5- Neurotransmission

Question 1

What is anxiety

Answer 1

A feeling of fear or dread when there is no ‘reasonable’ external cause for anxiety, and fear otherwise.

Question 2

Clinical anxiety refers to

Answer 2

Anxiety which is ‘pathological’, interfering with other activities and priorities.

Question 3

Symptoms of anxiety

Answer 3

• Phobia
• Panic
• Anxious misery
• Apprehensive expectation
• Obsessions

Question 4

Drug Treatment of Anxiety

Answer 4

• Barbiturates
• Benzodiazepines
• Selective serotonin reuptake inhibitors

Question 5

Selective serotonin reuptake inhibitors

Answer 5

• First line pharmacological treatment (NICE guidelines 2011)
• Used for general Anxiety disorder (GAD)
• They do have a delayed onset of action.

Question 6

Benzodiazepines

Answer 6

• Evidence for a specific anxiolytic effect
• They are substantially safer than barbiturates in overdose
• Used for a number of other clinical conditions
• Initially thought not to induce dependence however there seems to be an issue
• e.g. Valium

Question 7

Barbiturates

Answer 7

• have a low therapeutic index
• Act in a relatively non-specific way
• Induce tolerance and dependence
• Clinical use for anxiety ceased in the 1960’s.

Question 8

A ‘disease-centred’ model for anxiety believes

Answer 8

A drug restores the brain to normal function

Question 9

A ‘symptom-centred’ model for anxiety believes

Answer 9

Drugs produce specific changes in aspects of mood, motivation and cognition that make a condition, such as clinical anxiety, less disabling
No assumption drugs ‘reverse’ brain to normal

Question 10

Depolarisation will lead to

Answer 10

GABA release, which will act at the postsynaptic GABA receptors and then be transported back into the presynaptic terminal

Question 11

What do benzodiazepines do

Answer 11

Enhances the effect of GABA but has ‘no’ effect by itself.

Question 12

The alpha GABA receptor also has (separate) binding sites for

Answer 12

Alcohol and barbiturates

Question 13

How many subunits in the alpha GABA receptors are there

Answer 13

5 separate subunits - each is a protein and coded by a different gene

Question 14

Benzodiazepine-sensitive alpha GABA receptors are selectively expressed higher in which brain areas

Answer 14

The hippocampus, amygdala and related structures.

Question 15

Two major classes of GABA receptor subtypes

Answer 15

• Alpha GABA (GABAA)

- Beta GABA (GABAB), a metabotrophic receptor – G-protein coupled

Question 16

Fear-relevant words produce greater activation of

Answer 16

Amygdala

Question 17

Outputs from the amygdala can modulate different aspects of fear including

Answer 17

• Autonomic symptoms
• Hormonal changes
• Processing of fear-related stimuli

Question 18

How do those with damage to the amygdala react to fear

Answer 18

Their experience of fear and panic was as great as in the controls who also experienced a panic attack

Question 19

Complex neural loops run between cortex, striatum and thalamus (CSTC loops) and are responsible for

Answer 19

Modulation of motor output and cognition

Question 20

Which loop may be responsible for worry and anxiety

Answer 20

Dorsolateral prefrontal cortex (DLFPC)

Question 21

There is overlap between GAD and

Answer 21

Major depressive disorder (MDD)

Question 22

Selective serotonin reuptake inhibitors (SSRIs) will enhance

Answer 22

Serotonergic inhibition in both amygala- and CSTC related circuits

Question 23

Noradrenergic antagonists may reduce noradrenergic inputs which

Answer 23

Can reduce autonomic components of anxiety

Question 24

Selective serotonin reuptake inhibitors do what

Answer 24

Slow the the removal of serotonin from the synaptic cleft

Question 25

Buspirone acts as a partial agonist at

Answer 25

Some types of serotonin receptor

Question 26

Noradrenaline is both

Answer 26

• A peripheral stress hormone

- A central neurotransmitter.

Question 27

The locus coeruleus (hindbrain) contains

Answer 27

• noradrenergic cell bodies that project forwards to cortex

- Sub-cortical structures including the amygdala.

Question 28

Selective chemogenetic stimulation of noradrenergic cell bodies does what

Answer 28

Delays the extinction of a simple fear response in rats

Question 29

What is propranolol

Answer 29

A noradrenergic beta receptor antagonist.