Anxiolytics and Hypnotics

What autonomic changes occur during anxiety?

Release of noradrenaline/adrenaline increased heart rate increased arousal and alertness.

When does anxiety become pathological?

When fear occurs in anticipation or without external danger and interferes with daily activities.

What is the lifetime prevalence of GAD?

Approximately 4–7%.

Which sex is more affected by GAD?

Females more than males.

What is the DSM-IV description of GAD?

Excessive and difficult-to-control anxiety about several events or activities.

What are common symptoms of GAD?

Worry irritability insomnia muscle tension anticipating future harm.

Which brain region is involved in planning and predicting in GAD?

Prefrontal cortex.

Which brain region forms the basic fear circuit?

Amygdala.

What neurotransmitter dysfunction is associated with GAD?

GABA dysfunction.

What happens to hyperpolarisation in GABA dysfunction?

Reduced hyperpolarisation due to decreased chloride and calcium effects.

What triggers PTSD anxiety?

Recall of past stressful or traumatic experiences.

What are key symptoms of PTSD?

Re-experiencing trauma and hyper-arousal.

What brain change is associated with PTSD?

Reduced hippocampal activity.

Which sex is more affected by panic disorder?

Females more than males.

What characterises panic disorder?

Sudden attacks of overwhelming fear with somatic symptoms.

What are common somatic symptoms of panic disorder?

Sweating tachycardia hyperventilation.

What response is activated during panic disorder?

Fight or flight response.

Which brain region is involved in fear conditioning?

Hippocampus.

What chemicals are individuals with panic disorder oversensitive to?

Serotonin 5-HT noradrenaline NA and cortisol.

What is the UK prevalence of OCD?

About 1.2%.

What proportion of OCD cases are severe?

About 50%.

What are obsessions in OCD?

Intrusive thoughts that continually preoccupy the mind and increase anxiety.

What are compulsions in OCD?

Repetitive behaviours or rituals performed to reduce anxiety.

Which brain regions are involved in OCD?

Cortex and basal ganglia.

What is a specific/simple phobia?

A fear related to one specific thing or situation.

What is social phobia/social anxiety?

Fear of specific social situations or socialising in general.

What is agoraphobia?

Fear of certain places or situations.

What is GABA?

The main inhibitory neurotransmitter in the CNS.

What effect does GABA normally produce?

Neuronal hyperpolarisation and inhibition.

How does reduced GABA activity affect anxiety?

It increases anxiety.

What does 5-HT stand for?

Serotonin.

What role does serotonin play in anxiety?

It regulates mood and anxiety.

What role does noradrenaline play in anxiety?

It mediates the sympathetic fight or flight response.

What symptoms are linked to excess noradrenaline activity?

Tachycardia hyperarousal and panic symptoms.

How do benzodiazepines reduce anxiety?

They enhance GABA-A receptor activity and increase chloride ion influx.

Why are benzodiazepines mainly used short term?

Because they can cause tolerance dependence and sedation.

What do SSRIs do?

Increase serotonin availability by blocking reuptake.

What anxiety disorders are SSRIs commonly used for?

GAD OCD panic disorder and PTSD.

What do SNRIs increase?

Both serotonin and noradrenaline.

What are beta-blockers mainly used for in anxiety?

Reducing physical symptoms such as tachycardia.

How is insomnia linked to anxiety?

Anxiety increases arousal and disrupts sleep.

What are Z-drugs used for?

Promoting sleep in insomnia.

How do Z-drugs work?

They act on GABA-A receptors.

What are risks of insomnia therapeutics such as benzodiazepines and Z-drugs?

Dependence tolerance and daytime sedation.

What does tachycardia mean?

An abnormally fast heart rate usually over 100 bpm at rest.