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A 13-year-old boy is participating in a research study. His EEG findings demonstrate an increase in error-related
negativity. Which of the following disorders is most closely linked to this finding?

AAgoraphobiaCorrect Answer
BAttention-deficit/hyperactivity disorder
CConduct disorder
DPersistent depressive disorderYour Answer
ESchizophrenia

Correct Answer ( A )
Explanation:

Error-related negativity is one type of event-related potential that can be measured through the use of an EEG. A
study participant is given a time-limited task or choice and given immediate feedback regarding whether they
correctly performed the task or made the correct choice. The event-related potential measured 60 to 150
milliseconds after an incorrect choice is referred to as error-related negativity and is most closely associated
with anxiety disorders, such as agoraphobia, and obsessive-compulsive disorders. This electrical potential
appears to originate in the anterior cingulate cortex, which is involved in self-monitoring and behavioral
regulation. Based on a review of 22 studies, error-related negativity was found to predict the development of
anxiety disorders in youth across developmental periods. Agoraphobia refers to marked fear or anxiety about at
least two classic situations (e.g., using public transportation, standing in line). The fear must be secondary to the
affected individual’s fear that they might not be able to escape or help might not be available if they develop
incapacitating or embarrassing symptoms. Agoraphobia most commonly precedes the diagnosis of panic
disorder, has a mean age of onset of 17 years, is associated with significant impairment (even being
homebound), and follows a chronic course without treatment. The management of agoraphobia is based on
studies of associated panic disorder, and first-line treatments include cognitive behavioral therapy, selective
serotonin reuptake inhibitors, or a combination of both.
Although promising, EEG findings have not demonstrated sufficient specificity to be used as a diagnostic tool
for psychiatric disorders. Rather, the EEG is most clinically useful to rule out underlying medical etiologies for
psychiatric symptoms (e.g., seizure disorders, metabolic abnormalities). Some studies demonstrate significant
heritability of the amplitude of a particular evoked potential (P3) in attention-deficit/hyperactivity disorder
(B). Externalizing disorders, such as conduct disorder (C), and depressive disorders, such as persistent
depressive disorder (D), are generally associated with reductions in error-related negativity. Studies have
demonstrated abnormalities in posterior theta waves in individuals with schizophrenia (E).
Question: True or false: anxiety disorders are associated with overextinction of conditioned associations.

Reveal Answer: False. Anxiety disorders are associated with a lack of extinction after the initial threat is no
longer applicable.

Agoraphobia

Fear escape may be difficult or help not available if develops panic-like, embarrassing, or other
incapacitating Sxs in at least two specific situations:
Using public transportation, being in open spaces, being in enclosed spaces, standing in line or
being in a crowd, or being outside of home alone
May become homebound and dependent on others for basic needs
Incidence peaks late adolescence or early adulthood and 2:1 female preponderance
Premorbid anxiety disorders common
Subsequent development of depressive and substance use disorders
First-line interventions include CBT, SSRI, or both

References:

1. 1. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th ed.
American Psychiatric Publishing; 2013.
2. 2. Bennett S, Walkup JT. Anxiety disorders in children and adolescents: epidemiology, pathogenesis,
clinical manifestations, and course. Post TW, ed. UpToDate. UpToDate Inc. Accessed January 11, 2021.
3. 3. Johannesen JK, Skosnik PD. Applied electrophysiology. In: Sadock BJ, Sadock VA, Ruiz P, eds. Kaplan
& Sadock’s Comprehensive Textbook of Psychiatry. 10th ed. Wolters Kluwer; 2017:(Ch) 1.15.
4. 4. Spetie L, Arnold EL. Attention-deficit hyperactivity disorder. In: Martin A, Bloch MH, Volkmar FR,
eds. Lewis’s Child and Adolescent Psychiatry: A Comprehensive Textbook. 5th ed. Wolters Kluwer; 2018:
(Ch) 5.1.1.
5. 5. Taylor JH, Lebowitz ER, Silverman WK. Anxiety disorders. In: Martin A, Bloch MH, Volkmar FR, eds.
Lewis’s Child and Adolescent Psychiatry: A Comprehensive Textbook. 5th ed. Wolters Kluwer; 2018:(Ch)
5.5.1.

Reviewed February 2021

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Category: Anxiety Disorders

Subcategory: Agoraphobia

Question: 147820

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 A. A 22%
B. B 30%
C. C 5%
D. D 36%
E. E 8%

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Normal Lab Values

25-hydroxyvitamin D, serum 25–80 ng/mL 62–200 nmol/L
Activated partial thromboplastin time (APTT) 25–35 seconds 25–35 seconds
Adrenocorticotropic hormone (ACTH) 9–52 pg/mL 2–11 pmol/L
Alanine aminotransferase (ALT) 0–35 U/L 0–0.58 µkat/L
Albumin 3.5–5.5 g/dL 35–55 g/L
Alkaline phosphatase 45–115 U/L (men), 30–100 U/L (women) 0.75–1.92 µkat/L (men), 0.50–1.67 µkat/L
(women)
Ammonia 40–80 µg/dL 23–47 µmol/L
Amylase 0–130 U/L
Anion Gap 8–16 mEq/L 8–16 mmol/L
Aspartate aminotransferase (AST) 0–35 units/L 0–0.58 µkat/L
Bands < 1 x 10,000/µL < 1 x 10,000/mm3
Bicarbonate 23–28 mEq/L 23–28 mmol/L
Bilirubin, direct/conjugated 0–0.3 mg/dL 0–5.1 µmol/L
Bilirubin, total 0.3–1.2 mg/dL 5.1–20.5 µmol/L
Blood urea nitrogen (BUN) 8–20 mg/dL 2.9–7.1 mmol/L
B-type natriuretic peptide (BNP) <100 pg/mL < 100 ng/L
Calcium (ionized, adult) 4.5–5.6 mg/dL 1.05–1.3 mmol/L
Calcium (total) 9–10.5 mg/dL 2–2.6 mmol/L
Ceruloplasmin 16–31 mg/dL (men), 19–39 mg/dL (women)
Chloride 98–106 mEq/L 98–106 mmol/L
Cholesterol (Total: Adult) 150–199 mg/dL 3.88–5.15 mmol/L
COHb (%) Non Smoker: < 2% Smoker: <9% Non Smoker: < 2% Smoker: <9%
Copper 63.7–140.12 µg/dL 12–22 µmol/L
Cortisol (bedtime) 3–13 µg/dL 83–359 nmol/L
Cortisol (free, urine) < 50 µg/24 h 138 nmol/24 h
Cortisol (morning) 10–20 µg/dL 275.88–551.76 nmol/L
C-peptide - serum 0.5–2.0 ng/mL 0.17–0.66 nmol/L
C-reactive protein (CRP) < 5 mg/L
Creatine kinase (CK) 30–170 U/L 0.50–2.84 µkat/L
Creatinekinase – MB fraction (CK-MB) 0–7 ng/mL 0–7 µg/L
Creatinine 0.7–1.3 mg/dL 61.9–115 µmol/L
CSF Cell count 0-5 cells/µL 0-5 × 10⁶ cells/L
CSF Glucose 40–80 mg/dL 2.2–4.4 mmol/L
CSF Opening pressure 7-20 cm of H20
CSF Protein 15–50 mg/dL 150–500 mg/L
D-dimer < 0.5 µg/mL < 500 ng/mL
Erythrocyte sedimentation rate (ESR) 0–15 mm/hr (men) 0–20 mm/hr (women)
Estradiol (female, day 1-10) 14–27 pg/mL 50–100 pmol/L
Estradiol (female, day 11-20) 14–54 pg/mL 50–200 pmol/L
Estradiol (female, day 21-30) 19–41 pg/mL 70–150 pmol/L
Estradiol (male) 10–30 pg/mL 37–110 pmol/L
Ferritin, serum 15–200 ng/mL 15–200 µg/L
Fibrinogen, plasma 150–350 mg/dL 1.5–3.5 g/L
Follicle-stimulating hormone (female, follicular/luteal phase) 5–20 mU/mL 5–20 U/L
Follicle stimulating hormone (female, midcycle) 30–50 mU/mL 30–50 U/L
Follicle stimulating hormone (female, postmenopausal) > 35 mU/mL > 35 U/L
Follicle stimulating hormone (male) 5–15 mU/mL 5–15 U/L
Free Thyroxine (T4), serum 0.9–2.4 ng/dL 12–31 nmol/L
Free Triiodothyronine (T3), serum 2.3 - 4.2 pg/mL 0.04-0.06 pmol/L
Gastrin 0–180 pg/mL 0–86.58 pmol/L
GGT level 0 to 30 IU/L
Glucose (fasting) 70–100 mg/dL 3.9–5.6 mmol/L
Glycosylated hemoglobin 4%–5.9% 4%–5.9%
Haptoglobin 50–150 mg/dL 500–1500 mg/L
HDL (Men) ≥ 40 mg/dL 1.0 mmol/dL
HDL (Women) ≥ 50 mg/dL 1.3 mmol/dL
Hematocrit (Hct) (Female) 36–47% 0.36–0.47
Hematocrit (Hct) (Male) 41–51% 0.41–0.51
Hemoglobin (Hgb) (Female) 12–16 g/dL 120–160 g/L
Hemoglobin (Hgb) (Male) 14–17 g/dL 140–170 g/L
Insulin - serum < 25 mU/L < 174 pmol/L
Iron 60–160 µg/dL 11–29 µmol/L
Lactate dehydrogenase (LDH) 60–100 units/L 1.00–1.67 µkat/L
Lactic acid 6–16 mg/dL 0.67–1.8 mmol/L
LDL < 100 mg/dL
Lipase < 95 U/L < 1.59 µkat/L
Luteinizing hormone (female, follicular/luteal phase) 5–22 mU/mL 5–22 units/L
Luteinizing hormone (female, midcycle) 30–250 mU/mL 30–250 units/L
Luteinizing hormone (female, postmenopausal) > 30 mU/mL > 30 units/L
Luteinizing hormone (male) 3–15 mU/mL 3–15 units/L
Lymphocytes 1,000–4,000/µL (20–40%) 1,000–4,000/mm3 (20–40%)
Magnesium 1.5–2.4 mg/dL 0.62–0.99 mmol/L
Mean corpuscular hemoglobin concentration (MCHC) 32–36 g/dL 320–360 g/L
Mean corpuscular hemoglobin (MCH) 28–32 pg 0.4–0.5 fmol/cell
Mean corpuscular volume (MCV) 80–100 fL/red cell
Metanephrines (urine) < 1.2 mg/24 hours < 6.1 mmol/24 hours
Monocytes 100–700/µL (2–8%) 100–700/mm3 (2–8%)
Neutrophils 2500–8000/µL (55–70%) 2500–8000/mm3 (55–70%)
Parathyroid hormone (PTH) 10–65 pg/mL 10–65 ng/L
PCO₂ 35–45 mm Hg 4.7–6 kPa
pH 7.35-7.45 7.35-7.45
Phosphorus 3–4.5 mg/dL 0.97–1.45 mmol/L
Platelets 150,000–350,000/µL 150–350 × 10⁹/L
PO₂ 80–100 mm Hg 10.6–13.3 kPa
Potassium 3.5–5.0 mEq/L 3.5–5.0 mmol/L
Procalcitonin (adults and children > 72 hours old) < 0.15 ng/mL
Prolactin (Men) < 15 ng/mL < 15 µg/L
Prolactin (Nonpregnant women) < 20 ng/mL < 20 µg/L
Prolactin (Pregnant women) 36–372 ng/mL 36–372 µg/L
Protein C 65 to 135 IU dL-1
Prothrombin time (PT) 11–13 seconds 11–13 seconds
Pyruvate 300–900 µg/dL 34068.00–102204.00 µmol/L
Red blood cells (RBC) 4.7–6.1 x 10⁶/µL (men), 4.2–5.4 x 10⁶/µL (women)
Red cell distribution width (RDW) 11.6–14.6% 11.6–14.6%
Reticulocytes 0.5%–1.5% 0.5%–1.5%
Reverse Triiodothyronine (T3), serum 10–24 ng/dL 10–24 ng/dL
Sodium 136–145 mEq/L 136–145 mmol/L
Testosterone (adult male) 300–1200 ng/dL 10–42 nmol/L
Testosterone (female) 20–75 ng/dL 0.7–2.6 nmol/L
Thyroid-stimulating hormone (TSH) 0.5–5.0 µU/mL 0.5–5.0 mU/L
Total iron-binding capacity (TIBC) 250–460 µg/dL 45–82 µmol/L
Total Serum Protein 6.0–7.8 g/dL 60–78 g/L
Total Thyroxine (T4), serum 5–12 µg/dL 64–155 nmol/L
Total Triiodothyronine (T3), serum 70–195 ng/dL 1.1–3.0 nmol/L
Transferrin 200–360 mg/dL 24.60–44.28 µmol/L
Transferrin saturation 20–50% 20–50%
Triglycerides <150 mg/dL < 1.69 mmol/L
Troponin I 0–0.5 ng/mL 0–0.5 μg/L
Troponin T 0–0.10 ng/mL 0–0.10 µg/L
Tryptase < 11.5 ng/mL < 11.5 ng/mL
Urea 17–43 mg/dL 2.8–7.2 mmol/L
Uric acid, serum 2.5–8 mg/dL 0.15–0.47 mmol/L
White blood cells (WBCs) 4,000–10,000/µL 4.0–10.0 x 10⁹/L