View source for WBR0615

 {{WBRQuestion
|QuestionAuthor= {{Rim}} (Reviewed by Serge Korjian)
|ExamType=USMLE Step 1
|MainCategory=Pathophysiology
|SubCategory=Neurology
|MainCategory=Pathophysiology
|SubCategory=Neurology
|MainCategory=Pathophysiology
|SubCategory=Neurology
|MainCategory=Pathophysiology
|MainCategory=Pathophysiology
|MainCategory=Pathophysiology
|SubCategory=Neurology
|MainCategory=Pathophysiology
|SubCategory=Neurology
|MainCategory=Pathophysiology
|SubCategory=Neurology
|MainCategory=Pathophysiology
|SubCategory=Neurology
|MainCategory=Pathophysiology
|MainCategory=Pathophysiology
|SubCategory=Neurology
|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?
|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.
|AnswerA=Decrease in norepinephrine
|AnswerAExp=[[Norepinephrine]] is synthesized in the locus ceruleus and is increased in [[anxiety]].
|AnswerB=Increase in GABA
|AnswerBExp=GABA is synthesized in the nucleus accumbens and is decreased in anxiety.
|AnswerC=Decrease in GABA
|AnswerCExp=GABA is synthesized in the nucleus accumbens and is decreased in anxiety.
|AnswerD=Decrease in acetylcholine
|AnswerDExp=[[Acetylcholine]] is synthesized in the basal nucleus of Meynert and is decreased in [[Alzheimer]] but not in [[anxiety]].
|AnswerE=Increase in acetylcholine
|AnswerEExp=[[Acetylcholine]] is increased in [[Huntington's disease]] but not in [[anxiety]].
|EducationalObjectives=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.
|RightAnswer=C
|WBRKeyword=GABA, Anxiety, Generalized anxiety disorder, Epinephrine, Norepinephrine, Acetylcholine, 
|Approved=Yes
}}