Quiz
PSY2 GAD and phobias
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1Affective disorders include phobias, anxiety, depression, and bipolar disorder. They affect external [blank_start]response[blank_end] and internal [blank_start]emotion[blank_end]. Emotional symptoms are misery, apathy, pessimism, low [blank_start]self-esteem[blank_end], loss of [blank_start]motivation[blank_end], indecision, and more. Biological symptoms are loss of [blank_start]libido[blank_end], slowed [blank_start]thought[blank_end], [blank_start]sleep[blank_end] disturbances, and appetite [blank_start]changes[blank_end].
Explanation? [blank_start]Monoamine[blank_end] theory... CNS is deficient monoaminergic transmission such ie 5-HT/[blank_start]serotonin[blank_end], [blank_start]noradrenaline and dopamine[blank_end].- Aresponse
- Bemotion
- Cself-esteem
- Dmotivation
- Elibido
- Fthought
- Gsleep
- Hchanges
- IMonoamine
- Jserotonin
- Knoradrenaline and dopamine
2Not technically part of the learning objectives but it was in the lecture.....
Noradrenaline - regulates [blank_start]mood, arousal, cognitive, autonomic fns[blank_end]
Serotonin - regulates [blank_start]mood, anxiety, sleep[blank_end]
Dopamine - does so much, just remember: the [blank_start]tuberoinfundibular[blank_end] pathway controls [blank_start]prolactin[blank_end] secretion and we monitor that in some psychotic patients on meds that effect dopamine. also the [blank_start]mesolimbic[blank_end] pathway contols delusions and [blank_start]hallucinations[blank_end].- Amood, arousal, cognitive, autonomic fns
- Bmood, anxiety, sleep
- Ctuberoinfundibular
- Dprolactin
- Emesolimbic
- Fhallucinations
3Anxiety disorders -
1. [blank_start]Generalised[blank_end] anxiety disorder
2. [blank_start]Panic[blank_end] disorder
3. [blank_start]Social[blank_end] anxiety
[blank_start]CBT[blank_end] is usually first line followed by [blank_start]SSRIs and SNRIs[blank_end].
[blank_start]OCD and PTSD[blank_end] were previously classified as anxiety disorders but are now separate.- AGeneralised
- BPanic
- CSocial
- DCBT
- ESSRIs and SNRIs
- FOCD and PTSD
4Anxiety epidemiology:
- Specific phobias are [blank_start]common[blank_end] but patients rarely seek [blank_start]care[blank_end]. Response rates in about [blank_start]half[blank_end] of people and remission in about a [blank_start]quarter[blank_end].
- 7.7% [blank_start]women[blank_end] and 4.4% [blank_start]men[blank_end] diagnosed at some point
- Highest rates in women [blank_start]25 - 54[blank_end] (9%)
- Anxiety and depression are the [blank_start]second[blank_end] leading cause of loss of health after coronary heart disease
- Peoplw with GAD, panic disorder, and social anxiety [blank_start]50% more likely[blank_end] to experience suicidal ideation and suicide attempts- Acommon
- Bcare
- Chalf
- Dquarter
- Ewomen
- Fmen
- G25 - 54
- Hsecond
- I50% more likely
5Match the condition to the median age of onset.
Social anxiety - [blank_start]12[blank_end]
GAD - [blank_start]32[blank_end]
Panic disorder - [blank_start]24[blank_end]
Agoraphobia (fear of going somewhere or doing something that will cause anxiety or panic) - ~ [blank_start]22[blank_end]- A12
- B32
- C24
- D22
6Cognitive behavioral therapy (CBT) focuses on challenging and [blank_start]changing[blank_end] unhelpful cognitive distortions e.g. thoughts, beliefs, attitudes, and behaviors, improving [blank_start]emotional[blank_end] regulation, and the development of personal [blank_start]coping strategies[blank_end]. [blank_start]Group or solo[blank_end] intervention.
- Aemotional
- Bcoping strategies
- CGroup or solo
- Dchanging
7CBT disadvantages
- requires [blank_start]trained[blank_end] expert
- [blank_start]cost and access[blank_end], especially for rural patients
- poorly [blank_start]conducted or paced[blank_end] CBT is ineffective and possibly [blank_start]distressing[blank_end], leads to further CBt aversion
- requires [blank_start]EFFORT and PERSEVERANCE[blank_end] on patient's parT
- anxiety with [blank_start]exposure[blank_end] tasks is distressing
- can increase symptoms and distress [blank_start]initially[blank_end], has a similar dropout rate to [blank_start]antidepressants[blank_end]- Atrained
- Bcost and access
- Cconducted or paced
- Ddistressing
- EEFFORT and PERSEVERANCE
- Fexposure
- Ginitially
- Hantidepressants
8Experiencing stress especially early in life can induce sensitization and risk of psychiatric illness.
- ARichtig
- BFalsch
9Below are a list of anxiety symptoms. Select ALL that overlap with depression symptoms.
- ASleep issues
- BConcentration issues
- CFatigue
- DPsychomotor arousal (restlessness)
- EAnxiety
- FIrritability
- GPanic attacks
- HMuscle tension
- ICompulsion
10Comorbidity of anxiety and depression is common and increases severity of both, also increasing recovery or preventing it.
- ARichtig
- BFalsch
11GAD core symptoms: general or unexplained anxiety, worry, increased [blank_start]arousal[blank_end], difficulty [blank_start]concentrating[blank_end]. Diagnosis requires persistent symptoms most days >[blank_start]6 months[blank_end].
Panic disorder: begins as [blank_start]spontaneous[blank_end] panic attack, followed by >[blank_start]1 month[blank_end] of persistent [blank_start]concern[blank_end] about having another attack OR maladaptive* change in [blank_start]behavior[blank_end] related to attacks. Physical symptoms of attacks = [blank_start]abdominal and/or chest[blank_end] pain, [blank_start]chills or heat[blank_end] or both, dizziness, nausea, [blank_start]sweating, shaking, tachycardia[blank_end], increase RR.
* maladaptive = not adjusting adequately or appropriately- Aconcentrating
- Barousal
- C6 months
- Dspontaneous
- E1 month
- Fconcern
- Gbehavior
- Habdominal and/or chest
- Ichills or heat
- Jsweating, shaking, tachycardia
12Common conditions associated with panic;
- Substance induced: [blank_start]stimulant[blank_end] use(includes adverse affects of [blank_start]OTC[blank_end] meds), [blank_start]alcohol or benzo[blank_end] withdrawal, [blank_start]caffeine[blank_end] product use
- Medical conditions
1. Commonly [blank_start]hyper[blank_end]thyroidism, [blank_start]arrythmias[blank_end], seizure disorders, hypo[blank_start]glycaemia[blank_end]
2. Less commonly [blank_start]hypo[blank_end]thyroidism, [blank_start]PE, menopause, Cushings[blank_end]- Astimulant
- BOTC
- Calcohol or benzo
- Dcaffeine
- Ehyper
- Farrythmias
- Ghypo
- HPE, menopause, Cushings
- Iglycaemia
13Which of these is not a symptom of social anxiety disorder?
- ASweating
- BTachycardia
- CFlushing (face, neck)
- DDiarrhoea
- EConstipation
14Most people with social anxiety develop another concurrent mood, anxiety, or substance use disorder.
- ARichtig
- BFalsch
15Obsessive compulsive disorders are chronic and vary in [blank_start]severity[blank_end]. People with OCD have intense urges to perform acts which they know are senseless/excessive.
Obsessions:
- repetitive [blank_start]thoughts[blank_end] eg contaminated by germs, fear of harming other
- repetitive [blank_start]images[blank_end] eg sexually explicit, violent
- repetitive [blank_start]urges[blank_end] eg need for symmetry or order
Compulsions:
- repetitive [blank_start]activities[blank_end] eg hand washing, need to ask
- repetitive [blank_start]mental acts[blank_end] eg counting excessively, silently repeating words
[blank_start]Insight[blank_end] on which behaviors are abnormal or unnecessary varies, from good all the way to absent ([blank_start]delusional beliefs[blank_end]).
Diagnosis can be difficult.- Aseverity
- Bthoughts
- Cimages
- Durges
- Eactivities
- Fmental acts
- GInsight
- Hdelusional beliefs
16Pathology:
- Anxiety and fear symptoms linked to amygdala circuit ([blank_start]amygdala, ACC and OFC[blank_end] together) - specifically over-activation of the [blank_start]amygdala[blank_end]
- Worry (miseries, obsessions) linked to CSTC loop ([blank_start]cortico-striatal-thalamic-cortical[blank_end]), over-activation of [blank_start]thalamus and striatum[blank_end]
These circuits may be involved in all anxiety disorders.
- Avoidance linked to over-activation of the amygdala and [blank_start]periaqueductal gray[blank_end] (PAG). [blank_start]Fight or flight[blank_end] motor responvse.
- Breathing is regulated by the amygdala and [blank_start]parabrachial nucleus[blank_end] (PBN)... sense of being smothered, increased RR, explains those symptoms etc- Aamygdala, ACC and OFC
- Bamygdala
- Ccortico-striatal-thalamic-cortical
- Dthalamus and striatum
- Eperiaqueductal gray
- FFight or flight
- Gparabrachial nucleus
17SNRIs have a significantly longer response time in contrast to SSRIs.
- ARichtig
- BFalsch
18Selective [blank_start]serotonin reuptake inhibitors[blank_end] (SSRIs) are a class of drugs that are typically used as antidepressants or anxiolytics.
Fluoxetine, citalopram, escitalopram, sertraline, paroxetine, etc.
Side effects: commonly [blank_start]nausea or sedation, insomnia[blank_end], [blank_start]weight loss[blank_end] changes, sexual [blank_start]dysfunction[blank_end] (70% of patients, gender irrelevant), even [blank_start]anxiety[blank_end]. Some of these will go away eg nausea is transient. Low [blank_start]toxicity[blank_end] risk.
MoA: increased serotonergic acitivity/agents* enhances [blank_start]serotonergic input to the amygdala[blank_end], alleviating over-activation and anxiety. *Increased [blank_start]5-HT at synapses[blank_end]. Post-synaptic [blank_start]receptors[blank_end] send signal to post-synaptic cell [blank_start]nucleus[blank_end] to desensitize receptors. Time course to desensitization correlates with onset of [blank_start]tolerance[blank_end].
SSRIs vary a little...
- Fluoxetine also facilitates [blank_start]NA and DA release[blank_end]by acting on 5-HT Rs on [blank_start]GABAergic[blank_end] neurons
- Sertraline has effects on adrenergic receptors and [blank_start]DA[blank_end] reuptake inhibition
- Citalopram has an R enantionmer with weak [blank_start]antihistamine[blank_end] properties- Aserotonin reuptake inhibitors
- Bnausea or sedation, insomnia
- Cweight
- Ddysfunction
- Eanxiety
- Ftoxicity
- Gserotonergic input to the amygdala
- H5-HT at synapses
- Ireceptors
- Jnucleus
- Ktolerance
- LNA and DA release
- MGABAergic
- NDA
- Oantihistamine
19Tricyclic antidepressants (TCAs)
- Clomipramine, [blank_start]imipramine[blank_end] - for panic
- 2nd/3rd line
- Inhibit [blank_start]NA and/or 5-HT[blank_end] reuptake
- UEs: [blank_start]sedation[blank_end] and confusion, motor [blank_start]incoordination[blank_end], [blank_start]antimuscarinic[blank_end] - blurred vision, dry mouth, urinary retention, cardiotoxic - [blank_start]ventricular arrythmias, QT prolongation[blank_end]
- More drug interactions than SSRIs- Aimipramine
- BNA and/or 5-HT
- Csedation
- Dincoordination
- Eantimuscarinic
- Fventricular arrythmias, QT prolongation
20Other anxiolytics:
Benzodiazepines - alleviate anxiety by enhancing [blank_start]phasic inhibitory[blank_end] actions at [blank_start]post-synaptoic GABA(a)[blank_end] receptors int he amygdala.
SNRIs - [blank_start]venlafaxine[blank_end]
Alpha-2 agonist (affects NA and 5-HT) - [blank_start]mirtazipine[blank_end]
5-HT(1a) agonist - [blank_start]buspirone[blank_end]
Alpha-2-gamma ligands - [blank_start]pregabalin, gabapentin[blank_end] - bind to [blank_start]presynaptic[blank_end] receptors to block glutamate release
Atypical anti psychotics - [blank_start]quetiapine, olanzapine[blank_end]- Aphasic inhibitory
- Bpost-synaptic GABA(a)
- Cvenlafaxine
- Dmirtazipine
- Ebuspirone
- Fpregabalin, gabapentin
- Gpre-synaptic
- Hquetiapine, olanzapine
Informationen
- Beschreibung
- Der Nutzer hat seine Fachbereichs-Information gelöscht. Quiz am PSY2 GAD and phobias, erstellt von Gelöschter Nutzer am 14/10/2019.
- Autor
- Gelöschter Nutzer
- Sprache
- English
- Aufrufe
- 119
- Verlauf
- Erstellt am 14 Okt 2019 · aktualisiert am 14 Okt 2019
- Schlagwörter
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