Deck 17: Disorders of Anxiety and Impulsivity and the Drugs Used to Treat These Disorders

Question 1

Anxiety disorders

A) affect about 40% of Americans at some point in their lives.
B) are associated with major depression in about 35% of people.
C) include episodes of panic, phobic avoidance behaviors, and compulsive rituals.
D) are less disabling than other mental illnesses because anxiety has survival value.

Answer 1

C

Question 2

All of the following occur during anxiety except

A) stimulation of the parasympathetic nervous system.
B) sleep disturbances.
C) activation of the fight-or-flight response.
D) impaired concentration.

Answer 2

A

Question 3

Acute, relatively brief anxiety is most effectively treated with

A) tricyclic antidepressants.
B) cognitive behavior therapy.
C) benzodiazepine medications.
D) barbiturates.

Answer 3

C

Question 4

Which area of the brain coordinates the components of anxiety and other emotions?

A) Hypothalamus
B) VTA
C) Locus coeruleus
D) Amygdala

Question 5

In addition to the central nucleus of the amygdala, the _______ appears to play an important role in initiating sustained emotional responses of anxiety when danger signals are unclear.

A) hippocampus
B) bed nucleus of the stria terminalis (BNST)
C) lateral nucleus of the amygdala
D) prefrontal cortex (PFC)

Question 6

Which brain area exerts inhibitory control over the areas involved in emotions?

A) Parietal cortex
B) Prefrontal cortex
C) Limbic system
D) Temporal cortex

Question 7

Research looking into regions of the mouse hippocampus that play a role in memory encoding and retrieval showed that _______ neural activity in the _______ eliminated context-dependent fear.

A) increased; ventral dentate gyrus
B) suppression of; ventral dentate gyrus
C) increased; stria terminalis
D) suppression of; stria terminalis

Question 8

Which statement about corticotropin-releasing factor (CRF) is false?

A) CRF acts as both a hormone and a neurotransmitter.
B) Hormonal CRF activates the pituitary glands during stress.
C) CRF antagonists that reduce stress or anxiety have yet to be discovered.
D) High levels of CRF receptors are found in brain regions involved in anxiety.

Question 9

Which statement about the role of norepinephrine in anxiety is true?

A) Inhibition of the locus coeruleus can elicit alerting and fear responses in animals.
B) Abnormal sympathetic nervous system activation is a common feature of anxiety disorders.
C) Reduced norepinephrine activity can contribute to the formation of trauma memories in PTSD.
D) Some anxiety-reducing drugs work by enhancing norepinephrine pathways.

Question 10

Administration of _______ before retrieval of a traumatic memory seems to diminish the emotional aspects of the memory without affecting the memory itself, suggesting a role for these drugs in the treatment of _______.

A) a CRF antagonist; specific phobia
B) a β-blocker; PTSD
C) a benzodiazepine; PTSD
D) yohimbine; GAD

Question 11

Which of the following about the effect of anxiety-reducing drugs on locus coeruleus (LC) cell firing is true?

A) TCAs enhance norepinephrine action at inhibitory autoreceptors to reduce LC firing.
B) Benzodiazepines decrease the inhibitory effects of GABA on the cells in the LC.
C) SSRIs decrease serotonin, which inhibits LC firing.
D) Yohimbine increases serotonin and norepinephrine, resulting in a decrease in LC firing.

Question 12

Which statement regarding the role of GABA in anxiety is false?

A) The GABA drug muscimol causes anxiety.
B) Intracranial injections of benzodiazepines reduce anxiety in operant conflict tests.
C) Bicuculline enhances benzodiazepine-enhancement of behavior in the social interaction test in animals.
D) Benzodiazepine injections into the amygdala decrease the number of light-dark crossings in animals.

Question 13

Neurosteroids exert their _______ effects by _______.

A) anxiogenic; increasing LC firing
B) anxiolytic; activating the prefrontal cortex
C) anxiolytic; enhancing GABA's effect on chloride channels
D) anxiogenic; activating the hippocampus

Question 14

The research linking serotonin to anxiety is mostly based on

A) levels of serotonin turnover and metabolites in anxious individuals.
B) the fact that benzodiazepines have major effects of the serotonin system.
C) the monoamine hypothesis of anxiety, which is widely accepted.
D) the mechanism of action of anxiolytic drugs like BuSpar and the SSRIs.

Question 15

Dopamine plays a modulatory role in anxiety by apparently inhibiting _______ and thus increasing activation of the _______.

A) inhibitory control from the medial prefrontal cortex; amygdala
B) the amygdala; medial prefrontal cortex
C) the hypothalamus; sympathetic nervous system
D) the VTA; medial prefrontal cortex

Question 16

Adult mice exposed to early prenatal stress

A) show enhanced HPA axis activity in response to stress.
B) show increased methylation of the CRF promoter region in the hypothalamus.
C) have increased numbers of glucocorticoid receptors.
D) show decreased expression of CRF in the amygdala.

Question 17

The consequences of early exposure to stress include _______ and depend on both _______ and _______.

A) atrophy of the amygdala; genetics; gender
B) HPA axis response to stress; timing of stressor; gender
C) hyperactivity; age; ethnicity
D) cognitive changes; nutritional status; history of substance use

Question 18

Generalized anxiety disorder (GAD)

A) is one of the least common anxiety disorders.
B) generally starts in the teens or twenties and persists throughout life.
C) will lead to agoraphobia if untreated.
D) is genetically determined, as twin studies strongly indicate.

Question 19

Which statement about panic disorder is false?

A) The individual experiences intense parasympathetic arousal.
B) The individual feels like they are going to die or lose control.
C) The unpredictable nature of the attacks creates a feeling of anticipatory anxiety.
D) The worry of having attacks in unsafe places often leads to the development of agoraphobia.

Question 20

Which statement about phobias is true?

A) They involve fears that the person cannot recognize as extreme or irrational.
B) They do not differ among people from different cultures
C) They can be effectively treated by having the person relax while presenting the feared stimulus in gradually increasing intensities.
D) They are rarely so severe that they affect the quality of a person's life.

Question 21

Which statement about post-traumatic stress disorder (PTSD) is true?

A) It is diagnosed more frequently in men than in women
B) It is characterized by compulsive behavior done to ward off a perceived impending trauma.
C) It is characterized by nightmares and flashbacks in which people relive the traumatic event.
D) It is associated with physiological and psychological reactivity to random events.

Question 22

Which statement about OCD is true?

A) It is characterized by obsessions and compulsions.
B) It is currently considered to be the most common type of anxiety disorder.
C) People with OCD have delusional thinking and believe their fears are real.
D) Only humans and are affected by OCD; it does not occur in animals.

Question 23

Which of the following has been implicated as a risk factor or trigger in panic disorder?

A) Increased 5-HT_1A binding in the raphe
B) Breathing overly-oxygenated air
C) Injection with lactic acid
D) Injection with dopamine

Question 24

During an induced panic attack, an increase in the physiological signs of panic could be caused by _______, and increased activity of the _______ would make the person more aware of those sensations.

A) increased activity of the hippocampus; amygdala
B) decreased activity of the prefrontal cortex; sympathetic nervous system
C) increased activity of the amygdala; insula
D) increased activity of the insula; prefrontal cortex

Question 25

Which of the following may play role in a person's risk of getting PTSD?

A) Increased BDZ binding sites
B) Increased [¹¹C]flumazenil binding in cortical areas, hippocampus, and thalamus
C) Low cortisol levels associated with increased CRF and NE
D) Low levels of circulating catecholamines

Question 26

The _______ is believed to have a central role in the neurobiology associated with the characteristic repetitive and ritualistic thoughts associated with OCD.

A) substantia nigra
B) hippocampus
C) caudate nucleus
D) primary motor cortex

Question 27

Recent research showing abnormal activity in a region of the brain involved with motor output and behavioral planning of motor actions may have efficacy in the treatment of

A) phobias.
B) social anxiety.
C) PTSD.
D) OCD.

Question 28

Research shows that exposure therapy may be effective in treating _______, as evidenced by a reduction in _______ in patients post-treatment.

A) PTSD; glucocorticoid sensitivity
B) depression; cortisol levels
C) OCD; drug metabolism
D) GAD; dopamine levels

Question 29

Which of the following is not a clinical anxiety disorder recognized by the American Psychiatric Association?

A) Panic attacks
B) Obsessive-compulsive disorder
C) Phobias
D) Acute anxiety

Question 30

Which of the following is one way that benzodiazepines affect GABA at the synapse?

A) They act as GABA antagonists and produce inhibitory effects.
B) They halt inhibitory postsynaptic potentials.
C) They result in a local hyperpolarization.
D) They block the chloride ion channel.

Question 31

Anxiolytic drugs do not

A) produce relaxation along with drowsiness and poor motor coordination.
B) typically cause their effects on the CNS by increasing the transmitter dopamine.
C) include alcohol which has a very unsafe therapeutic index.
D) reduce seizures.

Question 32

While barbiturates are probably the oldest of the sedative-hypnotics, they are not currently used for anxiety/insomnia because

A) sodium amytal is the only barbiturate available.
B) they only come in short-acting forms.
C) they can be lethal, while benzodiazepines are much safer.
D) they do not help with insomnia.

Question 33

Which of the following is a side effect of the barbiturates?

A) Decreased metabolism of the drug over time
B) REM sleep rebound after withdrawal from the medication
C) Hypervigilance
D) Tolerance to the respiratory effects of the drug

Question 34

Tolerance develops to the _______ effects of barbiturates, but not to the _______ effects.

A) sedative; respiratory-depressant
B) muscle relaxant; mood
C) respiratory-depressant; hypnotic
D) reinforcing; sedative

Question 35

Which of the following is not a reason that the benzodiazepines are preferred over barbiturates?

A) They produce less sedation.
B) They have a low incidence of tolerance.
C) There is a less severe withdrawal syndrome.
D) They are more effective at reducing anxiety.

Question 36

Which of the following is an advantage that the benzodiazepines have over the barbiturates?

A) Benzodiazepines produce more metabolic tolerance than the barbiturates do.
B) Benzodiazepines have a lower therapeutic index.
C) There is an antagonist drug available to reverse the effects of benzodiazepine overdose but not barbiturate overdose.
D) Benzodiazepines can are useful as an anesthesia that produces unconsciousness.

Question 37

If individuals experience an abstinence syndrome when withdrawing from benzodiazepines, one would expect to see

A) a withdrawal syndrome that is life-threatening.
B) a milder withdrawal syndrome than one following ethanol or barbiturate withdrawal.
C) a more severe withdrawal syndrome than one following barbiturate withdrawal.
D) symptoms that include increased sleepiness and mania.

Question 38

The onset of action of benzodiazepines

A) is fairly constant, ranging from 10-20 hours.
B) is longer for drugs like Valium and Librium that have active metabolites.
C) the drug's lipid solubility.
D) is equal to the length of time it takes for phase I metabolism to occur.

Question 39

All of the following are therapeutic uses of the benzodiazepines except

A) presurgical anesthesia involving relaxation and decreased awareness.
B) treatment of insomnia.
C) muscle relaxation.
D) deep anesthesia involving loss of consciousness.

Question 40

Buspirone (BuSpar) has all of the following effects except

A) it is more effective at reducing the cognitive aspects of worry than the physical components of anxiety.
B) it is a partial agonist at the benzodiazepine receptor.
C) it does not cause sedation or confusion.
D) it is unlikely to be abused as it may cause dysphoria.

Question 41

One downside of buspirone (BuSpar) as an anxiolytic as compared to benzodiazepines is that it

A) is more addictive than benzodiazepines.
B) must be taken for a period of several weeks for effects to occur.
C) more frequently causes sedation or confusion.
D) results in muscle relaxation such that activities such as driving are limited.

Question 42

BuSpar's therapeutic effects are related to its actions on _______ receptors.

A) GABA_A
B) 5-HT_2A
C) 5-HT_1A
D) both GABA_A and GABA_B

Question 43

One significant problem with using antidepressants to relieve anxiety is that they

A) can take 4 to 6 weeks to work (such as in the case of SSRIs).
B) generally have more significant side effect profiles than other anxiolytic drugs.
C) have more abuse potential than other anxiolytic drugs.
D) are only helpful in treating anxiety in a small portion of the population.

Question 44

Which novel drug has been successful in reducing symptoms in people with OCD and PTSD?

A) Ritalin
B) Ketamine
C) Adderall
D) Modafinil

Question 45

How is it thought that low doses of psychedelics when combined with therapy work to successfully combat anxiety?

A) The psychedelic experience lowers anxiety levels and this effect lasts long after the drugs wears off.
B) The dissociative, mystic, and empathogenic effects of the drugs may allow patients to more readily identify and face underlying trauma.
C) Psychedelic drugs enhance parasympathetic nervous system activity.
D) Psychedelic drugs cause sedation and sleep, thereby lowering acute anxiety.

Question 46

Explain how anxiety can be both important and maladaptive for survival. In your answer describe the three-component model of anxiety.

Question 47

Compare and contrast fear and anxiety with respect to their triggering events and their neurobiology.

Question 48

Identify the major brain regions that are involved in anxiety. Which area plays a coordinating role? Cite evidence that shows GABA is involved in these pathways.

Question 49

Describe an animal model used to study anxiety.

Question 50

Describe the results of the experiment in which researchers examined whether activating LC-NE terminals in the BLA can cause anxiety-like behavior in mice. How is this finding relevant to future treatment of anxiety disorders?

Question 51

Describe how CRF acts as both a hormone and a neurotransmitter to coordinate the brain's response to stressors.

Question 52

Provide four pieces of evidence that suggest that norepinephrine plays a central role in the expression and treatment of anxiety disorders.

Question 53

Explain the evidence supporting a role for both genes and environment (especially exposure to early stress) in the expression of anxiety. Include physiological and behavioral findings in your answer. How are epigenetic factors involved?

Question 54

Name and describe the principal clinical anxiety disorders. For each, indicate risk factors and general treatments if known.

Question 55

Describe the incidence of PTSD and explain the relationship between occurrence of PTSD and type of trauma, genetic factors, and cortisol levels.

Question 56

Explain the effects of agonists, inverse agonists, and antagonists at the benzodiazepine site on GABA receptor function and on anxiety. How do the neuroactive steroids affect GABA receptors?

Question 57

Explain how barbiturates and benzodiazepines affect the GABA receptor complex. How does this relate to their clinical efficacy?

Question 58

Describe the general classification, characteristics, and uses of anxiolytic drugs.

Question 59

Identify several therapeutic uses for the benzodiazepine drugs. Give three reasons for why benzodiazepines are generally preferred over barbiturates as anxiolytics.

Question 60

Describe the unique clinical and synaptic effects of the drug buspirone (BuSpar). What are its advantages and disadvantages over the benzodiazepines?