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

Question 1

Which would be considered a positive symptom of schizophrenia?

a. Blunted affect
b. Auditory hallucinations
c. Poverty of speech
d. Lack of social interaction

Answer 1

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.

Question 2

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

Answer 2

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.

Question 3

Which neurotransmitter is reduced in people with schizophrenia?

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

Answer 3

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.

Question 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 
c. Temporal lobe 
d. Hypothalamus

Answer 4

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.

Question 5

Antipsychotic drugs block which neurotransmitter receptor?

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

Answer 5

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.

Question 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.

Answer 6

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.

Question 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

Answer 7

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.

Question 8

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.

Answer 8

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.

Question 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.

Answer 9

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.

Question 10

A decrease in receptor binding for which neurotransmitter is found in individuals with
depression?
a. Norepinephrine 
b. Serotonin
c. Dopamine 
d. Acetylcholine

Answer 10

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.

Question 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

Answer 11

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

Question 12

Which electrolyte imbalance contributes to lithium toxicity?

a. Hypernatremia
b. Hyponatremia
c. Hyperkalemia
d. Hypokalemia

Answer 12

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.

Question 13

Which neurotransmitter is inhibited in panic disorders?

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

Answer 13

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

Question 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?
a. 3
b. 6
c. 9
d. 12

Answer 14

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.

Question 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

Answer 15

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.

Question 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

Answer 16

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.

Question 17

A notable complication of panic disorder is:

a. Avolition
b. Anhedonia
c. Alogia
d. Agoraphobia

Answer 17

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.

Question 18

Persistent symptoms of posttraumatic stress disorder (PTSD) include:

a. Depression
b. Hypertension
c. Nightmares
d. Poor nutrition

Answer 18

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.

Question 19

Hallucinations, delusions, and thought disorders occur with alterations to which part of the
brain?
a. Temporal lobe 
c. Hypothalamus
b. Parietal lobe 
d. Cerebral cortex

Answer 19

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

Question 20

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

Answer 20

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.

Question 21

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

apply. )
a. Acetylcholine
b. Serotonin
c. Dopamine
d. Norepinephrine
e. Epinephrine

Answer 21

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

Question 22

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

Answer 22

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.

Question 23

Perceptions are experienced without external stimulation of the sense organs.

Answer 23

Hallucinations

Question 24

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

Answer 24

Delusions

Question 25

Fluent speech is difficult to comprehend.

Answer 25

Formal thought disorder

Question 26

Spontaneous speech is absent.

Answer 26

Alogia

Question 27

Condition is characterized by an inability to have emotional experiences.

Answer 27

Anhedonia

Question 28

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

Answer 28

Avolition