Anxiety

Question 1

Suprachiasmatic nucleus

Answer 1

Hypothalamus
Controls 24h circadian rhythm
Neurones here increase activity during the light phase, and decrease it during the night phase

Question 2

Melatonin

Answer 2

Increased during dark (sleep) phase

Question 3

Wakefulness

Answer 3

Cholinergic system (pedunculopontine and laterodorsal tegmental nuclei)
Monoaminergic projections (locus coeruleus, raphe nuclei, tuberomammillary nucleus)
Dopamine
Noradrenaline
Serotonin
Histamine
ACh
Orexin

Question 4

Sleep

Answer 4

GABA and galanin neurones (ventrolateral preoptic nucleus)
Melatonin
Adenosine

Question 5

Sleep cycles

Answer 5

Each cycle lasts approx. 90 mins

Cycles not identical in ratio NREM/REM sleep

Question 6

REM

Answer 6

rapid eye movement phase

Question 7

NREM

Answer 7

non-rapid eye movement phase

Question 8

SWS

Answer 8

slow wave sleep (NREM-3 and 4)

Question 9

How to assess sleep stages

Answer 9

Polysomnography

Question 10

Normal wakefulness EEG

Answer 10

Beta waves

13-30 Hz

Question 11

Awake + relaxed EEG

Answer 11

Alpha waves

8-12Hz

Question 12

Stage 1 NREM EEG

Answer 12

Theta waves

3.5-7.5Hz

Question 13

Stage 2 NREM EEG

Answer 13

Theta waves with sleep spindles and K complex

Question 14

Stage 3 + 4 NREM EEG

Answer 14

Delta waves
Less than 3.5Hz
Stage 3- less than 50%
Stage 4- more than 50%

Question 15

Types of Insomnia

Answer 15

Transient- jet lag
Short-term- bereavement, stress
Chronic- 3 weeks +

Question 16

Ideal drug for insomnia

Answer 16

Benzodiazepines (short-acting)

Z drugs

Question 17

Short term use Insomnia

Answer 17

Lorazepam

Temazepam

Question 18

Long term use Insomnia

Answer 18

Eszopiclone

Extended release Zolpidem

Question 19

Benzodiazepines SE

Answer 19

Change in sleep patterns
Daytime sedation
Rebound insomnia
Tolerance
Dependence

Question 20

Orexin system

Answer 20

Orexin (hypocretin)= peptide produced in hypothalamus
Orexin A
Orexin B
Effects mediated by Orexin 1 + 2 receptors
Regulates arousal, appetite, wakefulness

Question 21

Orexin deficiency

Answer 21

Narcolepsy- excessive sleepiness, increased frequency of falling asleep in daytime

Question 22

Suvorexant

Answer 22

Dual orexin receptor antagonist

Used to treat insomnia

Question 23

Types of anxiety disorders

Answer 23

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

Question 24

Structures involved in anxiety

Answer 24

Amygdala
Insula
Anterior cingulate
Prefrontal cortex
Thalamus
HPA axis abnormalities
Monoaminergic systems
GABAergic systems

Question 25

Genetics + anxiety

Answer 25

5HT transmission involved in genetic risk for anxiety disorders

Question 26

Genes + panic disorder

Answer 26

``` COMT CCK CCKb receptor Adenosine A2 receptor MAOa 5HT2 receptor ```

Question 27

KF1

Answer 27

If don't have it, increased fear/anxiety

Question 28

Benzodiazepines

Answer 28

Clonazepam | Lorazepam

Question 29

5HT1a agonists

Answer 29

Buspirone | Ipsapirone

Question 30

SSRIs

Answer 30

Fluoxetine | Escitalopram

Question 31

SNRIs

Answer 31

Venlafaxine | Duloxetine

Question 32

Beta adrenoreceptor antagonists

Answer 32

Propanolol

Question 33

Barbiturates problems

Answer 33

``` Drug dependence Tolerance Induction liver microsomal enzymes Fatal toxicity in overdose- resp. depression Speech drowsiness Withdrawal syndrome ```

Question 34

Benzodiazepine MOA

Answer 34

GABAa receptor Positive allosteric modulators Potentiates GABA-induced hyperpolarisation

Question 35

Flumazenil

Answer 35

Antagonist of benzodiazepines Used in benzodiazepine overdose Short half life

Question 36

Generalised anxiety disorder treatment

Answer 36

Buspirone Venlafaxine, duloxetine (SNRI) Fluoxetine, escitalopram (SSRI) Risperidone, quetiapine, olanzapine (APD)

Question 37

Benzodiazepine complications in elderly

Answer 37

``` Psychomotor impairment Risk of falls Daytime drowsiness Intoxication Amnesia Depression ```

Question 38

Z drug targets

Answer 38

Alpha subunits of GABAa receptors Zaleplon + zolpidem bind to alpha 1 subunit- hypnotic role Alpha 3 subunit- linked to anxiolytic effects