WBR0615

Author	[[PageAuthor::Rim Halaby, M.D. [1] (Reviewed by Serge Korjian)]]
Exam Type	ExamType::USMLE Step 1
Main Category	MainCategory::Pathophysiology
Sub Category	SubCategory::Neurology
Prompt	[[Prompt::A 23-year-old woman presents to the outpatient clinic with complaints of excessive worrying and inability to sleep. She is constantly anxious about issues related to work and family and has difficulty concentrating at work. The patient reports always being concerned about her son's safety at school, and cannot ignore the thoughts that her husband is in danger at his job. She is unable to sleep through the night despite improving her sleep hygiene. Which of the following neurotransmitter imbalances is most likely present in this patient?]]
Answer A	AnswerA::Decrease in norepinephrine
Answer A Explanation	[[AnswerAExp::Norepinephrine is synthesized in the locus ceruleus and is increased 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::C
Explanation	[[Explanation::The patient in this scenario is presenting with symptoms of excessive worrying, insomnia, decreased concentration and fatigue impairing her daily activities all of which are suggestive of generalized anxiety disorder. The neurotransmitters that are imbalanced in a state of anxiety are GABA, norepinephrine, serotonin and epinephrine. Classically, norepinephrine and epinephrine levels are elevated while GABA and serotonin levels are decreased. Educational Objective: GABA is decreased in anxiety disorders. References: Lydiard RB. The role of GABA in anxiety disorders. J Clin Psychiatry. 2003;64 Suppl 3:21-7.]]
Approved	Approved::Yes
Keyword	WBRKeyword::GABA, WBRKeyword::Anxiety, WBRKeyword::Generalized anxiety disorder, WBRKeyword::Epinephrine, WBRKeyword::Norepinephrine, WBRKeyword::Acetylcholine
Linked Question	Linked::
Order in Linked Questions	LinkedOrder::