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S3 Case 2 - Mental Health > Anxiety + Insomnia: Pathophysiology + Pharmacology > Flashcards

Anxiety + Insomnia: Pathophysiology + Pharmacology Flashcards

(52 cards)

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1
Q

Are anxiety + insomnia interlinked?

A

YES

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2
Q

What is anxiety?

A

Worried, tense or afraid about things that are about to happen, or which could happen

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3
Q

What’s the difference between anxiety + fear?

A

Anxiety = unknown threat
Fear = definite threat

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4
Q

How can anxiety be experienced?

A

Thoughts, feelings and physical sensations

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5
Q

What is an example of physical sensations of anxiety?

A

Increased HR
Increased BP

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6
Q

What is anxiety often a comorbidity of?

A

Mental health disorders
eg. schizophrenia

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7
Q

What are the psychological symptoms of anxiety?

A

Restlessness
Difficulty concentrating
Irritability

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8
Q

What are the physical symptoms of anxiety?

A

Fatigue
Muscle aches + tension
Insomnia

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9
Q

What are the behavioural symptoms of anxiety?

A

Avoidance
Engaging in unhealthy, risky or self-destructive behaviours
Becoming overly attached

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10
Q

What are the different types of anxiety disorders?

A

General anxiety disorder (GAD)
Panic disorder
Specific phobias
Social anxiety disorder
PTSD
OCD

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11
Q

What is panic disorder?

A

Scared of something - eg. an exam
BUT goes away after the exam has finished

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12
Q

How do you diagnose anxiety?

A

Has to be most days for at least 6 months
Significant distress in social, occupational or important areas
NOT due to medical condition or substance

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13
Q

How does stress happen?

A

Hypothalamus releases CRH
Acts on pituitary gland
Pituitary gland releases ACTH
Acts on adrenal gland
Releases cortisol
STRESS

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14
Q

What is the response to stress?

A

Increased cardiovascular tone
Suppression of digestion
Suppression of growth
Suppression of reproduction
Alter immune system
Sharpening of cognition

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15
Q

What is the overall treatment for anxiety?

A

Changes in lifestyle
Self-help
Psychotherapy
Pharmacotherapy

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16
Q

What is the 1st line treatment for anxiety?

A

SSRIs (selective serotonin reuptake inhibitors)
SNRIs (serotonin + norepinephrine reuptake inhibitors)

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17
Q

What is the 2nd line treatment for anxiety?

A

Tricyclic antidepressants
5-HTA agonist
Monoaminoxidase inhibitors

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18
Q

What is the 3rd line treatment for anxiety?

A

Benzodiazepines

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19
Q

What are examples of SSRIs?

A

Citalopram
Fluoxetine
Paroxetine

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20
Q

What are the advantages of SSRIs?

A

Effective against various types of anxiety disorders
Long lasting
Less addictive than benzodiazepines
Potent
Fewer side effects

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21
Q

What are disadvantages of SSRIs?

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A

Delay period (2-6 weeks)
Health issues if taken with other drugs

22
Q

Why is there a delay period in SSRIs?

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A

Receptors on pre-synaptic
Binds
= inhibits further release of serotonin
BUT after weeks auto-receptors desensitise

23
Q

What are the side effects of SSRIs?

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A

Insomnia
Nausea
Dizziness
Sexual dysfunction
Serotonin syndrome

24
Q

What does SNRIs do?

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A

Increase both serotonergic + noradrenergic transmission

25
Does SNRIs have more or less side effects than SSRIs?
LESS
26
What are examples of SNRIs?
Duloxetine Venlafaxine
27
What are TCAs antagonists of?
5-HT receptors Alpha1 adrenergic receptor Histamine receptor Muscarinic cholinergic receptor
28
What does it mean that TCAs are antagonists of lots of receptors?
Have LOTS of side effects
29
What are examples of TCAs?
Clomipramine Imipramine
30
What are side effects of TCAs?
Dry mouth Sedation Weight gain Constipation Dizziness Heart rhythm problems
31
What is the mechanism of action of SSRIs + SNRIs?
Promote neuroplasticity = promotes flexibility + make the brain more capable of changing = brain resists anxiety
32
What are benzodiazepines mechanism of action?
Activate GABA = hyperpolarisation = inhibits neurone = sedative drug
33
What are the advantages of benzodiazepines?
Quick onset
34
What are the disadvantages of benzodiazepines?
Highly addictive Withdrawal symptoms Impaired cognitive function
35
What criteria needs to be considered when choosing an anxiety drug?
Particular symptoms Side effects Whether one worked for a close relative Interaction with other medications Pregnancy Other health conditions
36
What is insomnia?
Difficulty falling asleep or staying asleep
37
What is short term insomnia?
Less than 3 months
38
What is long term insomnia?
3 months or longer
39
What are the cause of insomnia?
Stress Psychiatric conditions (depression, schizophrenia) Other medical conditions (Alzheimer's) Medications (SSRIs)
40
What sets the clock for your brain?
Suprachiasmatic nucleus (SCN)
41
What also influences your sleep?
Light exposure = tells you if night/day based on light let into eye
42
What is the sleep-wake cycle?
Arousal REM Timing Consolidation
43
What happens in wake promoting circuits?
Neurons release serotonin, noradrenaline, dopamine, Ach + histamine
44
Why is it significant that serotonin is released in the wake promoting circuit?
SSRIs can cause insomnia
45
What happens in NREM promoting circuits?
GABA is released in forebrain
46
What happens in REM promoting circuits?
GABA released into brainstem = stays asleep
47
What is the treatment for insomnia?
Changes in sleep pattern/lifestyle Tackle stress/anxiety Psychotherapy Pharmacotherapy
48
Which hypnotic was originally used to treat insomnia?
Barbiturates
49
Why aren't barbiturates not used to treat insomnia anymore?
Narrow therapeutic window Easy to overdose Fatal if combined with antidepressants, alcohol + other drugs
50
What were barbiturates replaced with?
Benzodiazepines
51
What are examples of benzodiazepines?
Diazepam Loprazolam Midazolam
52
What are the other drugs that can be used to treat insomnia?
Z drugs - eg. Zolpidem Antihistamines - eg. diphenhydramine Melatonin

S3 Case 2 - Mental Health (15 decks)

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