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BIOLOGY OF ANXIETY

BIOLOGY OF ANXIETY. Ken Coll, MD. Objectives/Disclosures. Review the basic neuroscience of fear and anxiety Correlate pragmatic clinical interventions with the underlying biological processes

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BIOLOGY OF ANXIETY

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  1. BIOLOGY OF ANXIETY Ken Coll, MD

  2. 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

  3. Anxiety is an Elephant

  4. STARTLE EAR PONS MOTOR

  5. CONDITIONED FEAR Light Central Nucleus of the Amygdala Basolateral Amygdala Shock

  6. 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

  7. Fear- Enhanced Startle Light Central Nucleus of the Amygdala Basolateral Amygdala Shock EAR PONS MOTOR

  8. Fear Enhanced Startle

  9. 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

  10. CONDITIONED FEAR AND SUSTAINED FEAR Bed Nucleus of the Stria Terminalis Light Basolateral Amygdala Shock Central Nucleus of the Amygdala

  11. 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

  12. Michael Davis, Emory University

  13. CONDITIONED FEAR AND SUSTAINED FEAR (Anxiety) Bed Nucleus of the Stria Terminalis Light Basolateral Amygdala Shock Central Nucleus of the Amygdala EAR PONS MOTOR

  14. Worry Enhanced Startle

  15. 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

  16. CORTEX AMYGDALA SENSORY THALAMUS

  17. TAKE HOME POINT • The interpretation of the event in the cortex has a huge effect on the amount of activation in the amygdala/BNST

  18. 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

  19. 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

  20. 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 CORTEX Central Gray Freeze, pain Retic Nuc of Pons Startle Trigeminal N Facial N Fear Face CORTEX CORTEX

  21. FRONTAL LOBES/Cortex BNST and Amygdala HIPPOCAMPUS BRAINSTEM

  22. FRONTAL LOBES/Cortex BNST and Amygdala HIPPOCAMPUS BRAINSTEM

  23. Extinction

  24. Hippocampus Amygdala BNST FEAR and ANXIETY

  25. Hippocampus Amygdala BNST d-cycloserine at NMDA REDUCED FEAR and ANXIETY

  26. Hippocampus Beta-blockers Amygdala BNST FEAR and ANXIETY

  27. BNST and Amygdala BETA and ALPHA BLOCKERS LOCUS Coeruleus Norepinephrine

  28. BNST and Amygdala SSRIs, SNRIs, Buspar SEROTONIN Raphe Nucleus SEROTONIN GA BA Cortex

  29. BNST and Amygdala Benzos and Beer GABA

  30. BNST and Amygdala alpha 2 delta ligands Blocks Glutamate

  31. Anxiety is an Elephant

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