Amygdala fear processing — MRCPsych Paper A MCQ

Instant feedback + full explanation. One question, done properly.

ModerateNeuroanatomyAmygdala fear processingMRCPsych Paper A

A 30-year-old woman has stereotyped focal aware seizures. Each begins with sudden intense fear and a sense of impending threat, followed by palpitations and an epigastric rising sensation. Video-EEG localises seizure onset to the mesial temporal region. Which structure is most closely associated with generating the affective fear component of these seizures?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: B — Amygdala

The correct answer is **A, the amygdala**. Sudden, stereotyped, unprovoked fear with autonomic arousal is a recognised affective manifestation of mesial temporal seizures. The amygdala is a key hub for threat detection, emotional salience and the generation of fear responses. The anterior insula contributes to interoceptive awareness of bodily arousal but is not the principal mesial temporal fear structure. The hypothalamus and periaqueductal grey mediate autonomic and defensive behavioural outputs downstream of limbic processing. The posterior cingulate is more strongly associated with internally directed cognition, autobiographical processing and the default mode network. The mesial temporal localisation and prominent subjective fear therefore identify the amygdala as the single best answer.

Reference: Tarrada A, Jamal Eddine Y. Fear in the neuropsychiatric aspects of epilepsy: What role for the amygdala? Neurophysiologie Clinique. 2025;55(4):103062. https://pubmed.ncbi.nlm.nih.gov/40101402/