Chap 7 - Anxiety Flashcards
(32 cards)
What is anxiety?
Anxiety is an emotional response in anticipation of future threat.
Classification of anxiety disorders.
Name the different Anxiety Disorders
▪▪ Separation anxiety disorder
▪▪ Selective mutism
▪▪ Specific phobia
▪▪ Social anxiety disorder (social phobia)
▪▪ Panic disorder
▪▪ Panic attack (specifier)
▪▪ Agoraphobia
▪▪ Generalised anxiety disorder
▪▪ Substance/medication-induced anxiety disorder
▪▪ Anxiety disorder due to another medical condition
▪▪ Other specified anxiety disorder
▪▪ Unspecified anxiety disorder
What anatomical structures form part of the limbic system?
** asked this question
- amygdala: which is key in the processing of emotionally salient stimuli
- hippocampus: involved
in fear memory encoding and processing - the medial prefrontal cortex, viz.
- the anterior
cingulate cortex - insular cortex
- subcallosal cortex
- medial frontal gyrus which are
involved in the modulation of affect.
What is the significance of the limbic system here?
It is involved with the pathogenesis of anxiety
What neurotransmitters are involved in the pathogenesis of anxiety?
monoamine transmitters
- serotonin
- noradrenaline
- dopamine
Describe the MOA of antidepressant and anxiolytic drugs in terms of neurotransmitters
They work through the monoamine pathways (serotonin, dopamine, noradrenalin)
- decreased inhibitory signals form GABA receptors
- increased excitatory signals
Screening tools used in primary care to detect anxiety?
HADS = Hospital Anxiety and Depression Scale
PRIME-MD = Primary Care Evaluation of Mental Disorders
First line treatment for anxiety?
Either medication or psychotherapy can be used as a first-line
treatment
The the main difference between the pharmacological first line and second line treatment
First line (SSRI, SNRI) are aimed at treating current anxiety symptoms
and preventing future recurrences of pathological anxiety
Second line agents are used to treat acute anxiety but do not have
any benefits in preventing symptom recurrences eg. Benzodiazepines, they are effective in treating acute anxiety, physiological
dependence occurs in all users and so misuse over time is a real concern
What is CBT? Cognitive Behavioral Therapy?
has the best evidence for efficacy
entails identifying maladaptive automatic thoughts and behaviours and then restructuring those thought patterns aided by the use of therapeutic exercises such as muscle relaxation and breathing
techniques.
What is panic disorder
Panic disorder is characterised by recurrent, spontaneous, and unexpected panic attacks
and for a one month period or more:
- persistent worry about having additional attacks
- worry about the implications of the attacks
- significant change in behaviour because of the attacks
More common in women
What are panic attacks?
Panic attacks are discrete periods of intense anxiety, associated with multiple physical
symptoms like trembling or shaking, sweating, palpitations, and shortness of breath, as well
as cognitive symptoms
What is Agoraphobia?
Agoraphobia is an irrational fear of places or situations where help may not be available, or
where escape is difficult
often leads to avoidance of places
What is the role of the amygdala?
**they asked this question
Amygdala: This almond-shaped structure in the temporal lobe plays a central role in the
co-ordination of fear-related behaviour and fear responses
What is the role of the locus ceruleus in the brain?
**they asked this question
Locus ceruleus: This is the primary noradrenergic nucleus in the mammalian brain. It receives
afferents from sensory systems which monitor the internal and external environment and
plays an important role in the processing of fear-related stimuli
What is the role of the thalamus?
Thalamus: Acts as a sensory relay station, which channels environmental
stimuli to the sensory cortex and amygdala
What is the role of the Hypothalamic-pituitary-adrenal axis?
Role in sympathetic activation and in the neuroendocrine response
Physical symptoms of a panic attack
▪▪ shortness of breath
▪▪ tachycardia
▪▪ dizziness, light-headedness
▪▪ paraesthesia
▪▪ chest pain or discomfort
▪▪ feeling of choking
▪▪ fainting, unsteadiness
▪▪ sweating
▪▪ tremor
▪▪ hot or cold flushes
▪▪ derealisation/depersonalisation
▪▪ urge to urinate/defecate
▪▪ dry mouth
▪▪ nausea
▪▪ muscle tension
▪▪ visual disturbances
▪▪ the person feels he/she’s going to die, lose control, or “go crazy”.
Eh don’t memorize this
Pharmacotherapy in treating panic disorder
a) SSRIs (e.g. fluoxetine) or SNRIs (e.g. venlafaxine)
b) Tricyclic antidepressants (TCAs) (e.g. imipramine)
c) Benzodiazepines (e.g. clonazepam, alprazolam)
d) Monoamine oxidase inhibitors (MAOIs) (e.g. phenelzine) and reversible inhibitors of
monoamine oxidase (RIMAs) (e.g. moclobemide)
The most important principle in pharmacotherapy in anxiety?
The most important principal in the pharmacotherapy of panic disorder is “start low, go slow,
end high”.
SSRIs/SNRIs
eg. Fluoxetine, Citalopram, Sertraline, Paroxetine, Fluvoxamine, Escitalopram, Venlafaxine
First line agents for the treatment of panic disorder
Better side effects vs TCAs
S/E = headache, nausea, loss of appetite and worsening of
anxiety when the medication is initiated. These effects are usually temporary. loss of libido and anorgasmia continues during maintenance
Tricyclic Antidepressants
Most NB ones = imipramine and clomipramine
Anticholinergic side effects NB.
Anticholinergic Side effects (TCA)
“mad as a hatter” = delirium, confusion, hallucinations
“hot as a hare” = fever, hyperthermia
“red as a beet” = flushing & vasodilation, orthostatic hypotension
“blind as a bat” = mydriasis (pupil dilation) blurred vision
“dry as a bone” = dry mouth, skin, mucous membranes
“the bowel and bladder lose their tone” = constipation, urinary retention, GI paralysis
“and the heart runs alone” = tachycardia
Benzodiazepines
S/E are bad = sedation, impairment in cognitive functioning, potentiation of
the effects of alcohol, risk of dependence, and withdrawal symptoms when terminated
advantage of these medications is their rapid onset of action
