NEURO: Anxiety Flashcards
What is anxiety?
It’s a feeling of worry, nervousness, or unease about something with an uncertain outcome.
When does anxiety become a problem?
It’s okay when its intensity is intermittent, and its source is from certain events or situations that would cause anxiety.
It becomes problematic when its intensity is chronic, and its source is irrational.
It can lead to social disturbances, avoidance behaviours, incessant worry and concentration and memory problems.
What are some symptoms of anxiety?
We have psychological and physiological symptoms of anxiety.
- nervous diarrhoea
- insomnia
- increased heart rate (tachycardia)
- increased respiratory rate
- dizziness
- headaches
- flush red
- sweating
- nausea
- pins and needles
What can be some causes of anxiety?
- past/childhood experiences
- everyday life and habits
- diet
- drugs and medication
- physical or mental health
- genetics? (we’re still looking)
What are the different anxiety disorders?
- Generalised Anxiety Disorder (GAD)
- Specific phobias
(agoraphobia) - Social phobias
(selective mutism) - Obsessive Compulsive Disorder (OCD)
- Post-Traumatic Stress Disorder (PTSD)
- Panic Disorder
Give some examples of specific phobias.
- ornithophobia
- vertigo
- podophobia
- acrophobia
Describe OCD.
OCD is obsessive compulsive disorder.
Obsessions – checking windows are closed, gas is off
Compulsions – avoiding cracks in pavements
It becomes a problem when it becomes debilitating.
Describe PTSD.
PTSD is post-traumatic stress disorder.
It is when you re-live unpleasant memories via flashbacks or nightmares.
Describe panic disorders.
Panic disorders don’t equal panic attacks.
You can suffer from a panic attack when overwhelmed by your anxiety.
Panic disorder is when an individual suffers from panic attacks with no apparent trigger.
What are some treatments for anxiety?
- Benzodiazepines
- 5-HT1A receptor agonists
- β-Adrenoceptor antagonists
- Antihistamines
Describe benzodiazepines.
They are positive modulators.
They increase GABA affinity by GABA binding site stabilisation.
BZDs bind at the αγ interface – but not to all GABA(A) receptors (because the GABA receptors 1,2,3 and 5 have a histidine residue, while the 4 and 6 have an arginine residue).
An example would be Flumenazil. Flumenazil is a competitive antagonist at the BZD binding site, and is used in overdose.
How do we choose which benzodiazepine to use?
Benzodiazepine choice is made based upon duration of action.
Short-action agents are preferred to hypnotics to avoid sedative actions throughout the day.
What are the cons of increasing of 5HT transmission?
- you get fewer 5HT(1A) receptors
- 5HT reuptake is inhibited
What are the cons of decreased 5HT transmission?
- you get fewer postsynaptic 5HT receptors
Users going ‘cold turkey’ can get severe seizures – why?
It’s due to the unpleasant withdrawal over the lack of pleasurable effect. With the withdrawal, we are left with decreased inhibitory, and a surge of excitatory signals (due to tolerance from the medication) so you essentially knock yourself out.
Previous symptoms are exacerbated due to neuroadaptations.
Benzodiazepines/Z-drugs contribute to a much lesser extent than barbituates.
Long-term anxiety states should not be treated with BZDs – SSRIs are the first choice for GAD.
