Patho Chapter 48 neurobiology of psychotic illnesses

It is true that the "negative" symptoms of schizophrenia a. are more easily managed than the positive symptoms. b. are thought to be mediated by D1 receptors in the brain. c. include rambling speech and delusional thoughts. d. are as a result of a deficiency of brain dopamine.

ANS B Negative symptoms of schizophrenia are thought to be associated with dopamine D1 receptor activity in the brain. Negative symptoms can be more difficult to recognize than positive symptoms. Rambling speech and delusional thoughts are positive symptoms. The positive symptoms of schizophrenia are thought to result from excessive dopamine D2 receptor activity in the brain

Depression is thought to be associated with a. abnormal personality development. b. early childhood emotional trauma. c. deficient brain norepinephrine and serotonin. d. excessive stimulation of D1 and D2 receptors in the brain.

ANS: C Depression is thought to occur when serotonin and norepinephrine activity in the brain is low. Depression is not associated with abnormal personality development. Early childhood emotional trauma is not necessarily associated with depression. Symptoms associated with schizophrenia are thought to be related to dopamine receptors

Schizophrenia is characterized by a. generalized anxiety. b. depression. c. disorganized thinking. d. eating disorders.

ANS: C Schizophrenia is now correctly understood as a split or separation among normally well-synchronized brain functions. This loss of synchronized brain functioning leads to thoughts, behaviors, and feelings that are disordered, disorganized, and disconnected from reality. Generalized anxiety and eating disorders are not associated with schizophrenia. Schizophrenia is not characterized by depression.

Lithium is used to manage mania because it a. inhibits norepinephrine and serotonin activity in the brain. b. is a CNS sedative. c. is converted to catecholamines within the brain. d. blocks D2 receptors in the brain.

ANS: A The management of mania is accomplished with the use of lithium because it inhibits the action of norepinephrine and serotonin in the brain. Mania is not managed with the use of a CNS sedative. The mechanism of lithium is not related to a conversion of catecholamine in the brain. Lithium does not have a mechanism of action where D2 receptors in the brain are blocked.

The action of most antidepressants currently available is to a. improve brain norepinephrine and serotonin activity. b. inhibit norepinephrine and serotonin activity. c. convert into catecholamines in the brain. d. block D2 receptors in the brain.

ANS: A Most currently available antidepressants act by improving brain norepinephrine and serotonin activity. Earlier generations of antidepressants had less specific effects on these neurotransmitters and significantly more side effects. The action of antidepressants is unrelated to conversion of catecholamines in the brain. D2 receptors in the brain are not blocked by antidepressants

________ is a term used to describe a serious and debilitating mental state. a. Psychosis b. Schizophrenia c. Major depressive disorder d. Dysthymia

ANS: A Psychosis is a term used to describe a serious and debilitating mental state. The narrowest definition refers to delusions and prominent hallucinations. Schizophrenia refers to a chronic, remitting, and relapsing psychotic disorder. Major depressive disorder involves a complex diagnosis which encompasses depression symptoms. Dysthymia is associated with long-term depression.

The schizophrenia category which indicates that the disturbance has continued but the active-phase symptoms are no longer met is the _____ Type. a. Residual b. Undifferentiated c. Paranoid d. Disorganized

ANS: A The Residual Type indicates that the disturbance has continued but the active-phase symptoms are no longer met. The Undifferentiated Type is essentially a catch-all category where the individual does not meet criteria for any of the other subtypes. The Paranoid and Disorganized Types are the least severe (in that order). The Paranoid and Disorganized Types are the least severe (in that order).

The symptoms of hallucinations and paranoia that accompany schizophrenia are thought to be as result of altered neurotransmitter activity in the brain, which results in excessive ________ receptor activation. a. D2 b. serotonin c. -adrenergic d. acetylcholine

ANS: A The positive symptoms of schizophrenia are thought to result from excessive dopamine D2 receptor activity in the brain. Depression is thought to be related to decreases in serotonin. Hallucinations and paranoia that accompany schizophrenia are not the result on excessive -adrenergic receptor activation. Excessive acetylcholine receptor activation is not the cause of hallucinations or paranoia

When a client is diagnosed with schizophrenia and asks what could have caused the disorder, the statements that could serve as a basis for answering include which of the following? (Select all that apply.) a. Schizophrenia may be related to abnormal cerebral structure. b. Schizophrenia is inherited as an autosomal recessive gene defect. c. Schizophrenia often develops in the absence of family psychopathology. d. Chronic prolonged stress may contribute to development of schizophrenia. e. Symptoms of schizophrenia may be associated with smoking

ANS: A, C, D A groundbreaking study showed that the neurochemical basis of schizophrenia might involve two processes: dopamine neurotransmission dysregulation and abnormal cerebral structure. Schizophrenia can and does develop in persons with no family history. In MRI studies of persons with schizophrenia, a link was found when psychological stress was placed on an individual. Genetic studies have found that the percentage of offspring who do and do not develop schizophrenia is about equal. Tobacco dependence is a common secondary disorder with schizophrenia.

Which symptoms would support a diagnosis of major depressive disorder? (Select all that apply.) a. Diminished interest or pleasure b. Incomprehensible speech c. Altered reality d. Psychomotor agitation or retardation e. Appetite disturbance

ANS: A, D, E To be diagnosed with MDD, an individual must experience five (or more) specified symptoms during the same 2-week period; this must also represent a change from previous functioning. In addition, at least one of the symptoms must be either depressed mood or loss of interest or pleasure. Symptoms include depressed mood, diminished interest or pleasure, appetite disturbance, insomnia, hypersomnia, psychomotor agitation, or retardation. Incomprehensible speech is associated with a positive symptom of schizophrenia. Altered reality is a symptom of psychosis.

Researchers suggest a mediating role between the later development of schizophrenia and a. prenatal radiation exposure. b. prenatal influenza exposure. c. childhood vaccinations. d. childhood chickenpox.

ANS: B Researchers have suggested that delivery complications could be a factor, playing a mediating role between prenatal influenza exposure and later development of schizophrenia. Prenatal radiation exposure is not a suggested mediator in the development of schizophrenia. The development of later schizophrenia is not suggested to be associated with childhood vaccinations. It is not suggested that childhood chickenpox is related to the development of schizophrenia.

The usual age of onset for schizophrenia in men is a. before puberty. b. 15 to 25 years. c. 40 to 65 years. d. after 65 years.

ANS: B The most common age of onset and diagnosis is between 15 and 25 years for men. Women are typically diagnosed between 25 and 35 years. Most persons first diagnosed with schizophrenia are between the ages of 15 and 54 years. The usual age of onset of schizophrenia occurs before the age of 25.

Which statement is true about the incidence of mental illness? a. There are minimal differences in how cultures view mental health. b. Women have twice the risk of experiencing anxiety disorders than men. c. Men are more likely to suffer from depression and anxiety than women are. d. Mood disorders are not likely to occur after the age of 65.

ANS: B Women are more than twice as likely to suffer from depression (including unipolar depression, dysthymia) and anxiety disorders (including panic disorder, post-traumatic stress disorder, generalized anxiety disorder, social anxiety, and phobias) than men. There are known differences in how cultures and regions around the world view mental health, and thus in how they express concerns about the body, self, and emotions. Reproductive hormones may play a role in exacerbating anxiety and depression in women. Mood disorders in the elderly are likely to be associated with concomitant illnesses or treatment.

Drugs that inhibit reuptake of norepinephrine or serotonin may be helpful in the management of a. schizophrenia. b. panic attacks. c. depression. d. delusional disorder.

ANS: C The management of major depressive disorder is aimed at increasing norepinephrine and serotonin activity in the brain. The goal of therapy in the management of schizophrenia is to alleviate some of the negative symptoms by blocking D1 receptors. Drugs that inhibit the reuptake of norepinephrine or serotonin are not useful in managing panic attacks. Delusional disorder is not managed with drugs that inhibit the reuptake of norepinephrine or serotonin.

Childlike silliness in a patient with schizophrenia is known as a. delusions. b. disorganized thinking. c. grossly disorganized behavior. d. asociality.

ANS: C Grossly disorganized behavior can range from childlike silliness to unpredictable agitation, and impairs tasks of daily living. Delusions, or systematic, fixed, false beliefs, usually involve themes of persecution, REF, somatization, religiosity, or grandiosity. Disorganized thinking is usually evaluated by an individual's speech, and is frequently characterized by frequent derailment or loose associations, invented words, tangential idea, and, when most severe, incomprehensible speech. Asociality is a negative symptom of schizophrenia.

An elderly patient is taking antipsychotic drugs and begins to develop involuntary chewing motions. The patient is likely exhibiting signs of a. dementia. b. Parkinson disease. c. tardive dyskinesia. d. dysthymia.

ANS: C Older patients may suffer side effects such as tardive dyskinesia, a disorder related to antipsychotic drug dosage and duration and characterized by involuntary chewing motions and darting of the tongue. It is generally accepted practice that antidepressants should be prescribed at lower dosages and titrated upward more slowly in the elderly. Antipsychotic medication use is not related to the development of dementia. Parkinson disease is not diagnosed by involuntary chewing motions. Dysthymia is related to major depressive disorder

Drug therapy with a dopamine receptor antagonist is initiated to manage a patient's symptoms of schizophrenia. The goal of treatment is to a. increase dopamine activity. b. reduce serotonin activity. c. stabilize dopamine activity. d. effect serotonin and norepinephrine neurotransmitters.

ANS: C The aim for effective antipsychotic medication is to stabilize, rather than reduce, dopamine activity. The newest medications show greater affinity for serotonin receptors (negative symptoms) and moderate affinity for dopamine and norepinephrine receptors (positive symptoms).

In youth, it is estimated that ____ will be diagnosed with serious mental illness between the ages of 13 and 18 years. a. 5% b. 26.2% c. 46.3% d. 75%

ANS: C I n youth, 46.3% will be diagnosed with serious mental illness between the ages of 13 and 18 years. In the United States today, approximately 5% of all adults meet criteria for serious mental illness. 26.2% of the U.S. adult population will have experienced an SMI in the previous year. 75% of youth are not diagnosed with serious mental illness.

Mania and depression are both characterized by a. high energy and hyperactivity. b. poor appetite. c. hopelessness. d. altered decision making ability.

ANS: D Depression is manifested by reduced decision making capacity and mania is manifested by an inability to concentrate. High energy and hyperactivity is seen in mania only. Depression is manifested by poor appetite, whereas mania is associated with an increased appetite. Hopelessness is associated with depression.

Which manifestation is characteristic of the "positive" symptoms of schizophrenia? a. Social withdrawal b. Flat affect c. Lack of speech d. Hallucinations

ANS: D Positive symptoms include the psychotic dimension, or distortions in thought content (delusions) and perception (hallucinations), as well as the disorganization dimension, or disorganization in speech and behavior. Asociality is considered a negative symptom. Flat affect is considered to be a cognitive symptom. Lack of speech is not considered to be a positive symptom of schizophrenia.

A client who reported hearing voices, some of them saying bad and hurtful things, will now eat only food from unopened sealed packages. The behaviors described indicate that the patient may be experiencing _____ symptoms. a. bipolar b. obsessive-compulsive c. personality d. psychotic

ANS: D Psychosis associated with MDD is thought to result from extreme symptoms of a prolonged duration. Auditory hallucinations, delusions, and disorganization may become prominent symptoms. Bipolar disorder is characterized by recurring symptoms of depression and elation. Obsessive-compulsive disorder is not typically evidenced by withdrawn behavior or auditory hallucinations. Withdrawn behavior and auditory hallucinations are symptoms of psychosis

A mild form of hyperactivity in which social functioning is not significantly impaired is called a. anhedonia. b. dysphoria. c. dysthymia. d. hypomania.

ANS: D The individual experiencing hypomania has a sudden onset of increased energy, expanded self-esteem, and decreased anxiety; these typically are reported to have improved his or her productivity and are experienced as an acceptable natural high. Anhedonia is a loss of pleasure. Dysphoria is not a condition in which social functioning is not impaired. Depression with one or two symptoms that last 2 years or more is commonly referred to as dysthymia.

The assessment of a client recently diagnosed with schizophrenia confirms good cognitive function and reveals affect that is animated. The client is open about describing the voices and the content of their comments, but demonstrates a disorganized thought process. These findings suggest that a. "negative" psychotic symptoms predominate. b. there is a high risk for suicidal behaviors. c. drug therapy is likely to be ineffective. d. "positive" psychotic symptoms predominate.

ANS:D Positive symptoms of schizophrenia include the psychotic dimension and distortions of thought and perception, as well as the disorganization dimension. Auditory hallucinations are commonly experienced as voices. Negative symptoms are considered to be restricted affect, or asociality. The patient in this scenario does not appear to be at high risk for suicidal behaviors. The findings suggested do not indicate that the patient has ineffective drug therapy