Exam 4

Question 1

Which receptor is hypothesized to be the major central biological flaw in schizophrenia?

Answer 1

Mesolimbic dopamine pathway — From ventral tegmental area (VTA) to limbic brain, particularly nucleus accumbens
Hyperactive D2 receptors in mesolimbic pathway cause positive sxs, psychosis.
“Mesolimbic dopamine hypothesis of positive symptoms of schizophrenia”
Mesocortical dopamine pathway — From VTA to prefrontal cortices
Deficient DA results in cognitive, negative, affective sxs
“Mesocortical dopamine hypothesis of cognitive, negative, and affective symptoms of schizophrenia”
May be due to abnormal neurodevelopment or to blockade of D2 receptors by APs
Abnormal NMDA-Glu receptors on parvalbumin-containing GABA interneurons in prefrontal cortex:
Cause “dysconnectivity” w/ the presynaptic Glu neurons since the GABA neurons cannot be properly excited
Causes GABA interneurons to release too little GABA to bind to postsynaptic Glu pyramidal neurons
Causes disinhibition/hyperactivity of those Glu “pyramidal neurons” (neurons that project to other areas)
Leads to “downstream” dysfunction (in circuits, other brain areas)
Hyperactive prefrontal Glu neurons that project to DA neurons in VTA that form the mesolimbic pathway:
Cause hyperactive mesolimbic pathway
Causes positive sxs of schizophrenia, psychosis in general)
Similar problem occurs in ventral hippocampus.
Hyperactive Glu neurons project to GABA neurons in nucleus accumbens that project to GABA neurons in globes pallidus (part of the basal ganglia) that project to DA neurons in VTA that form the mesolimbic pathway:
Cause same hyperactive mesolimbic pathway, positive sxs
Hyperactive prefrontal Glu neurons that project to GABA interneurons in VTA that synapse w/ DA neurons that form the mesocortical pathway:
Cause hypoactive mesocortical pathway
Causes cognitive, negative, affective sxs of schizophrenia

Question 2

What is the strongest predictor of real-world functioning in patients suffering from schizophrenia?

Answer 2

Cognitive/Executive symptoms are the strongest predictors of real-world functioning in schizophrenia.

Question 3

Why might patients with schizophrenia have difficulty interpreting social cues and have distortions in social judgment and reasoning?

Answer 3

(a) their amygdalae are hyperactive when viewing neutral faces
(b) their amygdalae are hypoactive when viewing scary faces
(c) they suffer dysconnectivity between emotion and goal-directed behavior.

Question 4

T/F Neuroimaging and neuropsychological assessment have the potential (hopefully in the not-to-distant future) to identify early, subclinical, or pre- symptomatic patients w/ schizophrenia.

Answer 4

T

Question 5

What are the different symptom profiles of major depression that are associated with abnormalities of 5-HT?

Answer 5

Low “level” of 5-HT system is associated with increased “negative affect.”
Dysphoria, rumination, guilt/disgust, worthlessness, loneliness, fear/anxiety, irritability, hostility, suicidality
Particularly affects prefrontal cortex, amygdala, hypothalamus

Question 6

T/F Symptoms of fatigue, difficulty concentrating, sleep problems or psychomotor retardation/agitation may occur in someone with an anxiety disorder or a mood disorder.

Answer 6

T

Question 7

T/F A major hypothesis is that the biologic basis of bipolar symptoms may be due to unstable “out-of-tune” circuits, resulting in inefficient information processing during both manic and depressive episodes.

Answer 7

T

Question 8

T/F Mistakenly diagnosing bipolar depression as being unipolar depression (i.e., major depressive disorder) is a minor mistake.

Answer 8

F

Question 9

What does NMDA-R hypofunction in patients suffering from schizophrenia cause?

Answer 9

(a) hypoactivity of the mesocortical pathway, resulting in cognitive, negative and affective symptoms
(b) hyperactivity of the mesolimbic pathway, resulting in positive symptoms.

Question 10

What are fear and panic associated with?

Answer 10

Dysfunction of circuits that involve the

amygdala

Question 11

What are worry and obsession associated with?

Answer 11

Dysfunction of circuits that involve the cortex, basal ganglia (striatum), and thalamus.

Question 12

T/F Numerous medical conditions can cause depression, mania, or anxiety even when
these affect other body systems in addition to the CNS.

Answer 12

T

Question 13

It has been disproven that all drugs of abuse and behavioral addictions cause intense and phasic DA firing in the mesolimbic pathway shortly after taking the drug or engaging in the behavior and hypofunction of the mesolimbic pathway during withdrawal (DA deficit).

Answer 13

F

Question 14

What is compulsive drug use linked to?

Answer 14

(a) neuroplastic changes with the DA reward circuit down-regulating (tolerance) and the compulsive (habit) circuit getting stronger
(b) craving caused by classical conditioning to associated stimuli
(c) associative learning/conditioning

Question 15

What is one of the major reasons why the benefits of drug rehab programs often do not last unless there is follow-up treatment designed to offset it?

Answer 15

Associative learning/conditioning

Question 16

Which type of neurocognitive disorder (NCD) is most associated w/ beta-amyloid (neuritic) plaques and neurofibrillary tangles in addition to impairments in declarative memory, language, and other cognitive impairments?

Answer 16

Alzheimer’s disease

Question 17

What is NCD due to frontotemporal lobar degeneration (“frontotemporal dementia”) is associated with?

Answer 17

Primarily executive dysfunction and changes in mood and behavior

Question 18

Patients w/ Alzheimer’s disease (AD) eventually have severe memory and other cognitive impairments but may not have emotional, behavioral, or perceptual
abnormalities.

Answer 18

F

Question 19

What is the “gold standard” for diagnosing AD in a living pt?

Answer 19

A medical workup (H&P, labs, neuroimaging) and neuropsychological assessment.

Question 20

T/F In this course, Dr. Burke clearly expressed his belief (and supported that belief with many examples) that psychiatric sx’s that occur during neurological or other medical illnesses/conditions are often due to the pathology of the illnesses/ conditions and not just psychological reactions to having such illnesses/conditions. However, there may also be psychological reactions superimposed on the primary
sxs.

Answer 20

T

Question 21

T/F Before beginning individual psychotherapy with a client with a mood or anxiety disorder, a therapist should review past medical records and recommend a current medical evaluation (unless a recent one within the last several months has already been performed).

Answer 21

T

Question 22

What is the best technique/method for predicting real-world functioning after a CNS injury?

Answer 22

Neuropsychological assessment
Studying pts w/ lesions compared to normals has provided invaluable insights into brain-behavior relationships.
Caution — Because function “x” is lost by a lesion in area “A” does not mean that “A” is the sole site responsible for “x.”
Doing so w/ reliable, valid instruments, combined w/ qualitative observations, is one of greatest contributions.
Sometimes, is important for differential diagnosis or forensic issues
Most often, is invaluable for measuring:
Pt’s strengths, weaknesses
Addressing questions about treatment, rehabilitation, functioning in real-world activities
Interdisciplinary, comprehensive approaches hold greatest promise.
Combining numerous neuroimaging techniques and neuropsychology may get most complete, accurate picture for Dx, Tx, understanding of brain behavior relationships.
Every technique has strengths, limitations.

Question 23

Lesions in which region of the prefrontal cortex may cause cognitive inflexibility and perseveration?

Answer 23

Dorsolateral prefrontal cortex (DLPFC).

Question 24

Lesions in which region of the prefrontal cortex may cause significant behavioral disinhibition (e.g., angry outbursts); inappropriate social interactions with fellow employees; and decreased concern for social rules?

Answer 24

Orbitofrontal cortex (OFC)

Question 25

Which period is the most critical for a woman to avoid drugs, stress, or toxins?

Answer 25

1st trimester

Question 26

T/F The benefits of complex environments for offspring may occur if the offspring themselves were raised in complex environments or if the mothers were exposed to complex environments during pregnancy; and the benefits include larger, more adaptable brains.

Answer 26

T

Question 27

What might ADHD patients suffer from?

Answer 27

Dysfunction of the dorsal portion of the ACC,

prefrontal cortex, and basal ganglia (including loops that connect these structures).

Question 28

What has ADHD been associated with?

Answer 28

ADHD has been associated with genetic factor(s) or maturational delay

Question 29

What are the usual causes of the academic and interpersonal difficulties experienced by ADHD patients?

Answer 29

Abnormal attention and executive functioning, not primary dysfunction of such structures as the hippocampus

Question 30

What are the most significant negative outcomes caused by closed-head injury (CHI)?

Answer 30

Executive, emotional, personal, social, and vocational difficulties. However, they also may suffer from deficits in attention, information processing speed, and memory. Most of these are due to lesions in the frontal and temporal lobes; but damage to axons and edema may cause disconnection between areas and overall decreased efficiency.

Question 31

T/F Due to the potential severity and complexity of impairment, comprehensive
neuropsychological assessment is more important for patients who have suffered a
CHI, compared to patients who have suffered a penetrating head injury or postconcussive syndrome with no previous head injury.

Answer 31

T

Question 32

What might chronic overactivity of the HPA-axis lead to?

Answer 32

The release of high levels of cortisol

Question 33

What might the release of high levels of cortisol lead to?

Answer 33

(a) inhibit the immune and reproductive systems (libido, reproductive hormones)
(b) cause appetite/weight gain and glucose intolerance
(c) increase the risk for depression, anxiety, and cognitive dysfunction

Question 34

What are the two biochemical systems that stress activates including the differences between them, when the effects of each occurs, and the duration of those effects relative to each other?

Answer 34

(Hint: one involves NE via the sympathetic
nervous system and the other involving cortisol via the HPA-axis)

Two separate biochemical pathways activated.
“Fast response” by norepinephrine/epinephrine released via the sympathetic nervous system (SNS)
Effects within seconds, but only lasts minutes
Prepares body for sudden burst of activity
“Slow response” by cortisol (the main glucocorticoid) released via the hypothalamic-pituitary-adrenal (HPA) axis
Activated in minutes to hours and may last hours Prepares body for longer-lasting adaptations
Restores energy that has been expended
Promotes gluconeogenesis, lypolysis, protein catabolism (breakdown)
Raises blood glucose levels
But chronic output may increase risk of insulin-resistant diabetes, muscle weakness/wasting.
Cortisol shuts down systems not immediately needed to deal with stressor.
Inhibits immune system
Can lead to infections

Question 35

What are the different symptom profiles of major depression that are associated with abnormalities of DA?

Answer 35

Low “level” of DA system is associated with decreased “positive affect.”
Dysphoria, anhedonia, loss of motivation & enthusiasm, apathy, anergia or psychomotor retardation, impaired attention & cognition, decreased self-confidence
Particularly affects prefrontal cortex, nucleus accumbens, basal ganglia, hypothalamus

Question 36

What are the different symptom profiles of major depression that are associated with abnormalities of NE?

Answer 36

Low “level” of NE system is associated with increased “negative affect” and decreased “positive affect.”