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Applied Pathophysiology > Sleep/Anxiety Disorders > Flashcards

Sleep/Anxiety Disorders Flashcards

1
Q

What is a psychiatric disorder?

A

CNS diseases characterized by disturbances in emotion, cognition, motivation, and socialization

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2
Q

What does heterogenous syndrome mean?

A

the disease looks very different in different people

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3
Q

What is the first stage of the sleep cycle?

A

Getting drowsy

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4
Q

what is the second stage of the sleep cycle?

A

starting to doze off

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5
Q

what are the 3rd/4th stages of sleep cycle?

A

delta sleep

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6
Q

what is delta sleep?

A

deep sleep with muscle atonia

restorative

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7
Q

How many sleep cycles usually occur during a night?

A

4-6

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8
Q

what are circadian rhythms?

A

physical, mental, and behavioural changes that roughly follow a 24hr cycle, responding primarily to light and darkness in a person’s environment

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9
Q

What is the physiologic difference between NREM and REM sleep?

A

NREM - enabled by primary serotonergic tracts in medulla and dorsal Raphe nucles
REM - turned on my cholinergic tracts, turned off by noradrenergic areas

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10
Q

when do you dream? during REM or non REM?

A

REM

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11
Q

What NTs are responsible for alertness/wakefulness? (6pts)

A 
DA
NE
Ach
His
Sub P
Corticotropin releasing factor (CRF) becomes cortisol
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12
Q

What are some different ways insomnia can affect a person’s sleep cycle?

A

difficulty falling asleep
difficulty staying asleep
non-restorative sleep

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13
Q

what are the 3 types of insomnia? how long do they last?

A

transient - few days to a week
acute - several weeks
chronic - months to years

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14
Q

what could cause transient insomnia?

A

stress
illness
jet lag

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15
Q

what could cause acute insomnia?

A

stress
illness
grief

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16
Q

what could cause chronic insomnia?

A

long term health/stress problems

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17
Q

what are the 11 points of sleep hygiene?

A

1) establish regular time sto go to bed and wake up
2) sleep only as much as necessary to feel rested
3) go to bed only when sleeping. avoid long periods of wakefulness in bed
4) if you don’t fall asleep in 20-30min, leave bed and do something relaxing
5) avoid daytime naps
6) schedule worry time during the day (don’t take troubles to bed)
7) exercise routinely, but not near bedtime
8) minimize sensory stimulation at bedtime (light, sound, temp, etc)
9) decrease use of alcohol, caffeine, nicotine especially in the evening
10) avoid large quantities of liquids in evening
11) do something relaxing and enjoyable before bed

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18
Q

what is sleep apnea?

A

pauses in breathing, shallow or infrequent breathing while asleep

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19
Q

What are the 2 kinds of sleep apnea? which is more common?

A

obstructive sleep apnea - more common

central sleep apnea

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20
Q

what is obstructive sleep apnea?

A

throat muscles relax (upper airway collapse)

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21
Q

what is central sleep apnea?

A

brain doesn’t send proper signals to the muscles that control breathing

22
Q

what are some symptoms of sleep apnea? (7pts)

A 
tiredness
loud snoring
insomnia
abrupt awakenings with SOB
morning headaches
waking up with a dry mouth or sore throat
attention problems
23
Q

what is the most common way to treat sleep apnea?

A

positive airway pressure (PAP)

24
Q

how does PAP work to treat sleep apnea?

A

produces a positive pressure column in upper airway using room air to maintain patency
tube attaches PAP machine to mask that covers nose

25
Q

what is restless leg syndrome (RLS)?

A

disorder of part of the NS that affects the legs and causes the urge to move them

26
Q

what causes RLS?

A

iron deficiency in sub nigra

27
Q

how can RLS affect sleep?

A

symptoms usually worsen during rest and when someone tries to sleep, leading to insomnia

28
Q

what are the 3 models to describe the pathophysiology of anxiety disorders?

A

noradrenergic model
GABA receptor model
Serotonin model

29
Q

what is the noradrenergic model?

A

the ANS is hypersensitive and overreacts to various stimuli
the locus ceruleus (LC) is the primary NE containing site and the hypersensitivity leads to excess NE release, leading to increased Glu release

30
Q

what is the GABA receptor model?

A

natural regulation of serotonin, NE, and DA is under-performing
GABA not binding to GABA-A receptor enough?

31
Q

what is the serotonin model?

A

greater 5-HT activity leads to a decrease in NE activity in LC
Less LC firing causes an excess of NE

32
Q

what classes of drugs would you use to target the 3 models?

A

Noradrenergic - antidepressants and diazepines
GABA - diazepines, GABA agonists
5-HT - SSRIs

33
Q

what are some symptoms of anxiety disorders? (6pts)

A

1) restlessness or feeling keyed up/on edge
2) being easily fatigued
3) difficulty concentrating or mind going blank
4) irritability
5) muscle tension
6) sleep disturbance

34
Q

what is the difference between short term symptom anxiety and an anxiety disorder?

A

anxiety - supposed to be there and be adaptive to a threat or potential threat
anxiety disorder - the anxious feeling is there even when there is no real threat present

35
Q

what is required to diagnose someone with anxiety disorder?

A

excessive anxiety and worry occurring more days than not for at least 6 months about a number of issues
the person finds it hard to control the worry, also associated with 3 or more of 6 symptoms

36
Q

how is Gravol (dimenhydinate) relevant in sleep/anxiety disorders?

A

antihistamine/anticholinergic that has an off-label use as a sleep aid
acts as a CNS depressant, causing drowsiness and sedation

37
Q

what is Gravol typically used for?

A

motion sickness

38
Q

what are some classes of drugs that can help treat insomnia?

A 
anticonvulsants
adrenergic blockers
diuretics
SSRIs
steroids
stimulants
antidepressant (trazodone)
melatonin agonists
GABAa agonists (benzodiazepines, zoplicone)
39
Q

what are the treatment targets for insomnia?

A

enhance GABA, 5-HT

inhibit His, Ach, NE, DA, sub P, corticotropin releasing factor (cortisol)

40
Q

what are some psychiatric causes of anxiety?

A

depression
schizophrenia
bipolar disorder
alzheimers

41
Q

what are some classes of drugs that can help treat anxiety?

A 
antidepressants
bronchodilators
steroids
herbals
thyroid
stimulants
42
Q

what classes of drugs treat the physical symptoms of anxiety the best?

A

GABAa agonists - quick response

antidepressants - increase symptoms first then make them go away after long term use

43
Q

what are benzodiazepines (BZP)?

A

GABA agonists - decrease CNS excitability via enhancing GABA

44
Q

what kind of properties do BZPs possess?

A

muscle relaxant
anxiolytic (inhibits anxiety)
sedative/hypnotic
anticonvulsant

45
Q

what is the problem with BZPs?

A

they work too well and there is a high risk of dependency with BZPs that have quick onset and clearance

46
Q

how do antidepressants work to treat anxiety?

A

modulate serotonin, NE, and DA

47
Q

what is parasomnia?

A

abnormal behaviour of the NS during sleep

48
Q

what is narcolepsy?

A

disorder involving the loss of the brain’s ability to regulate sleep-wake cycles normally

49
Q

what is situational anxiety?

A

the feeling of anxiety caused by a new or changing event

50
Q

what is PTSD?

A

psychiatric disorder that can occur following the experience or witnessing of a life-threatening events, or serious/traumatic events during childhood or adulthood

51
Q

what is OCD?

A

Disorder where the person experiences obsessions (unwanted/disturbing images, feelings, or thoughts that cause anxiety) and convulsions (deliberate behaviours/mental acts to reduce the anxiety caused by the obsession)

52
Q

what is a panic attack?

A

periods of intense fear or apprehension of sudden onset accompanied by at least four or more bodily or cognitive symptoms

Applied Pathophysiology (11 decks)

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