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PSY2 GAD and phobias

Deleted user 20 questions Updated 14 Oct 2019

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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].
1. Aresponse
2. Bemotion
3. Cself-esteem
4. Dmotivation
5. Elibido
6. Fthought
7. Gsleep
8. Hchanges
9. IMonoamine
10. Jserotonin
11. 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].
1. Amood, arousal, cognitive, autonomic fns
2. Bmood, anxiety, sleep
3. Ctuberoinfundibular
4. Dprolactin
5. Emesolimbic
6. 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.
1. AGeneralised
2. BPanic
3. CSocial
4. DCBT
5. ESSRIs and SNRIs
6. 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
1. Acommon
2. Bcare
3. Chalf
4. Dquarter
5. Ewomen
6. Fmen
7. G25 - 54
8. Hsecond
9. 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]
1. A12
2. B32
3. C24
4. 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.
1. Aemotional
2. Bcoping strategies
3. CGroup or solo
4. 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]
1. Atrained
2. Bcost and access
3. Cconducted or paced
4. Ddistressing
5. EEFFORT and PERSEVERANCE
6. Fexposure
7. Ginitially
8. Hantidepressants
8Experiencing stress especially early in life can induce sensitization and risk of psychiatric illness.
1. ATrue
2. BFalse
9Below are a list of anxiety symptoms. Select ALL that overlap with depression symptoms.
1. ASleep issues
2. BConcentration issues
3. CFatigue
4. DPsychomotor arousal (restlessness)
5. EAnxiety
6. FIrritability
7. GPanic attacks
8. HMuscle tension
9. ICompulsion
10Comorbidity of anxiety and depression is common and increases severity of both, also increasing recovery or preventing it.
1. ATrue
2. BFalse

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
1. Aconcentrating
2. Barousal
3. C6 months
4. Dspontaneous
5. E1 month
6. Fconcern
7. Gbehavior
8. Habdominal and/or chest
9. Ichills or heat
10. 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]
1. Astimulant
2. BOTC
3. Calcohol or benzo
4. Dcaffeine
5. Ehyper
6. Farrythmias
7. Ghypo
8. HPE, menopause, Cushings
9. Iglycaemia
13Which of these is not a symptom of social anxiety disorder?
1. ASweating
2. BTachycardia
3. CFlushing (face, neck)
4. DDiarrhoea
5. EConstipation
14Most people with social anxiety develop another concurrent mood, anxiety, or substance use disorder.
1. ATrue
2. BFalse
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.
1. Aseverity
2. Bthoughts
3. Cimages
4. Durges
5. Eactivities
6. Fmental acts
7. GInsight
8. 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
1. Aamygdala, ACC and OFC
2. Bamygdala
3. Ccortico-striatal-thalamic-cortical
4. Dthalamus and striatum
5. Eperiaqueductal gray
6. FFight or flight
7. Gparabrachial nucleus
17SNRIs have a significantly longer response time in contrast to SSRIs.
1. ATrue
2. BFalse
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
1. Aserotonin reuptake inhibitors
2. Bnausea or sedation, insomnia
3. Cweight
4. Ddysfunction
5. Eanxiety
6. Ftoxicity
7. Gserotonergic input to the amygdala
8. H5-HT at synapses
9. Ireceptors
10. Jnucleus
11. Ktolerance
12. LNA and DA release
13. MGABAergic
14. NDA
15. 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
1. Aimipramine
2. BNA and/or 5-HT
3. Csedation
4. Dincoordination
5. Eantimuscarinic
6. 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]
1. Aphasic inhibitory
2. Bpost-synaptic GABA(a)
3. Cvenlafaxine
4. Dmirtazipine
5. Ebuspirone
6. Fpregabalin, gabapentin
7. Gpre-synaptic
8. Hquetiapine, olanzapine

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Description: User has deleted their subject information Quiz on PSY2 GAD and phobias, created by Deleted user on 14/10/2019.
Author: Deleted user
Language: English
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History: Created on 14 Oct 2019 · updated on 14 Oct 2019
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PSY2 GAD and phobias

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