Neurobiology and Psychopharamcology distinct symptoms of anxiety

Reply to each post with 1-2 paragraphs including references 

Post1: Tvine  

Neurobiology of Post-Traumatic Stress Disorder

Posttraumatic Stress Disorder (PTSD) can be defined as a mental health condition developed after experiencing a traumatic event(s). The analysis of the neurobiology of PTSD comprises a complex interaction between neurotransmitters, brain regions, and the stress response system. Neurobiology explains how neurotransmitters play an extensive role in the development and maintenance of PTSD as discussed below.

Serotonin (5-HT): The prevalence of reduced levels of serotonin is common among individuals with symptoms of impulsivity, mood disturbances, and aggression. Also, serotonin is intricated in the regulation of sleep, mood, and emotional responses some of the core factors influencing PTSD (Cutler et al., 2023).

Norepinephrine (NE): High levels of norepinephrine are common when individuals experience traumatic experiences leading to an overactivation of the sympathetic nervous system. The heightened noradrenergic activity leads to increased vigilance, hyperarousal, and flashbacks which are characteristics of PTSD.

Glutamate: The experience of traumatic events leads to an imbalance between inhibitory and excitatory neurotransmissions. The result affects emotional processing and memory consolidation which exacerbate the prevalence of PTSD in an individual.

• Gamma-Aminobutyric Acid (GABA): GABA constitutes the primary inhibitor neurotransmitter in the brain. A decrease in GABA activity contributes to symptoms of anxiety and hyperarousal which are common in PTSD individuals (Hinton & Johnston, 2018). Furthermore, GABA plays an integral role in the moderation of stress responses.

Patient Presentation

• The severity and duration of the prevalence of PTSD symptoms may vary and impact the daily functioning of individuals differently. The most common symptoms presented by individuals with PTSD include experiences of flashbacks, irritability, intrusive memories, avoidance of reminders, nightmares, sleep disturbances, hypervigilance, and difficulty concentrating.

Evidence-Based Treatment

• The treatment of PTSD often involves plans that are individualized to increase the efficiency in dealing with the specific needs and preferences of the patient. A consideration of a comprehensive and multidisciplinary approach is fundamental to enhance the collaboration between physicians, mental health professionals, and support networks that respectively play an integral role in resolving PTSD issues and optimizing the outcomes. Some of the common evidence-based treatment plans consist of pharmacotherapy which includes the use of antidepressant medications such as selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) (Watkins et al., 2018). Cognitive-behavioral therapy (CBT) comprises a trauma-focused CBT that aids in confronting and processing traumatic memories in a controlled and safe approach. The use of Eye Movement Desensitization and Reprocessing (EMDR) is a common therapeutic approach that has been used to help individuals effectively process and integrate distressing experiences through bilateral simulation of traumatic memories.

Post 2: Jarrod

• Anxiety can be broken down into two core symptoms of fear and worry (Stahl, 2013). Many suffering from an anxiety disorder will have the core symptoms along with increased arousal, fatigue, difficulty concentrating, sleep problems, irritability, and muscle tension (Stahl, 2013). Anxiety and fear symptoms are regulated by an amygdala-centered circuit. Symptoms of worry are associated with malfunctioning of cortico-striato-thalamo-cortical (CSTC) loops, which are regulated by serotonin, GABA, dopamine, norepinephrine glutamate, and voltage-gated ion channels (Stahl, 2013). Specifically for Generalized anxiety disorder (GAD), malfunctioning in the amygdala and CSTC worry loops may be more persistent and consistent, yet not as severe and less persistent in comparison to other anxiety disorders such as panic disorder where the fear is more intense yet less consistent (Stahl, 2013). Patients with GAD will have a lot of the same symptoms as other anxiety disorders such as fear, worry, increased arousal, fatigue, difficulty concentrating, sleep problems, irritability, and muscle tension. For GAD the symptoms of worry or fear will be more consistent and often less severe than other disorders. Patients will present as anxious, having a consistent worrying and/or fearful feeling but are unable to determine a cause.  They may have difficulty concentrating, sleeping, and become easily irritable.

The treatment for GAD overlap greatly with those for other anxiety disorders (Stahl, 2013). Along with cognitive behavioral therapy (CBT) first-line medications include SSRIs and SNRIs, benzodiazepines, buspirone, pregabalin, and gabapentin (Stahl, 2013). Due to the possibility of dependence, abuse, and withdrawal, many providers are reluctant to prescribe benzodiazepines for most anxiety disorders.  Where I work, providers rarely prescribe benzodiazepines at time of discharge for these reasons. This is especially true for GAD due to the long-term nature of GAD other medications should be used and benzodiazepines should only be used at the beginning of treatment due to delayed onset of action of other medications (Stahl, 2013). Second-line medications include tricyclic antidepressants (TCAs), mirtazapine, trazodone, and serotonin partial agonist/reuptake inhibitors (Stahl, 2013).

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