24. Anxiety and anxiolytics

Question 1

What are the different types of anxiety disorders?

Answer 1

Panic disorder
Agoraphobia
Social phobia - social anxiety disorder
Simple phobia
Obsessive compulsive disorder
Post-traumatic stress disorder
Generalised anxiety disorder

Question 2

Which neurological structures are involved in anxiety disorders?

Answer 2

Amygdala - involved in the control of fear and anxiety potentially thought to be perceived as a type of fear
HPA axis - some abnormalities in the stress response

Question 3

Which neurotransmitters are involved in anxiety disorders?

Answer 3

Monoaminergic systems (5-HT, dopamine)
GABAergic systems

Question 4

Explain the role of the amydala in anxiety

Answer 4

There is a hyperactivity of the limbic structures i.e. the amygdala and there is an accompanied inability of cortical structures to control this hyperactivity

Question 5

What are the different types of anxiolytics and give specific examples?

Answer 5

Benzodiazepines - clonazepam, alprazolam
5-HT1a agonists e.g. buspirone, ipsapirone
B-adrenoreceptor antagonist e.g. propranolol
SSRIs e.g. fluoxetine, escitalopram, paroxetine

Question 6

What are barbiturates?

Answer 6

These are anxiolytics which are no longer used as they were associated with a lot of issues

These were positive allosteric modulators at the GABAa receptors and they caused these channels to remain open for longer

Question 7

What were the issues associated with barbiturates?

Answer 7

Very strong CNS depressants so many adverse effects
Major risk of drug dependence
Development of tolerance
Fatal toxicity in overdose - respiratory depression
Accumulation causes drowsiness, disorientation, ataxia, slurred speech

Question 8

At what receptor do benzodiazepines have an effect?

Answer 8

These are positive allosteric modulators at GABAa receptors

These cause the channels to open more frequently than normal

Question 9

How is benzodiazepine overdose managed?

Answer 9

Flumazenil
This acts as an antagonist at the benzodiazepine binding sites
Has a short half life

Question 10

What are the complications of benzodiazepine use in the elderly?

Answer 10

Psychomotor impairment
Risk of falls
Daytime drowsiness
Intoxication
Amnesia
Depression
Respiratory problems
Abuse and dependancy