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184 Cards in this Set
- Front
- Back
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What is the difference between fear and anxiety? |
Fear has an identifiable source, anxiety is just overall worry |
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What do people with anxiety worry about? |
Potential outcomes, very vague, |
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Which is a more sever physiological insult to the CNS fear or anxiety? |
anxiety |
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How does most anxiety manifest itself? |
feelings of concern or worry and anticipation of negative outcomes |
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What are the responses of the body to anxiety? |
restlessness, impaired concentration, sleep disturbances, irritability, appetite disruptions |
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Is all anxiety bad? Explain |
no, moderate levels of anxiety can drive positive behavior such as productivity |
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What do anxiety and evolution have to do with each other? |
it was selected for evolutionarily, meaning humans are prone to be uptight |
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What is anxiety important evolutionarily to survival? |
1. warns of danger 2. activates the fight-or-flight response 3. enabling us to cope with impending emergencies |
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How is the fight or flight response not helpful in modern life? |
Too much anxiety in non-threatening situations like when making a speech or taking an exam |
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How is preparedness beneficial? |
It keeps people and animals alive |
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Why is anxiety selected for? |
More likely to survive and be cautious and aware |
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Anxiety in small doses is clearly a necessary stimulus for what |
optimum performance in many everyday situations (ex: studying a lot before exams because you are worried about doing well) |
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When anxiety increases beyond a certain level, what happens to performance? |
it deteriorates noticeably (excess anxiety inhibits behavior) |
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Who invented the inverted U theory? |
Hans-Seyle |
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What is the inverted u theory? |
Past some threshold performance decreases |
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What are the axis of the inverted U theory? |
Performance on the Y and stress on the X (looks like a U) |
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What are the three main parts of the three-component model of anxiety? |
1. Potential Stressors 2. Bodily effects/ upsetting thoughts 3. Ineffective behavior |
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What are potential stressors? |
Failures, time pressures, personal issues, insults, frightening events |
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What are some examples of some bodily effects? |
Autonomic emergency response, shallow breathing, pounding heart, tense muscles, digestive problems, sleep disturbances, fatigue, psychotic illness |
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What are examples of upsetting thoughts? |
Anger, fear, preoccupation, doubts, negative self-talk, repeated danger thoughts, worry about body reaction and health |
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What are some examples of ineffective behavior? |
escape, avoidance, indecision, aggression, inflexible responses, poor judgement, inefficiency, drug use |
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Do physical symptoms and thought patterns affect each other? |
yes, you can treat one and affect the other in both cases |
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The steps of the three-component model of anxiety |
Potential stressors--> stressors perceived as a threat--> Bodily effects and/or upsetting thoughts--> ineffective behavior |
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What is a major component of several emotion processing circuits? |
amygdala |
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What does the amygdala do with the senses? |
receives input with all five senses and has reciprocal communication with frontal lobe |
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What two types of highly processed information does the amygdala receive? |
1. sensory 2. cognitive |
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What does amygdala mean? |
Almond |
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What exactly is the amygdala? |
cluster of 12 nuclei and biggest one looks like an almond |
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Does the amygdala look like an almond? |
sort of--> the biggest one actually looks like almond |
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What is the broad job of the amygdala? |
coordinate all the of the sensory and cognitive info and send outputs to different brain regions |
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The amygdala coordinates what? |
Components of emotion |
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What comes from the amygdala? |
Conditioned fear and anxiety-provoking stimuli |
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Where is the amygdala located? |
just above the roof of the mouth and back very central |
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What is an experiment that shows how valuable the central amygdala is? |
Playing a tone and then conditioning the animal to be scared because you give them a shock. If you block the amygdala you do not get nervous |
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What happens if you activate GABA A receptors? |
inhibit the nucleus of the amygdala |
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What are the brain areas that the amygdala goes to? |
lateral hypothalamus, dorsal motor nucleus of Vagus, parabrachial nucleus, VTA, LC, PPN, Nucleus reticularis, periaqueductal gray, trigeminal and facial nuclei, paraventricular nucleus of hypothalamus |
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The amygdala orchestrates the components of what emotion? |
fear |
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What are the components of fear? |
1. sympathetic nervous system activation 2. enhanced reflexes 3. increased vigilance 4. activation of the HPA axis etc. |
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What is the HPA axis? |
hypothalamic-pituitary-adrenal axis |
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What is the HPA also called? |
The stress hormone system |
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What is the neurotransmitter that is the output of the central nucleus of the amygdala? |
NE |
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Where is NE from? |
the adrenal glands |
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Where is NE from? |
The adrenal glands |
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What does the NE from the adrenal glands do? |
Activates sympathetic |
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What does CRF stand for? |
Corticotropin-releasing factor |
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Where is CRF released from? |
the hypothalamus |
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What is CRF released in response to? |
stress |
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What does the CRF release cause? |
the release of ACTH |
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What does ACTH mean? |
adrenocorticotropic hormone |
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From where is ACTH released? |
Anterior pituitary |
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What is the pathway for anxiety? |
Hypothalamus, pituitary, adrenal gland |
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If you block the pathway you can |
block anxiety |
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What are glucocorticoids? |
The stress hormones |
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What do glucocorticoids do? |
Induce physiological changes that provide the means to adapt to environmental challenges |
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What is an example of a glucocorticoid? |
cortisol |
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Where does NE come from? |
The adrenal gland |
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What causes the release of NE? |
nerves |
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What does the release of NE from the adrenal gland stimulate? |
The peripheral effects of sympathetic nervous system activation |
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Can NE cross the BBB? |
NO |
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T or F: CRF can act as a neurotransmitter in multiple brain areas associated with anxiety |
True |
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What does CRF act alone as in the brain to do? |
to promote the lack of stress |
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What is the first hormone that gets activatd when the amygdala is over stimulated? |
CRF |
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What does CRF cause? |
The behavioral signs of anxiety as well as altered sympathetic nervous system function |
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Where do CRF neurons originate? |
in the amygdala central nucleus |
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Where do the CRF neurons originating in the amygdala project to? |
The locus coeruleus (LC) |
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What do the CRF neurons activate? |
The adrenergic component of the stress response |
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What activates CRF1 receptors? |
CRF |
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What does activating the CRF 1 receptors do? |
causes NE release |
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Where is NE made? |
Locus Coreleus |
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Why is CRF sent to the LC? |
To cause release of NE in CNS |
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What does a high concentration of NE release mean? |
Cognitive vigilance |
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the LC is a major cluster of what type of cells? |
Noradrenergic cells |
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What does the NE in the LC cause? |
focused attention, formation of emotional memories, subjective effect of nervousness |
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Where is the LC? |
near top of brain stem in the back portion |
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What does the GABA A receptor have? |
a chloride channel |
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What happens when you activate the GABA A receptor? |
Chloride channels hyper polarize the membrane |
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What do BDZ and Barbiturates cause? |
Sedation and reduced anxiety by binding to allosteric sites on the receptor complex |
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Which is safer barbiturates or BDZ? |
benzodiazepines |
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Why are barbiturates so unsafe? |
they are too good at activating GABA A, so they just shut down everything |
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What is Valium used to treat? |
Seizures |
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What do general depressants do? |
Reduce anxiety and inhibit the central amygdala |
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How do BDZs work? |
dont activate GABA A, they help it be better and work allosterically |
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Where does the picture make it look like GABA is present? |
on the outer edges |
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What have animal studies found the natural differences in anxiety levels are correlated with? |
The number of BDZ binding sites in several brain areas |
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What do PET scans of patients with panic disorders show? |
Less benzodiazepine binding (less GABA A) in the CNS |
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Where was the decrease in benzodiazepine binding particularly apparent? |
in the Frontal lobes |
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T or F: Some people have an inherent risk for having higher anxiety levels |
True |
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There are lower levels of _________ receptors in people with panic disorders |
GABA A |
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Why does less GABA A most likely correlate with anxiety levels? |
less inhibitory so the amygdala is overactive |
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Reduced BDZ binding sites may result in what |
The failure of GABA inhibition |
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What does the failure of GABA inhibition lead to? |
uncontrolled panic attacks, phobias, generalized anxiety, and the hyperarousal of PTSD |
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What other drug is GABA A also a target for? |
Alcohol |
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What neurotransmitter plays a large role in anxiety modulation? |
Serotonin |
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What is serotonin also called? |
5-HT |
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What does 5-HT stand for? |
5-hydroxytryptamine |
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What is a way to reduce anxiety using 5-HT function? |
enhancing 5-Ht function by blocking reuptake transporter or stimulating 5-HT(1A) receptors reduces anxiety |
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What do SSRIs do? |
Enhance 5-HT function |
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What are SSRIs used to treat? |
A variety of anxiety disorders |
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Stimulating serotonin is a __________ way to ease anxiety |
reasonably effective |
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What medicine is a moderate way to was anxiety? |
Zoloft |
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T or F: severe cases of anxiety respond well to SSRIs |
False |
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T or F: Benzodiazepines are non addictive |
False, they are addictive |
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How is a genetic predisposition for panic well-documented? |
A high concordance rate in monozygotic twins |
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Anxiety has what type of risk? |
Inheritable |
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How does environment make a difference in development of an anxiety disorder? |
Some may have genetic risk but if they live a great life they may not feel anxiety |
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Environment is more like a ____________ |
trigger |
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Which is more important environment or genetics? |
Environment |
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what is the concordance rate for anxiety? |
25% |
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What are the types of disorders that are grouped together? |
1. Generalized anxiety disorder 2. Panic Attacks 3. OCD 4. Phobias 5. PTSD |
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Is GAD well-known to be heritable? |
yes |
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Are panic attacks well-known to be heritable? |
Yes, most severe heritability |
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Is OCD well-known to be heritable? |
yes |
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What do phobias require? |
Specific Stimuli |
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Each group does what with different types of drugs? |
Responds differently |
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Phobias can usually be treated with what? |
Behavioral desensitization |
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What is behavioral desensitization? |
Presenting the fear-inducing stimulus in gradual increments, allowing the individual to maintain a relaxed state while confronting the source fear |
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What does a more contemporary version of behavioral desensitization utilize? |
exposure therapy in a virtual reality setting |
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Why is the contemporary version of behavioral desensitization not widely utilized? |
Too expensive. Also, most people want a drug |
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What are drugs that relieved anxiety called? |
anxiolytics (reduces anxiety) |
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What are sedative-hypnotic drugs? |
CNS depressants |
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What can sedative-hypnotic drugs do? |
sedate you |
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What are some examples of sedative-hypnotic drugs? |
Barbiturates and benzodaizepines and alcohol |
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Which sedative-hypnotic is not technically used in a hospital setting? |
Alcohol |
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What do benzodiazepines, barbiturates, and alcohol all do to neuronal excitability? |
reduce neuronal excitability |
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What is the primary mechanism of action for drugs that reduce anxiety? |
Involves enhancing GABA transmission |
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T or F: BDZ are allosteric |
yes |
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What are the four examples of BDZ agonists? |
Midazolam, Clonazepam, Flunitrazepam, Diazepam |
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What is the order of the most modulation of GABA-induced chloride (Cl-) flux? |
Diazepam, Flunitrazepam, Clonazepam, Midazolam |
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What do anxiolytics often produce? (moderate doses) |
Calm and relaxed state |
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What do anxiolytics produce at higher doses? |
drowsiness, mental clouding, and incoordination |
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What do anxiolytics sometimes induce at high doses? |
Sleep |
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What are anxiolytics that induce sleep called? |
Hypnotics |
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What do CNS depressants cause at really high doses? |
Coma and death |
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What is the spectrum of decreasing consciousness as the drug increases? |
Alertness, relief from anxiety, sedation, sleep, general anesthesia, coma and Death |
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Where should drugs stop? |
Relief from anxiety |
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What does anxiety have a comorbidity with? |
depression |
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What do BDZs do? |
Enhance the effect of GABA |
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What do BDZs do in the absence of GABA? |
They have no effect on channel opening |
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What is the BDZ effect of enhancing GABA but having no effect in its absence? |
Allosteric Activation |
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T or F: BDZs have a low therapeutic index |
False, High therapeutic index |
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What do high doses of BDZs produce? |
Disorientation, cognitive impairment, and amnesia but no respiratory depression |
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Do BDZs cause dependency? |
Yes |
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BDZs have a drug interaction with what? |
Alcohol |
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What can happen when you drink alcohol with BDZs? |
the risk of coma and death because of the additive effect |
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Do BDZs induce liver enzymes? |
NO |
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What do BDZs result in? |
Less tolerance because they do not induce liver enzymes |
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T or F: Barbiturates decrease the affinity of the GABAa receptor for GABA |
False, Increase |
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What can barbiturates do at high doses? |
They can open the Cl- channel without GABA |
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Which one is potentially lethal, barbiturates of benzodiazepines? |
Barbiturates |
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Benzodiazepines have essentially replaced what in the treatment of anxiety disorders? |
Barbiturates (not used anymore because they are lethal) |
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Why were second-generation anxiolytics developed? |
To have fewer side effects than BDZs |
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What is BuSpar or Buspirone less effective in reducing, the physical symptoms or anxiety or the cognitive aspects of worry and poor concentration? |
Less effective in reducing the physical symptoms |
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Are SSRIs super effective at helping anxiety? |
Not really, especially in comparison to Benzos. SSRIs are better at reducing constant thought patterns and cognitive aspects and not good with panic disorders |
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What are the pharmacodynamics of Buspirone? |
At least 9 different receptors |
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Buspirone is an example of what? |
A second generation anxuiolytic |
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What are the advantages of buspirone? (4) |
1. Treats depression that often accompanies anxiety 2. Anxiety reduction is not accompanied by sedation, confusion, or mental clouding. 3. Does not enhance CNS-depressant effects of alcohol or other CNS depressants 4. Not a sedative |
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Buspirone has ________ potential for recreational use or dependance. |
Little or no |
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Has there been a withdrawal symptom associated with buspirone? |
None has been reported |
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What is the onset of buspirone effectiveness in humans? |
Quite long |
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What is the effectiveness of buspirone in comparison to the BDZs? |
It is less effective at relieving anxiety than BDZs are |
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For what situation are buspirones not super effective for because of their delayed onset? |
It is less useful for patients who take the drug only when needed for situation anxiety |
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For which receptors is buspirone an agonist? |
5HT (1A), 5HT (2a), 5HT (2B), (5HT, 2C), and alpha 1 and alpha (1D) |
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What are the alpha receptors? |
Adrenergic receptors |
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What are 5Ht receptors? |
Serotonin |
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For what receptors is buspirone an Antagonist? |
D2, D3, and D4 |
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What are D receptors for? |
Dopamine |
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Both anxiety and depression can be treated by what? |
Antidepressants |
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What two things or diseases often occur together? Percentage that have both |
Depression and anxiety (50-60%) |
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Different types of anxiety respond _________ to certain drugs |
Better or worse (differently) |
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What are the trade names of benzodiazepines? |
Valium, Xanax |
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What anxiety disorders work well with benzodiepines? |
GAD, PTSD, panic disorder |
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What are the trade names of tricyclic antidepressants? |
Tofranil, Aventil |
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What are tricyclic antidepressants good at treating? |
Panic disorder, GAD, OCD, PTSD |
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What are the trade names of MAOs? |
Nardil, Parnate |
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What are MAOs good at fixing? |
Social phobia, panic disorders |
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What are trade names of SSRIs? |
Prozac, Zoloft, Paxil |
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What are the anxiety disorders that SSRIs are particularly good at treating? |
Social Phobia, Panic disorder, OCD, PTSD |
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What is the trade name of Buspirone? |
Buspar |
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What are Buspirones particularly good at treating? |
GAD, Panic disorder, OCD |
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What are the first-line of defense usually for anxiety and why? |
SSRIs because they have fewer troubling sid effects |
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What are the positive aspects of SSRIs |
1. Few side effects 2. High therapeutic index 3. Low abuse potential |
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What is the plan of attack for anxiety? |
try 3-4 SSRIs before low doses of BDZ |
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Why would you start to immediately treat anxiety with a BDZ? |
if it is super debilitating |
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SSRIs on cause what? |
Physical Dependence but not a lot of mental dependence symptoms but you do vomit |
