelings of fear)
What is the two-systems model of fear?
One system is for generating conscious feelings of fear (cognitive circuit)
One system is for controlling behavioural and physiological reactions (defensive survival circuit)
They both do have some interaction with each other
