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BIOLOGY OF ANXIETY Ken Coll, MD
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Objectives/Disclosures
Review the basic neuroscience of fear and anxiety Correlate pragmatic clinical interventions with the underlying biological processes Through exploration of the biology of anxiety, identify potential avenues for additional treatment modalities No Disclosures/Conflicts
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Anxiety is an Elephant
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STARTLE EAR PONS MOTOR
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Central Nucleus of the Amygdala
CONDITIONED FEAR Light Central Nucleus of the Amygdala Basolateral Amygdala Shock
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Sweat, CV, BP, Pupil Dilate
Lateral Hypo Sweat, CV, BP, Pupil Dilate Parabrachial Nuc- respiratory Dorsal Mot Nuc/Nuc Ambig Urination/def Central Amygdala VTA/LC/BF Vigilant Arouse Paravent Nuc Hormone release Central Gray Freeze, pain Retic Nuc of Pons Startle Trigeminal N Facial N Fear Face
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Fear- Enhanced Startle
Light Central Nucleus of the Amygdala Basolateral Amygdala Shock EAR PONS MOTOR
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Fear Enhanced Startle
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Sweat, CV, BP, Pupil Dilate
Lateral Hypo Sweat, CV, BP, Pupil Dilate Parabrachial Nucleus Respiratory Dorsal Mot Nuc/Nuc Ambig Urination/def Central Amygdala VTA/LC/BF Vigilant Arouse Paravent Nuc Hormone Release Central Gray Freeze, Pain Retic Nuc of Pons Startle Trigeminal N Facial N Fear Face
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CONDITIONED FEAR AND SUSTAINED FEAR
Bed Nucleus of the Stria Terminalis Light Basolateral Amygdala Shock Central Nucleus of the Amygdala Light and shock signals from sensory centers
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Sweat, CV, BP, Pupil Dilate
Lateral Hypo Sweat, CV, BP, Pupil Dilate Parabrachial Nuc- Respiratory Dorsal Mot Nuc/Nuc Ambig Urination/def Bed Nucleus Stria Terminalis VTA/LC/BF Vigilant Arouse Paravent Nuc Hormone release Central Gray Freeze, pain Retic Nuc of Pons Startle Trigeminal N Facial N Fear Face
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Michael Davis, Emory University
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CONDITIONED FEAR AND SUSTAINED FEAR (Anxiety)
Bed Nucleus of the Stria Terminalis Light Basolateral Amygdala Shock Central Nucleus of the Amygdala EAR PONS MOTOR
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Worry Enhanced Startle
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TAKE HOME POINT The varying degree of fear and anxiety inherent in the anxiety disorders is correlated, at least in part, with the varying degree of activation between the amygdala and the bed nucleus of the stria terminalis
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CORTEX AMYGDALA SENSORY THALAMUS SNAKE VS HOSE
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TAKE HOME POINT The interpretation of the event in the cortex has a huge effect on the amount of activation in the amygdala/BNST
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Sweat, CV, BP, Pupil Dilate
Lateral Hypo Sweat, CV, BP, Pupil Dilate Parabrachial Nuc- Respiratory Dorsal Mot Nuc/Nuc Ambig Urination/def Bed Nucleus and Amygdala VTA/LC/BF Vigilant Arouse Paravent Nuc Hormone release Central Gray Freeze, pain Retic Nuc of Pons Startle Trigeminal N Facial N Fear Face
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Sweat, CV, BP, Pupil Dilate
Lateral Hypo Sweat, CV, BP, Pupil Dilate Parabrachial Nuc- Respiratory Dorsal Mot Nuc/Nuc Ambig Urination/def Bed Nucleus and Amygdala VTA/LC/BF Vigilant Arouse Paravent Nuc Hormone Release Central Gray Freeze, pain Retic Nuc of Pons Startle Trigeminal N Facial N Fear Face
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Sweat, CV, BP, Pupil Dilate
CORTEX Lateral Hypo Sweat, CV, BP, Pupil Dilate Parabrachial Nuc- Respiratory Dorsal Mot Nuc/Nuc Ambig Urination/def CORTEX CORTEX RTE Bed Nucleus and Amygdala CORTEX VTA/LC/BF Vigilant Arouse Paravent Nuc Hormone Release CORTEX CORTEX Inputs from the cortex can be received via CORTEX Central Gray Freeze, pain Retic Nuc of Pons Startle Trigeminal N Facial N Fear Face CORTEX CORTEX
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FRONTAL LOBES/Cortex BNST and Amygdala HIPPOCAMPUS BRAINSTEM
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FRONTAL LOBES/Cortex BNST and Amygdala HIPPOCAMPUS BRAINSTEM
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Extinction
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Hippocampus Amygdala BNST FEAR and ANXIETY
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REDUCED FEAR and ANXIETY
Hippocampus Amygdala BNST d-cycloserine at NMDA REDUCED FEAR and ANXIETY
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Hippocampus Beta-blockers Amygdala BNST FEAR and ANXIETY
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BETA and ALPHA BLOCKERS
BNST and Amygdala BETA and ALPHA BLOCKERS LOCUS Coeruleus Norepinephrine
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SSRIs, SNRIs, Buspar BNST and Amygdala Raphe SEROTONIN Nucleus
GA BA Cortex
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BNST and Amygdala Benzos and Beer GABA
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BNST and Amygdala alpha 2 delta ligands Blocks Glutamate
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Anxiety is an Elephant
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