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. Educational Objective: References: ]]
Approved	Approved::No
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