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{{WBRQuestion
{{WBRQuestion
|QuestionAuthor={{Rim}}
|QuestionAuthor= {{Rim}} (Reviewed by Serge Korjian)
|ExamType=USMLE Step 1
|ExamType=USMLE Step 1
|MainCategory=Pathophysiology
|MainCategory=Pathophysiology
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|MainCategory=Pathophysiology
|MainCategory=Pathophysiology
|SubCategory=Neurology
|SubCategory=Neurology
|MainCategory=Pathophysiology
|MainCategory=Pathophysiology
|MainCategory=Pathophysiology
|MainCategory=Pathophysiology
|MainCategory=Pathophysiology
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|MainCategory=Pathophysiology
|MainCategory=Pathophysiology
|SubCategory=Neurology
|SubCategory=Neurology
|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?  
|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.
|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.
|AnswerA=Decrease in norepinephrine
|AnswerA=Decrease in norepinephrine
|AnswerAExp=[[Norepinephrine]] is synthesized in the locus ceruleus and is increased in [[anxiety]] but not in [[anxiety]].
|AnswerAExp=[[Norepinephrine]] is synthesized in the locus ceruleus and is increased in [[anxiety]].
|AnswerB=Increase in GABA
|AnswerB=Increase in GABA
|AnswerBExp=GABA is synthesized in the nucleus accumbens and is decreased in anxiety.
|AnswerBExp=GABA is synthesized in the nucleus accumbens and is decreased in anxiety.
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|AnswerE=Increase in acetylcholine
|AnswerE=Increase in acetylcholine
|AnswerEExp=[[Acetylcholine]] is increased in [[Huntington's disease]] but not in [[anxiety]].
|AnswerEExp=[[Acetylcholine]] is increased in [[Huntington's disease]] but not in [[anxiety]].
|Approved=No
|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
}}
}}

Latest revision as of 01:11, 28 October 2020
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::
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