PSY2 GAD and phobias

Affective 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].

Not 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].

Anxiety 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.

Anxiety 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

Match 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]

Cognitive 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.

CBT 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]

Experiencing stress especially early in life can induce sensitization and risk of psychiatric illness.

Below are a list of anxiety symptoms. Select ALL that overlap with depression symptoms.

Comorbidity of anxiety and depression is common and increases severity of both, also increasing recovery or preventing it.

GAD 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

Common 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]

Which of these is not a symptom of social anxiety disorder?

Most people with social anxiety develop another concurrent mood, anxiety, or substance use disorder.

Obsessive 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.

Pathology: - 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

SNRIs have a significantly longer response time in contrast to SSRIs.

Selective [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

Tricyclic 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

Other 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]