Deck 14: Treatments for Anxiety Disorders

Question 1

A strong physiological fear response associated with intense apprehension, fearfulness, or terror is referred to as a ____.

A) post-traumatic stress disorder
C) generalized anxiety disorder
B) panic attack
D) specific phobia

Answer 1

B

Question 2

Which brain structure interfaces with the amygdala to let Stephen know that he should not fear the barking dog because the dog is on a leash held closely to its owner?

A) thalamus
C) caudate putamen
B) hippocampus
D) nucleus accumbens

Answer 2

B

Question 3

Individuals who experience their first panic attack often mistake it for ____.

A) vertigo
C) a stroke
B) a seizure
D) a heart attack

Answer 3

D

Question 4

Serena is an constant state of worry; for example, she wonders if every cold symptom that might arise is a sign of a terminal illness. Her constant state of worry causes her to feel exhausted at night. What is Serena most likely suffering from?

A) obsessive -compulsive disorder
C) post-traumatic stress disorder (PTSD)
B) generalized anxiety disorder
D) panic disorder

Question 5

This in turn causes the release of ____ from the adrenal gland.

A) adenosine and acetylcholine
C) epinephrine and acetylcholine
B) adenosine and norepinephrine
D) epinephrine and norepinephrine

Question 6

Which brain pathway provides information about the basic features of the barking sound to Stephen, letting him know that there is a loud noise without indicating what the sound actually is?

A) hippocampal-amygdala pathway
B) hippocampal-cortical-amygdala pathway
C) thalamo-amygdala pathway
D) thalamo-cortical-amygdala pathway

Question 7

Once activated, the locus coeruleus directly causes the release of ____.

A) adenosine
C) epinephrine
B) acetylcholine
D) norepinephrine

Question 8

Sidney has profound anxiety when in situations where she cannot run out and escape easily, such as at a crowded movie theater. During these situations, Sidney experiences ____.

A) acrophobia
C) androphobia
B) agliophobia
D) agoraphobia

Question 9

Leeda thinks constantly about contracting a deadly infectious disease from touching a public surface (e.g., door handle). Her thoughts and mental images regarding contracting a deadly disease are intrusive, causing her anxiety and distress. What is Leeda most likely suffering from?

A) obsessive-compulsive disorder
C) post-traumatic stress disorder (PTSD)
B) generalized anxiety disorder
D) panic disorder

Question 10

Significant anxiety provoked by exposure to specific feared objects or situations is referred to as a ____.

A) post-traumatic stress disorder
C) generalized anxiety disorder
B) panic attack
D) specific phobia

Question 11

Kessler and colleagues (2005) estimate what percent of U.S. individuals have had an anxiety disorder in their lifetime?

A) about 10 percent
C) about 30 percent
B) about 20 percent
D) about 40 percent

Question 12

Stephen decides to walk calmly past the dog, but avoids stopping to pet the dog because of its aggressive bark. Which brain structure received inputs from the amygdala to determine's Stephen's behavioral response to the barking dog?

A) hypothalamus
C) prefrontal cortex
B) thalamus
D) locus coeruleus

Question 13

Theo, an Iraq war veteran, jumps up and turns around every time he hears a loud noise, experiencing intense fear during this startle response. What is Theo most likely suffering from?

A) obsessive-compulsive disorder
C) post-traumatic stress disorder (PTSD)
B) generalized anxiety disorder
D) panic disorder

Question 14

According to Norrholm & Ressler (2009), genetic risk accounts for what percent of anxiety disorder diagnoses?

A) 10 to 20 percent
C) 30 to 40 percent
B) 20 to 30 percent
D) 40 to 50 percent

Question 15

Which brain structure is strongly associated with fear and anxiety in both humans and animals?

A) amygdala
C) nucleus accumbens
B) hippocampus
D) cerebellum

Question 16

Which of Stephen's brain structures receives inputs from the amygdala to determine's Stephen's physiological response to the barking dog?

A) thalamus and prefrontal cortex
C) locus coeruleus and prefrontal cortex
B) thalamus and hypothalamus
D) locus coeruleus and hypothalamus

Question 17

Which is an example of a physiological response that may occur following activation of the sympathetic nervous system in response to a fearful stimuli?

A) hypoperfusion
C) pupil constriction
B) increased blood pressure
D) increased digestive responses

Question 18

Which type of anxiety disorder is least likely to involve abnormal functioning of the amygdala?

A) obsessive-compulsive disorder
C) post-traumatic stress disorder (PTSD)
B) generalized anxiety disorder
D) panic disorder

Question 19

Which brain pathway provides information to Stephen about what the loud noise is (e.g., the dog barking)?

A) hippocampal-amygdala pathway
B) hippocampal-cortical-amygdala pathway
C) thalamo-amygdala pathway
D) thalamo-cortical-amygdala pathway

Question 20

According to the text, second only to specific phobia, the most common type of anxiety disorder is ____.

A) panic disorder
C) generalized anxiety disorder
B) obsessive-compulsive disorder
D) social phobia

Question 21

Which is an example of an ultrashort acting barbiturate?

A) mephobarbitaol
C) thiopental
B) secobarbital
D) pentobarbital

Question 22

What accounts for the differences in length of drug action among benzodiazepines?

A) Solubility
C) Metabolism
B) Absorption rate
D) Time release capsules

Question 23

Benzodiazepines were developed in the 1960s as anxiolytic drugs in response to ____.

A) the ineffectiveness of barbiturates in treating anxiety
B) the broad therapeutic index of barbiturates with prolonged use
C) increased barbiturate use and overdose
D) a need to provide more affordable anxiolytic drugs

Question 24

Based on studies where people rated the subjective effects of barbiturates and benzodiazepines, what can we conclude about the rewarding properties of these drugs?

A) Neither barbiturates nor benzodiazepines were rated as very rewarding.
B) Both barbiturates and benzodiazepines are rated as very rewarding.
C) The effects of benzodiazepines appear more rewarding than the effects of barbiturates.
D) The effects of barbiturates appear more rewarding than the effects of benzodiazepines.

Question 25

In comparison with barbiturates, what made benzodiazepines, such as Librium and Valium, so appealing for outpatient use?

A) Long-lasting effect
C) Quick metabolism
B) Limited sedative effect
D) Dual antidepressant action

Question 26

What effect will this have on their GABA neurotransmission?

A) GABA receptor positive modulator; enhancing excitation
B) GABA receptor negative modulator; decreasing excitation
C) GABA receptor positive modulator; enhancing inhibition
D) GABA receptor negative modulator; decreasing inhibition

Question 27

Prolonged increases in levels of the stress hormone cortisol are associated with damage to the ____.

A) amygdala
C) thalamus
B) hippocampus
D) hypothalamus

Question 28

Neil begins to measure the anxiolytic responsiveness of the mice using an elevated plus maze. What brain structure is directly modulated by the barbiturates to affect anxiety?

A) cerebral cortex
C) cerebellum
B) medulla
D) amygdala

Question 29

Which is an example of a long acting barbiturate?

A) mephobarbitaol
C) thiopental
B) secobarbital
D) pentobarbital

Question 30

Introduced in the early 1900s, the first anxiolytic drugs consisted of ____.

A) barbiturates
C) opioids
B) benzodiazepines
D) cannabinoids

Question 31

During which phase of the general adaptation syndrome can the body no longer maintain high, sustained levels of physiological arousal, leading to impaired immune system function and reduced metabolic activity?

A) caution
C) resistance
B) alarm
D) exhaustion

Question 32

Which is an active metabolite formed from the metabolism of long acting benzodiazepines?

A) midazolam
C) alprazolam
B) oxazepam
D) diazepam

Question 33

Neil notices that the mice are showing a sedative response to the barbiturates. What brain region is responsible for this effect?

A) cerebral cortex
C) cerebellum
B) medulla
D) amygdala

Question 34

What neurotransmitter plays a key role in mediating both the therapeutic and aversive effects of barbiturates?

A) glutamate
C) dopamine
B) GABA
D) serotonin

Question 35

A sustained level of physiological arousal in response to prolonged stress, involving release of corticotrophin releasing factor, occurs during which phase of the general adaptation syndrome?

A) caution
C) resistance
B) alarm
D) exhaustion

Question 36

What are the three phases of the general adaptation syndrome proposed by Selye (1950)?

A) calm, resistance, and caution
C) alarm, caution, and exhaustion
B) calm, alarm, and caution
D) alarm, resistance, and exhaustion

Question 37

After abruptly stopping barbiturate use, Hailey experiences anxiety, muscle weakness, and abdominal pain. What syndrome does Hailey most likely have?

A) GABA withdrawal syndrome
C) barbiturate abstinence syndrome
B) prolonged barbiturate use syndrome
D) anxiolytic cessation syndrome

Question 38

Acute reactions to fearful stimuli, including activation of the sympathetic nervous system, occur during which phase of the general adaptation syndrome?

A) caution
C) resistance
B) alarm
D) exhaustion

Question 39

Activation of the hypothalamic-pituitary-adrenal (HPA) axis controls what type of fearful response and is involved in which phase of the general adaptation syndrome?

A) behavioral response: alarm phase
C) physiological response: alarm phase
B) behavioral response: resistance phase
D) physiological response: resistance phase

Question 40

Most deaths occurring from barbiturate overdose result from ____.

A) respiratory depression
C) seizure
B) cardiac arrest
D) hypoperfusion

Question 41

Which of the following is a candidate for an endozepine, and is an endogenous naturally occurring chemical that binds to the same receptor sites as benzodiazepines?

A) GABA
C) diazepam-binding inhibitor
B) glutamate
D) pro-GABA facilitator

Question 42

The high affinity benzodiazepine binding site, contained on the α₁ subunit of the GABA_A receptor is referred to as the ____ site.

A) BZ I
C) BZ III
B) BZ II
D) BZ IV

Question 43

The low affinity benzodiazepine binding site, contained on the α₂, α₃, or α₅ subunits of the GABA_A receptor is referred to as the ____ site.

A) BZ I
C) BZ III
B) BZ II
D) BZ IV

Question 44

Anxiolytics are identified in animal behavioral models before they are tested in humans. Many of these models are developed for face validity and thus use tasks that can produce behaviors indicative of stress, fear, or anxiety. Describe three such tests, including how they are conducted and their utility in testing anxiolytic effects.

Question 45

How may SNRIs facilitate a reduction in anxiety?

A) Inhibition of postsynaptic norepinephrine receptors leads to the eventual sensitization of β₁ adrenoceptors.
B) Inhibition of postsynaptic norepinephrine receptors leads to the eventual desensitization of β₁ adrenoceptors.
C) Activation of postsynaptic norepinephrine receptors leads to the eventual sensitization of β₁ adrenoceptors.
D) Activation of postsynaptic norepinephrine receptors leads to the eventual desensitization of β₁ adrenoceptors.

Question 46

Which statement best summarizes the failure rate of SSRIs and SNRIs for the treatment of anxiety?

A) About one-tenth of patients do not respond adequately, the same rate as for the treatment of depression.
B) About one-tenth of patients do not respond adequately, a much higher rate than for the treatment of depression.
C) About one-third of patients do not respond adequately, the same rate as for the treatment of depression.
D) About one-third of patients do not respond adequately, a much higher rate than for the treatment of depression.

Question 47

Which statement best reflects current notions about the abuse potential for benzodiazepines?

A) Abuse potential is high, as evidenced by benzodiazepine withdrawal syndrome.
B) Abuse potential is low, as evidenced by a lack of withdrawal symptoms following chronic benzodiazepine use.
C) Abuse potential is variable, depending greatly on the presence of cytochrome P450 polymorphisms.
D) Abuse potential is widely debated; physical dependence occurs but not psychological dependence or tolerance.

Question 48

Postdoctoral research fellow Shayla places a rat in an elevated plus maze to determine its level of anxiety. Which behavior indicates a reduction in anxiety?

A) The rat jumps off of the elevated maze.
B) The rat does not try to escape the elevated maze.
C) The rat spends more time in the open arm.
D) The rat spends more time in the closed arm.

Question 49

Describe the role of BZ I and BZ II sites, which are found on GABA_A receptors, in mediating the diverse effects of benzodiazepines in the brain. Discuss how benzodiazepines affect GABA neurotransmission and how they modulate different behavioral or physiological responses.

Question 50

Out of the currently prescribed antidepressant drugs, which are most often used for the treatment of anxiety?

A) SSRIs and SNRIs
B) SSRIs and atypical antidepressants
C) MAO inhibitors and SNRIs
D) MAO inhibitors and atypical antidepressants

Question 51

A behavioral test is used in rodents that establishes a conflict between reward (water) and punishment (shock) in response to a presented stimulus. This test is used especially to test anxiolytic drugs and is referred to as a(n) ____ conflict test.

A) Vogel
C) aversive conditioning
B) Porsolt
D) associative learning

Question 52

Alan notices reduced alertness and reduced cognitive function based on battery of behavioral tests. What mechanistic action of the benzodiazepine explains this effect?

A) Activation of BZ I sites in the cortex
B) Activation of BZ I sites in the hypothalamus
C) Activation of BZ II sites in the cortex
D) Activation of BZ II sites in the hypothalamus

Question 53

Alan performs an elevated plus maze experiment, measuring a reduction in anxiety in the rat. What mechanistic action of the benzodiazepine explains this effect?

A) Activation of BZ I sites in both the amygdala and hypothalamus
B) Activation of BZ II sites in both the amygdala and hypothalamus
C) Activation of BZ I sites in the amygdala; activation of BZ II sites in the hypothalamus
D) Activation of BZ II sites in the amygdala; activation of BZ I sites in the hypothalamus

Question 54

Postdoctoral research fellow Amber monitors anxiety in rats by placing them in an open field apparatus and measuring thigmotaxia. Based on this test, which behavior indicates a reduction in anxiety?

A) The rats spend more time in the center of the open field apparatus.
B) The rats spend more time near the walls of the open field apparatus.
C) The rats spend more time exploring the apparatus in isolation.
D) The rats spend more time interacting with newly introduced rats.

Question 55

Alan notices a disruption of balance and coordination in the rat. What mechanistic action of the benzodiazepine explains this effect?

A) Activation of BZ I sites in the cerebellum
B) Activation of BZ I sites in the amygdala
C) Activation of BZ II sites in the cerebellum
D) Activation of BZ II sites in the amygdala

Question 56

What mechanistic action of anti-depressant drugs working at the 5-HT1_A autoreceptors mediates their anxiolytic effects?

A) Activation of 5-HT1_A receptors
C) Sensitization of 5-HT1_A receptors
B) Inhibition of 5-HT1_A receptors
D) Desensitization of 5-HT1_A receptors

Question 57

Evidence suggests that ____ receptors serve a critical function for serotonin's effects on anxiety.

A) 5-HT_1A
C) 5-HT_2A
B) 5-HT_1B
D) 5-HT_2B

Question 58

The following patients take a benzodiazepine drug at the same time. The effect of this drug is likely to last longest in which patient?

A) Chad, who has a cytochrome P450 polymorphism, causing decreased activity of these enzymes
B) Heather, who has higher than normal levels of GABA receptors
C) Erwin, who has higher than normal levels of cytochrome P450 enzymes
D) Luisa, who has a GABA_A receptor polymorphism, causing a stronger binding affinity for benzodiazepines

Question 59

What is an example of an anticonvulsant drug used to treat anxiety?

A) valproic acid
C) zolpidem
B) eszopiclone
D) alprazolam