Anxiolytic & Hypnotic

agents

Presented by:
Tocpel, S.
 Anxiolytic agents
• Anti-anxiety drugs
• Medication that is prescribed to treat anxiety
and anxiety disorders.
• It’s effect is in contrast to anxiogenic agents,
which increase anxiety.
 Anxiety
• A mood condition that is related to situations or events
that a person feels unable to cope with.
• Anxiety is a common human experience that may be a
reaction to an external threat or an inner conflict. It
comprises a powerful emotional component associated
with fearful thoughts and a physiological response.
• Although potentially it has beneficial effects of
enhancing performance through a 'fight or flight'
response, in some cases anxiety may also cause
significant distress and profound negative effects on
behaviour. In these cases anxiety is pathological.
 Manifestations of Anxiety
• Verbal complaints. The patient says he/she is
anxious, nervous, edgy.
• Somatic and autonomic effects. The patient is
restless & agitated, has tachycardia, increased
sweating, weeping & often gastrointestinal
disorders.
• Social effects. Interference with normal
productive activities.
 Pathological Anxiety
• Manifestations
 Severity. Intense fear response compared to actual danger
 Autonomy. Anxiety ‘has a life of it’s own’
 Changed behaviors. Due to anxiety
 Duration. Continues after the acute stressor.
• Types
 'Primary' pathological anxiety arises where the anxiety is
the primary problem
 'Secondary' pathological anxiety can also be a feature of
every major psychiatric syndrome, due to a disturbance in
mood or thinking.
 Anxiety Disorders
• Generalized anxiety disorder (GAD)
 Excessive worry about various things for at least 6
months
 Anxiety is difficult to control
 Accompanying somatic symptoms (effects of chronic
tension)
• Obsessive Compulsive Disorder (OCD)
 Presence of obsessions (thoughts) or compulsions
(behaviours)
 Symptoms are felt by patient to be unreasonable or
excessive
• Panic disorder
 Severe fear or discomfort peaking within 10
minutes
 Characteristic physical / psychological symptoms
 Episodes are recurrent and some are unexpected
 Anxiety about further attacks or consequences of
attacks
• Social anxiety Disorder
 Recurrent fears of social or performance
situations
 Situations avoided or endured with distress
 Clinically important distress or impairment of
functioning
• Post traumatic stress disorder (PTSD)
Severe traumatic event that threatened death
or serious harm
Felt intense fear, horror or helplessness
Repeated reliving experiences
Phobic avoidance of trauma-related stimuli
Hyperarousal
Symptoms last 1 month and cause clinically
important distress or impairment of
functioning
 Anatomy
• The brain amygdala appears key in modulating
fear and anxiety. Patients with anxiety
disorders often show heightened amygdala
response to anxiety cues.
• Hyper responsiveness of the amygdala may
relate to reduced activation thresholds when
responding to perceived social threat.
 Pathophysiology
• In the central nervous system (CNS), the major
mediators of the symptoms of anxiety
disorders appear to be norepinephrine,
serotonin, dopamine, and gamma-
aminobutyric acid (GABA). Other
neurotransmitters and peptides, such as
corticotropin-releasing factor, may be
involved. Peripherally, the autonomic nervous
system, especially the sympathetic nervous
system, mediates many of the symptoms.
• Positron emission tomography (PET) scanning
has demonstrated increased flow in the right
parahippocampal region and reduced
serotonin type 1A receptor binding in the
anterior and posterior cingulate and raphe of
patients with panic disorder. MRI has
demonstrated smaller temporal lobe volume
despite normal hippocampal volume in these
patients. The CSF in studies in humans shows
elevated levels of orexin, also known as
hypocretin, which is thought to play an
important role in the pathogenesis of panic in
rat models.