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Chapter 47. Neurobiology of Anxiety Disorders

Jonathan M. Amiel, M.D.; Sanjay J. Mathew, M.D.; Amir Garakani, M.D.; Alexander Neumeister, M.D.; Dennis S. Charney, M.D.
DOI: 10.1176/appi.books.9781585623860.422869

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Excerpt

Our understanding of the neurobiological basis of fear and anxiety continues to improve at a rapid pace. The principal brain regions involved in processing and responding to anxiety are known, many neurochemical systems mediating responses to fearful stimuli have been identified, and new technologies are advancing the study of the interactions of these brain regions with one another. There is also active investigation regarding the relationship between genes and the environment in the development of chronically dysregulated anxiety with the hope that characterizing the neurobiology of anxiety will bring forth therapeutic advances that reduce the significant burden and long-term functional impairment associated with anxiety disorders.

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FIGURE 47–1. Brain circuits implicated in fear and anxiety.A major function of the amygdala is the integration of information from the thalamus and cortical regions into efferent signals (thick arrows). Integration of signals occurs in the basolateral amygdaloid complex, whereas efferent responses are mediated by the central nucleus. Reciprocal circuits to the cortex and the hippocampus are particularly relevant to affective modulation and contextual memory (thin arrows).

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Sample questions:
1.
Formal studies of fear learning processes date back to the experiments of the Russian physiologist Ivan Pavlov in the late nineteenth century. Pavlov observed that dogs salivate when presented with food and that when the presentation of food was paired repeatedly with the sound of a bell, the dogs would salivate when the bell was rung, just as they would when presented with food. The habitual response of salivation to the sound of the bell is called
2.
The goal of pharmacotherapy and psychotherapy of anxiety disorders is to delink neutral stimuli from aversive responses. What is this process called?
3.
Which of the following 36—amino acid peptide found mostly in the locus coeruleus, hypothalamus, amygdala, hippocampus, basal ganglia, and midbrain nuclei is expressed under fearful conditions and appears to inhibit or contain the stress response?
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