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Chapter 19: Neurobiology of Schizophrenia, Mood Disorders, and Anxiety Disorders

MULTIPLE CHOICE
1. Which would be considered a positive symptom of schizophrenia?
a. Blunted affect
c. Poverty of speech
b. Auditory hallucinations
d. Lack of social interaction
ANS: B

Positive symptoms frequently occur during a psychotic episode, when an individual loses
touch with reality and experiences something that should be absent (e.g., hallucinations). The
remaining options are classified as negative symptoms.
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REF: Pages 644-646

2. The onset of schizophrenia can be triggered by which prenatal occurrence?


a. Viral infection
c. Maternal smoking
b. Maternal depression
d. Exposure to toxic waste
ANS: A

A leading hypothesis for the cause of schizophrenia suggests that the illness results from
neurodevelopmental defects that occur in fetal life. Several early environmental factors have
been suggested to increase the risk of developing schizophrenia, including viral infection
during pregnancy, prenatal nutritional deficiencies, and perinatal complications, such as birth
defects and neonatal hypoxia. No current research supports the theory that any of the other
options are prenatal triggers of schizophrenia.
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REF: Page 642

3. Which neurotransmitter is reduced in people with schizophrenia?


a. Dopamine
c. Acetylcholine
b. Gamma-aminobutyric acid
d. Serotonin
ANS: B

In the dorsal prefrontal cortex of schizophrenic brains, glutamic acid decarboxylase, the major
enzyme in gamma-aminobutyric acid GABA biosynthesis, is diminished, which likely impairs
synaptic performance and cognitive and behavioral functions associated with this brain region.
The other neurotransmitters mentioned in the option choices are not related to the presentation
of schizophrenia.
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REF: Page 643

4. Alterations in which part of the brain are linked to hallucinations, delusions, and thought

disorders associated with schizophrenia?


a. Parietal lobe
b. Limbic system
ANS: C

c. Temporal lobe
d. Hypothalamus

Only temporal lobe alterations may be responsible for the production of positive
schizophrenic symptoms, such as hallucinations, delusions, thought disorders, and bizarre
behavior.
PTS: 1

REF: Page 642

5. Antipsychotic drugs block which neurotransmitter receptor?


a. Norepinephrine
c. Serotonin
b. Gamma-aminobutyric acid
d. Dopamine
ANS: D

The dopamine hypothesis initially suggested that abnormal elevation in dopaminergic


transmission contributes to the onset of schizophrenia. This hypothesis was based on
pharmacologic studies showing that antipsychotic drugs are potent blockers of brain dopamine
receptors; therefore the other options are incorrect.
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REF: Page 643

6. What data confer the link between bipolar disorders and schizophrenia?
a. Individuals with bipolar disorder who exhibit psychotic behaviors have deficits in

reelin expression linked to genetic loci located on chromosome 22.


b. Individuals with schizophrenia who exhibit psychotic behaviors have deficits in

serotonin linked to genetic loci located on chromosome 16.


c. Individuals with bipolar disorder who exhibit psychotic behaviors have deficits in

gamma-aminobutyric acid (GABA) linked to genetic loci located on chromosome


20.
d. Individuals with schizophrenia who exhibit psychotic behaviors have deficits in
reelin expression linked to genetic loci located on chromosome 18.
ANS: A

Interestingly, loci on chromosomes 18 and 22 have been linked to bipolar disorder and
schizophrenia. Individuals with bipolar disorder, who may exhibit psychotic behavior, have
deficits in reelin expression linked to genetic loci located on chromosome 22, which confers
susceptibility to schizophrenia. The remaining options do not appropriately describe the link
between bipolar disorder and schizophrenia.
PTS: 1

REF: Pages 647-648

7. Hypothalamic-pituitary-adrenal (HPA) system abnormalities exist in a large percentage of

individuals with:
a. Schizophrenia
b. Major depression

c. Mania
d. Panic disorder

ANS: B

Excessive activation of the HPA system resulting in elevated glucocorticoid secretion is found
in a large percentage (30% to 70%) of people with major depression, suggesting that
mechanisms responsible for HPA hormone alterations contribute to the pathophysiologic
condition of depression. HPA system abnormalities do not necessarily exit in individuals
represented by the remaining options.
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REF: Page 648

8. The common property among the three types of medications used to treat depression is that

they:
Increase neurotransmitter levels within the synapse.
Increase neurotransmitter levels in the presynapse.
Decrease neurotransmitter levels in the postsynapse.
Decrease neurotransmitter levels within the synapse.

a.
b.
c.
d.

ANS: A

All available antidepressants share the common property, albeit through different mechanisms,
that increasing monoamine neurotransmitter levels within the synapse is the basis for their
antidepressant effects. The processes by which antidepressants affect depression make the
remaining options untrue.
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REF: Page 648

9. The link between major depression and cortisol secretion is that individuals with depression:
a. Show suppression of plasma cortisol when given dexamethasone.
b. Have a decreased plasma cortisol level, despite the administration of exogenous

corticosteroids.
c. Show that persistently elevated plasma cortisol levels can result in inflammation

that is believed to trigger depression.


d. Have normal plasma cortisol levels throughout the day when they take

antidepressant medication as prescribed.


ANS: C

.
Persistent elevations in cortisol may also induce immunosuppression that compromises the
bodys immune systems to contain inflammation and infectious diseases. Increasing evidence
suggests that inflammation is another risk factor that triggers the onset of depression. The
options related to dexamethasone and exogenous corticosteroids are not true as they apply to
depression and cortisol secretion.
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REF: Page 648

10. A decrease in receptor binding for which neurotransmitter is found in individuals with

depression?
a. Norepinephrine
b. Serotonin

c. Dopamine
d. Acetylcholine

ANS: B

Postmortem and/or brain imaging studies of individuals with depression reveal a widespread
decrease in serotonin 5-HT1A-receptor subtype binding in frontal, temporal, and limbic cortex,
as well as serotonin-transporter binding in cerebral cortex and hippocampus. A decrease in
receptor binding is not observed in the other neurotransmitters.
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REF: Page 650

11. When treating individuals with depression, the result produced by electroconvulsive therapy

(ECT) is believed to be an alteration in:


a. The monoamine systems
b. Serotonin

c. Norepinephrine
d. The limbic system

ANS: A

Although the mechanism of action of ECT is not clear, the procedure is known to produce
alterations in only the monoamine systems.
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REF: Page 652

12. Which electrolyte imbalance contributes to lithium toxicity?


a. Hypernatremia
c. Hyperkalemia
b. Hyponatremia
d. Hypokalemia
ANS: B

Lithium toxicity can be a result of hyponatremia. Lithium is normally removed from the
kidneys; however, when the body is sodium depleted, the kidneys reabsorb sodium along with
lithium. Lithium toxicity does not result from any of the remaining options.
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REF: Pages 652-653

13. Which neurotransmitter is inhibited in panic disorders?


a. Norepinephrine
c. Dopamine
b. Serotonin
d. Gamma-aminobutyric acid (GABA)
ANS: D

Panic disorder also may involve the GABA-benzodiazepine (BZ) receptor system. The other
options are more related to depression.
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REF: Page 654

14. A criterion for a diagnosis of generalized anxiety disorder (GAD) is a period of excessive

worrying that lasts for at least how many months?


c. 9
d. 12

a. 3
b. 6

ANS: B

GAD is diagnosed when an individual spends at least 6 months worrying excessively and
exhibits at least three of the six symptoms. Although 3 months is not sufficient time, the
remaining options are excessive.
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REF: Page 655

15. Individuals who eat aged cheese and avocado when taking monoamine oxidase inhibitors

(MAOIs) may experience:


a. Kidney damage
b. Hypertensive crisis

c. Orthostatic hypotension
d. Weight gain

ANS: B

MAOIs also may induce acute and heightened elevations in blood pressure (e.g., hypertensive
crisis) after the intake of tyramine-rich foods, such as aged cheeses, sour cream, pods of broad
beans, pickled herring, liver, canned figs, raisins, and avocados. The ingestion of tyraminerich foods is not a trigger for the remaining options.
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REF: Page 651

16. Electroconvulsive therapy (ECT) is used to treat depression:


a. In pregnant women
b. By enhancing the effect of antidepressants
c. As a first-line treatment before medications
d. That is unipolar
ANS: A

ECT is used to treat depression when individuals fail to respond to antidepressants or when
they are severely depressed, pregnant, suicidal, or psychotic. The other options are not true
regarding the conditions of this treatment.
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REF: Page 652

17. A notable complication of panic disorder is:


a. Avolition
c. Alogia
b. Anhedonia
d. Agoraphobia
ANS: D

Of the available options, the only notable complication of panic disorder is the development
of agoraphobia or phobic avoidance of places or situations where escape or help is not readily
available.
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REF: Page 654

18. Persistent symptoms of posttraumatic stress disorder (PTSD) include:


a. Depression
c. Nightmares
b. Hypertension
d. Poor nutrition
ANS: C

.
In PTSD, the individual re-experiences the traumatic event as intrusive collections or
flashbacks during the day and during persistent nightmares. Nightmares replicate the
traumatic experiences and often prevent sleep. The remaining options are not typically
attributed to PTSD.
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REF: Page 656

19. Hallucinations, delusions, and thought disorders occur with alterations to which part of the

brain?
a. Temporal lobe
b. Parietal lobe

c. Hypothalamus
d. Cerebral cortex

ANS: A

Only temporal lobe alterations may be responsible for the production of positive
schizophrenic symptoms, such as hallucinations, delusions, and thought disorders.
PTS: 1

REF: Page 642

MULTIPLE RESPONSE
20. Significant numbers of individuals with depression have problems related to: (Select all that

apply.)

a.
b.
c.
d.
e.

Sleep cycles
Weight stabilization
Eating patterns
Thyroid function
Cognitive skills

ANS: A, B, C, D

Insomnia, loss of appetite and body weight, and reduced interest in pleasurable activities and
interpersonal relationships frequently accompany depression. Approximately 20% to 30% of
persons with unipolar depression have an altered hypothalamic-pituitary-thyroid (HPT)
system. Impaired cognitive skills are not necessarily associated with depression.
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REF: Pages 648 | Pages 650-651

21. Which neurotransmitter is inhibited in generalized anxiety disorder (GAD)? (Select all that

apply.)
Acetylcholine
Serotonin
Dopamine
Norepinephrine
Epinephrine

a.
b.
c.
d.
e.

ANS: B, D

Abnormalities in the norepinephrine and serotonin systems were reported in GAD. The other
options are more related to depression.
PTS: 1

REF: Page 655

22. What are the most common side effects of selective serotonin reuptake inhibitors (SSRIs)?

(Select all that apply.)


Orthostatic hypotension
Dry mouth
Sleep disturbances
Agitation
Nausea

a.
b.
c.
d.
e.

ANS: C, E

Common side effects of SSRIs include sleep disturbances (e.g., insomnia) and nausea. The
remaining options are not common side effects of SSRIs.
PTS: 1

REF: Page 652

MATCHING

Match the terms with the corresponding descriptions.


______ A. Delusions
______ B. Formal thought disorder
______ C. Anhedonia
______ D. Hallucinations
______ E. Alogia
______ F. Avolition

23.
24.
25.
26.
27.
28.

Perceptions are experienced without external stimulation of the sense organs.


Persistent beliefs are contrary to the educational and cultural background of the individual.
Fluent speech is difficult to comprehend.
Spontaneous speech is absent.
Condition is characterized by an inability to have emotional experiences.
Condition is characterized by a deficit in spontaneous or goal-directed activities.

23. ANS: D
PTS: 1
REF: Page 644
MSC: A hallucination is a perception experienced without external stimulation of the sense organs.
24. ANS: A
PTS: 1
REF: Page 646
MSC: A delusion is a persistent belief contrary to the educational and cultural background of the
individual.
25. ANS: B
PTS: 1
REF: Page 646
MSC: A common form of disorganized speech is formal thought disorder, which involves fluent
speech that is difficult to comprehend.
26. ANS: E
PTS: 1
REF: Page 646
MSC: Alogia is the absence of spontaneous speech production for the purpose of answering questions
or expressing oneself.
27. ANS: C
PTS: 1
REF: Page 646
MSC: In anhedonia, individuals are unable to experience emotions such as pleasure or pain; they
report a sense of detachment from the environment.
28. ANS: F
PTS: 1
REF: Page 646
MSC: Avolition is a deficit in spontaneous or goal-directed behavior in which an individual may sit
for prolonged periods and must be prodded into completing simple daily tasks.