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

The onset of schizophrenia can be triggered by which prenatal occurrence? a. Viral infection b. Maternal depression c. Maternal smoking 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.

The common property among the three types of medications used to treat depression is that they: a. Increase neurotransmitter levels within the synapse. b. Increase neurotransmitter levels in the presynapse. c. Decrease neurotransmitter levels in the postsynapse. d. Decrease neurotransmitter levels within the synapse.

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.

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.

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.

Persistent beliefs are contrary to the educational and cultural background of the individual.

Delusions

Fluent speech is difficult to comprehend.

Formal thought disorder

Perceptions are experienced without external stimulation of the sense organs.

Hallucinations

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.

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.

Significant numbers of individuals with depression have problems related to: (Select all that apply.) a. Sleep cycles b. Weight stabilization c. Eating patterns d. Thyroid function e. 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.

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.

A criterion for a diagnosis of generalized anxiety disorder (GAD) is a period of excessive worrying that lasts for at least how many months? a. 3 c. 9 b. 6 d. 12

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.

Which neurotransmitter is reduced in people with schizophrenia? a. Dopamine b. Gamma-aminobutyric acid c. Acetylcholine 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.

Which electrolyte imbalance contributes to lithium toxicity? a. Hypernatremia b. Hyponatremia c. Hyperkalemia 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.

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 tyramine-rich foods is not a trigger for the remaining options.

Which would be considered a positive symptom of schizophrenia? a. Blunted affect b. Auditory hallucinations c. Poverty of speech 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.

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.

Which neurotransmitter is inhibited in generalized anxiety disorder (GAD)? (Select all that apply.) a. Acetylcholine b. Serotonin c. Dopamine d. Norepinephrine e. Epinephrine

ANS: B, D Abnormalities in the norepinephrine and serotonin systems were reported in GAD. The other options are more related to depression.

Persistent symptoms of posttraumatic stress disorder (PTSD) include: a. Depression b. Hypertension c. Nightmares 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.

Alterations in which part of the brain are linked to hallucinations, delusions, and thought disorders associated with schizophrenia? a. Parietal lobe b. Limbic system c. Temporal lobe d. Hypothalamus

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

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 body's 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.

What are the most common side effects of selective serotonin reuptake inhibitors (SSRIs)? (Select all that apply.) a. Orthostatic hypotension b. Dry mouth c. Sleep disturbances d. Agitation e. Nausea

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.

A notable complication of panic disorder is: a. Avolition b. Anhedonia c. Alogia 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.

Which neurotransmitter is inhibited in panic disorders? a. Norepinephrine b. Serotonin c. Dopamine 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.

Antipsychotic drugs block which neurotransmitter receptor? a. Norepinephrine b. Gamma-aminobutyric acid c. Serotonin 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.

Spontaneous speech is absent.

Alogia

Condition is characterized by an inability to have emotional experiences.

Anhedonia

Condition is characterized by a deficit in spontaneous or goal-directed activities.

Avolition