Affective disorders include phobias, anxiety, depression, and bipolar disorder. They affect external ❌ and internal ❌. Emotional symptoms are misery, apathy, pessimism, low ❌, loss of ❌, indecision, and more. Biological symptoms are loss of ❌, slowed ❌, ❌ disturbances, and appetite ❌.

Explanation? ❌ theory... CNS is deficient monoaminergic transmission such ie 5-HT/❌, ❌.

Not technically part of the learning objectives but it was in the lecture.....
Noradrenaline - regulates ❌
Serotonin - regulates ❌
Dopamine - does so much, just remember: the ❌ pathway controls ❌ secretion and we monitor that in some psychotic patients on meds that effect dopamine. also the ❌ pathway contols delusions and ❌.

Anxiety disorders -
1. ❌ anxiety disorder
2. ❌ disorder
3. ❌ anxiety

❌ is usually first line followed by ❌.
❌ were previously classified as anxiety disorders but are now separate.

Anxiety epidemiology:
- Specific phobias are ❌ but patients rarely seek ❌. Response rates in about ❌ of people and remission in about a ❌.
- 7.7% ❌ and 4.4% ❌ diagnosed at some point
- Highest rates in women ❌ (9%)
- Anxiety and depression are the ❌ leading cause of loss of health after coronary heart disease
- Peoplw with GAD, panic disorder, and social anxiety ❌ to experience suicidal ideation and suicide attempts

Match the condition to the median age of onset.
Social anxiety - ❌
GAD - ❌
Panic disorder - ❌
Agoraphobia (fear of going somewhere or doing something that will cause anxiety or panic) - ~ ❌

Cognitive behavioral therapy (CBT) focuses on challenging and ❌ unhelpful cognitive distortions e.g. thoughts, beliefs, attitudes, and behaviors, improving ❌ regulation, and the development of personal ❌. ❌ intervention.

CBT disadvantages
- requires ❌ expert
- ❌, especially for rural patients
- poorly ❌ CBT is ineffective and possibly ❌, leads to further CBt aversion
- requires ❌ on patient's parT
- anxiety with ❌ tasks is distressing
- can increase symptoms and distress ❌, has a similar dropout rate to ❌

GAD core symptoms: general or unexplained anxiety, worry, increased ❌, difficulty ❌. Diagnosis requires persistent symptoms most days >❌.
Panic disorder: begins as ❌ panic attack, followed by >❌ of persistent ❌ about having another attack OR maladaptive* change in ❌ related to attacks. Physical symptoms of attacks = ❌ pain, ❌ or both, dizziness, nausea, ❌, increase RR.

* maladaptive = not adjusting adequately or appropriately

Common conditions associated with panic;
- Substance induced: ❌ use(includes adverse affects of ❌ meds), ❌ withdrawal, ❌ product use
- Medical conditions
1. Commonly ❌thyroidism, ❌, seizure disorders, hypo❌
2. Less commonly ❌thyroidism, ❌

Obsessive compulsive disorders are chronic and vary in ❌. People with OCD have intense urges to perform acts which they know are senseless/excessive.
Obsessions:
- repetitive ❌ eg contaminated by germs, fear of harming other
- repetitive ❌ eg sexually explicit, violent
- repetitive ❌ eg need for symmetry or order
Compulsions:
- repetitive ❌ eg hand washing, need to ask
- repetitive ❌ eg counting excessively, silently repeating words

❌ on which behaviors are abnormal or unnecessary varies, from good all the way to absent (❌).
Diagnosis can be difficult.

Pathology:
- Anxiety and fear symptoms linked to amygdala circuit (❌ together) - specifically over-activation of the ❌
- Worry (miseries, obsessions) linked to CSTC loop (❌), over-activation of ❌
These circuits may be involved in all anxiety disorders.
- Avoidance linked to over-activation of the amygdala and ❌ (PAG). ❌ motor responvse.
- Breathing is regulated by the amygdala and ❌ (PBN)... sense of being smothered, increased RR, explains those symptoms etc

Selective ❌ (SSRIs) are a class of drugs that are typically used as antidepressants or anxiolytics.
Fluoxetine, citalopram, escitalopram, sertraline, paroxetine, etc.
Side effects: commonly ❌, ❌ changes, sexual ❌ (70% of patients, gender irrelevant), even ❌. Some of these will go away eg nausea is transient. Low ❌ risk.
MoA: increased serotonergic acitivity/agents* enhances ❌, alleviating over-activation and anxiety. *Increased ❌. Post-synaptic ❌ send signal to post-synaptic cell ❌ to desensitize receptors. Time course to desensitization correlates with onset of ❌.

SSRIs vary a little...
- Fluoxetine also facilitates ❌by acting on 5-HT Rs on ❌ neurons
- Sertraline has effects on adrenergic receptors and ❌ reuptake inhibition
- Citalopram has an R enantionmer with weak ❌ properties

Tricyclic antidepressants (TCAs)
- Clomipramine, ❌ - for panic
- 2nd/3rd line
- Inhibit ❌ reuptake
- UEs: ❌ and confusion, motor ❌, ❌ - blurred vision, dry mouth, urinary retention, cardiotoxic - ❌
- More drug interactions than SSRIs

Other anxiolytics:

Benzodiazepines - alleviate anxiety by enhancing ❌ actions at ❌ receptors int he amygdala.

SNRIs - ❌

Alpha-2 agonist (affects NA and 5-HT) - ❌

5-HT(1a) agonist - ❌

Alpha-2-gamma ligands - ❌ - bind to ❌ receptors to block glutamate release

Atypical anti psychotics - ❌