WBR0615
| Author | [[PageAuthor::Rim Halaby, M.D. [1]]] |
|---|---|
| Exam Type | ExamType::USMLE Step 1 |
| Main Category | MainCategory::Pathophysiology |
| Sub Category | SubCategory::Neurology |
| Prompt | [[Prompt::A 23 year old female is complaining of excessive worrying and inability to sleep. She is constantly worried throughout the day about issues related to work and family and even minor things that are unlikely to happen. She has difficulty concentrating at work as she is always thinking whether her son is safe at school. The patient tells you that one day she went crazy because her husband was late for dinner and she was very worried he had an accident. She is unable to sleep at night and feels tired all day long. Based on the history of the patient, which of the following changes in neurotransmitters is most likely present?]] |
| Answer A | AnswerA::Decrease in norepinephrine |
| Answer A Explanation | [[AnswerAExp::Norepinephrine is synthesized in the locus ceruleus and is increased in anxiety but not in anxiety.]] |
| Answer B | AnswerB::Increase in GABA |
| Answer B Explanation | AnswerBExp::GABA is synthesized in the nucleus accumbens and is decreased in anxiety. |
| Answer C | AnswerC::Decrease in GABA |
| Answer C Explanation | AnswerCExp::GABA is synthesized in the nucleus accumbens and is decreased in anxiety. |
| Answer D | AnswerD::Decrease in acetylcholine |
| Answer D Explanation | [[AnswerDExp::Acetylcholine is synthesized in the basal nucleus of Meynert and is decreased in Alzheimer but not in anxiety.]] |
| Answer E | AnswerE::Increase in acetylcholine |
| Answer E Explanation | [[AnswerEExp::Acetylcholine is increased in Huntington's disease but not in anxiety.]] |
| Right Answer | RightAnswer:: |
| Explanation | [[Explanation::The patient presents with symptoms of excessive worrying, lack of sleep, decreased concentration and fatigue impairing her daily activities which are all suggestive of an anxiety disorder. The neurotransmitters that play a role in anxiety are GABA, norepinephrine, serotonin and epinephrine. In anxiety, norepinephrine and epinephrine levels are elevated while GABA and serotonin levels are decreased.
Educational objective: GABA is decreased in anxiety disorders. Reference:
Lydiard RB. The role of GABA in anxiety disorders. J Clin Psychiatry. 2003;64 Suppl 3:21-7. |
| Approved | Approved::No |
| Keyword | |
| Linked Question | Linked:: |
| Order in Linked Questions | LinkedOrder:: |