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Chapter 8 Practice Exam Questions

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Konstantine Zakzanis

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Chapter 8: Mood Disorders LEARNING GOALS 1. Be able to describe the symptoms of depression and mania, the diagnostic criteria for depressive disorders and bipolar disorders, and the epidemiology of these disorders. 2. Be able to discuss the genetic, neurobiological, social, and psychological factors that contribute to the symptoms of mood disorders. 3. Be able to identify the medication and psychological treatments of depressive and manic symptoms, and the current views of electroconvulsive therapy. 4. Be able to explain the epidemiology of suicide, the neurobiological, social, and psychological risk factors associated with suicide and methods for preventing suicide. Summary Clinical Descriptions and Epidemiology  There are two broad types of mood disorders: depressive disorders and bipolar disorders.  Depressive disorders include major depression and dysthymia, and bipolar disorders include bipolar I disorder, bipolar II disorder, and cyclothymia.  Bipolar I disorder is defined by mania or mixed episodes. Bipolar II disorder is defined by hypomania and episodes of depression. Major depressive disorder, bipolar I disorder, and bipolar II disorder, are episodic. Recurrence is very common in these disorders.  Dysthymia and cyclothymia are characterized by low levels of symptoms that last for at least two years.  Major depression is one of the most common psychiatric disorders, affecting as many as 16.2% of people during their lifetime. Rates of depression are twice as high in women as in men. Bipolar I disorder is much more rare, affecting approximately 1% of people. Etiology  Genetic studies provide evidence that bipolar disorder is strongly heritable and that depression is somewhat heritable.  Neurobiological research has focused on the sensitivity of postsynaptic receptors rather than on the amount of various transmitters, with the strongest evidence for changes in serotonin receptors in depression, and potential changes in the dopamine receptors within the reward system as related to mania.  Bipolar and unipolar disorders seem tied to elevated activity of the amygdala, and diminished activity in regions of the prefrontal cortex, the hippocampus, and the anterior cingulate.  Overactivity of the hypothalamic-pituitary-adrenal axis is also found among depressive patients, manifested by high levels of cortisol and poor suppression of cortisol by dexamethasone.  Socioenvironmental models focus on the role of negative life events, lack of social support, and family criticism as triggers for episodes, but also consider ways in which a person with depression may elicit negative responses from others. People with weaker social skills and those who tend to seek more excessive reassurance are at elevated risk for the development of depression.  Psychological theories of depression include psychoanalytic, emotion and personality, and cognitive models. Psychoanalytic formulations focus on anger turned inward, but this idea has not been supported. Neuroticism appears to consistently predict the onset of depression. Beck’s cognitive theory ascribes causal significance to negative schemata and cognitive biases.According to hopelessness theory, low self-esteem or beliefs that an event will have long-term meaningful consequences can instill a sense of hopelessness, which is expressed in a specific set of depressive symptoms called hopelessness depression.  Psychological theories of depression in bipolar disorder are similar to those proposed for unipolar depression. Some researchers have proposed that mania may arise after negative experiences, but others suggest that it stems from dysregulation in the reward system in the brain, so that it can be triggered by life events involving success and unrealistically positive cognitions about future goals. Treatment  Several psychological therapies are effective for depression, including interpersonal therapy, cognitive therapy, social-skills therapy, behavioral activation therapy, and behavioral marital therapy.  The major approaches that have been found to help as adjuncts to medication for bipolar disorder include psychoeducation, family therapy, and cognitive therapy.  Electroconvulsive shock and several antidepressant drugs (tricyclics, selective serotonin reuptake inhibitors, and MAO inhibitors) have proved their worth in lifting depression. Lithium is the best-researched treatment for prevention of mania, but Depakote and Olanzapine also help decrease manic symptoms. Suicide  Men, elderly people, and people who are divorced or widowed are at elevated risk for suicide. Most people who commit suicide meet diagnostic criteria for psychiatric disorders, with more than half experiencing depression. Suicide is at least partially heritable, and neurobiological models focus on serotonin and over- activity in the HPA. Social changes are common precedents to anomic suicide. Individual vulnerability may be tied to difficulty achieving high goals, poor problem-solving, hopelessness, lack of reasons to live, and low life satisfaction.  Several approaches have been taken to promote prevention. For people with a mental illness, psychological treatments and medications to quell symptoms help reduce suicidality. However, many people believe it is important to address suicidality more directly. Problem-solving therapy has shown promise in reducing suicidal behavior, but not all results have been positive. Suicide hotlines are found in most cities, but it has been hard to conduct research demonstrating that these work. 1. Vanessa reported feeling a lack of energy, difficulty sleeping, loss of appetite, difficulty concentrating, and a loss of interest in activities she previously enjoyed. Based on this information, which of the following is the most likely diagnosis for Vanessa? a. eating disorder b. major depression c. bipolar disorder d. generalized anxiety disorder Answer: B Type:Applied Page: 230-231 2. Which of the following is considered an uncommon symptom of depression? a. Increased activity level; agitation b. Sleeping more than usual. c. Sleeping less than usual. d. All of the above are common symptoms of depression. Answer: D Type: Factual Page: 230-231 3. Jacqueline has been depressed, ongoing, for the past three years. Based on this information, the best diagnosis for Jacqueline would be a. dysthymic disorder. b. cyclothymic disorder. c. bipolar disorder. d. major depressive episode. Answer:AType:Applied Page: 231 4. Which of the following factors have NOT been proposed as an explanation for the gender difference in depression? a. Girls are more likely to be exposed to sexual abuse than boys. b. Women tend to be more creative than men. c. Women are more likely to be exposed to chronic stressors in adulthood. d. Social roles promote emotion-focused coping among women. Answer: B Type: Factual Page: 232 Focus on Discovery 8.1 5. Jack reports being in a wonderful mood. He has been very active at work lately, even working far into the night, as he seems to need only a few hours of sleep at night. He is very talkative and quickly moves from one topic to another, describing a scheme he has for making a fortune in the stock market. Which of the following diagnoses would best fit Jack? a. overanxious disorder b. dysthymic disorder c. bipolar disorder d. cyclothymia. Answer: C Type: Applied Page: 233 6. Which of the following diagnoses have been referred to as the “common cold of mental illness”? a. major depression b. dysthymic disorder c. bipolar disorder d. cyclothymia Answer:AType: Factual Page: 231 7. Jacob is 77 years old and has begun to complain of difficulty in concentration and memory problems. He lives alone and does not have any major medical problems. On the basis of this information, Jacob likely has a. alcoholism. b. panic disorder. c. depression. d. All of the above are equally likely. Answer: C Type:Applied Page: 231 8. Which of the following people is least likely to have major depression? a. a 45-year-old wealthy woman b. a 35-year-old unemployed man c. a 20-year-old wealthy man d. a 19-year-old woman who has had one episode of depression in the past Answer: C Type:Applied Page: 231 9. The DSM-IV recognizes which of the following forms of bipolar disorders? a. bipolar I and bipolar II b. bipolar I, bipolar II and cyclothymia c. bipolar and cyclothymia d. bipolar I, bipolar II and bipolar III Answer: B Type: Factual Page: 233-234 10. Which of the following statements is true? a.All people who experience manic symptoms will experience symptoms of depression at some point during their lifetime. b. An episode of depression is required for the diagnosis of Bipolar I. c.An episode of depression is required for the diagnosis of Bipolar II. d. All of the above are true. Answer: C Type: Factual Page: 234 11. “Flight of ideas” refers to a. a schizophrenic's delusional thinking. b. a depressed person's suicidal thinking. c. the thinking of a person with dementia. d. a manic person's rapid shifts of topic while speaking. Answer: D Type: Factual Page: 233 12. To be diagnosed with bipolar I, a person a. must be currently experiencing manic symptoms. b. must have experienced hypomanic symptoms as well as depressive symptoms at some point in their life. c. must have had at least one episode of mania or a single mixed episode at some point in their life. d. must have experienced at least one depressive episode. Answer: C Type: Factual Page: 233 13. Which of the following best describes hypomania? a. A type of mania that alternates with depression. b. Atype of mania more common in dysthymic patients. c.Amore severe form of mania. d. Aless severe form of mania. Answer: D Type: Factual Page: 233 14. Which of the following is a chronic, milder form of bipolar disorder? a. dysthymic disorder b. cyclothymic disorder c. manic-depression d. hypomanic disorder Answer: B Type: Factual Page: 234 15. In a given day,Alan experiences severe depression as well as episodes of extreme elation. Based on this information only,Alan a. probably only has mania. b. is experiencing a mixed episode. c. may not meet criteria for bipolar disorder. d. has an excellent prognosis. Answer: B Type:Applied Page: 233 16. Juan has symptoms of sad mood most of the day, increased sleep, agitation, poor appetite, and concentration difficulties. Julia, on the other hand, has symptoms of loss of interest in activities, lethargy, increased appetite, feelings of worthlessness, and recurrent thoughts of death. What can be concluded regarding Juan and Julia? a. Both Juan and Julia have major depression, and have it at a similar level of severity. b. Juan has mania, whereas Julia has major depression. c. Both have major depression, but it is unclear whether they are qualitatively part of the same class. d. Both have bipolar I disorder. Answer: C Type:Applied Page: 235 17. Every winter for the past three years, Natalie has felt extremely depressed for a period of months and is unable to keep up with her responsibilities because of her low energy and difficulty concentrating. She always appears to feel better by early spring and is at her best during the summer. Which of the following DSM-IV diagnoses would best fit Natalie? a. cyclothymic disorder b. major depression--melancholic subtype c. major depression--seasonal type d. Natalie’s symptoms reflect normal mood fluctuations and would not be given a DSM- IV diagnosis. Answer: C Type:Applied Page: 235 18. In the past year, John has had three depressive episodes and two manic episodes. Which of the following DSM-IV diagnoses would best fit John? a. bipolar I disorder-rapid cycling type a. bipolar II disorder-rapid cycling type c. cyclothymia d. major depressive disorder-rapid cycling type Answer:AType:Applied Page: 235 19. The mood disorder subtype of “melancholic” describes people who a. sleep virtually all the time. b. have little energy or motivation. c. feel no pleasure in anything. d. exhibit clear physiological symptoms. Answer: C Type: Factual Page: 235 20. Which of the following is true? a. There is a negative relationship between mood and creativity. b. There is a positive relationship between mood and creativity. c. Creativity causes improvements in mood. d. Depression causes creative outbursts. Answer: B Type: Factual Page: 236: Focus on Discovery 8.2 21. Hannah and Heidi are identical twins. If Hannah develops bipolar disorder, what are the odds that Heidi will develop it as well? a. 37% b. 85% c. 25% d. 70% Answer: D Type: Factual Page: 237 22. Which of the following has the highest heritability estimates? a. major depressive disorder b. bipolar disorder c. dysthymia d. cyclothymia Answer: B Type: Factual Page: 238 23. Since mood disorders are characterized by many different symptoms, most researchers believe that a. mood disorders will eventually be related to a single gene which regulates mood. b. mood disorders will eventually be related to a set of genes. c. mood disorders must be due to dysregulation of norepinephrine and serotonin. d. mood disorders are related to a single gene called N34. Answer: B Type: Factual Page: 238 24. Norepinephrine and serotonin are a. the two parts of the autonomic nervous system. b. antidepressant medications. c. neurotransmitters. d. structures in the limbic system. Answer: C Type: Factual Page: 238 25. Which of the following statements supports the argument that neurotransmitters may not be as important in mood disorders as some researchers have believed them to be? a. Many people with mania and depression showed no disturbances in their absolute levels of neurotransmitters. b. Antidepressants relieve depression symptoms immediately. c. Serotonin is not found in the brains of some depressed persons. d. Increases in dopamine levels can trigger manic symptoms. Answer:AType:Applied Page: 239 26. Given the inconsistent evidence about levels of neurotransmitters in people with mood disorders, researchers have begun to focus research efforts on a. whether specific levels of serotonin or dopamine are important. b. understanding the types of people who have no disturbances in their absolute levels of neurotransmitters. c. finding a new neurotransmitter. d. the sensitivity of postsynaptic receptors. Answer: D Type:Applied Page: 239 27. Tryptophan is used for a. lowering serotonin levels. b. examining dopamine receptors. c. depleting norepinephrine levels. d. raising sensitivity for serotonin. Answer:AType: Factual Page: 239 28. Which of the following statements is true? a. Tryptophan is used to lower dopamine levels. b. People who are vulnerable to depression may have less sensitive serotonin receptors. c. People who are vulnerable to depression may have highly sensitive serotonin receptors. d. A person who has very sensitive serotonin receptors is expected to experience lots of depressive symptoms as their serotonin levels drop. Answer: B Type:Applied Page: 239 29. Which of the following types of brain imaging studies are most commonly used in research on mood disorders? a. structural and functional b. structural and operative c. density and structural d. functional and spherical Answer:AType: Factual Page: 240 30. The amygdala a. helps a person recall memories. b. helps a person execute plans. c. regulates heart rate. d. helps a person assess how emotionally important a given stimulus is. Answer: D Type: Factual Page: 240 31. Functional studies of people with major depression show a. elevated activity in the amygdala. b. decreased activity in the amygdala. c. diminished volume in the prefrontal cortex. d. diminished volume of the hippocampus. Answer:AType: Factual Page: 240 32. John is in the middle of a major depressive episode. His friend, Sophie, has never experienced depression and she is trying to be supportive of John. If you were to show both John and Sophie photos of people with sad or angry expressions on their face, a. structural activation studies would most likely indicate that John has a stronger and more sustained reaction in his amygdala than Sophie. b. functional activation studies would most likely indicate that Sophie has a stronger and more sustained reaction in her amygdala than John. c. functional activation studies would most likely indicate that John has a stronger and more sustained reaction in his amygdala than Sophie. d. Based on this information, both Sophie and John would probably have the same amount of activity in their amygdalas. Answer: C Type: Applied Page: 240 33. Some researchers believe that depressive symptoms such as decreased pleasure and motivation and manic symptoms such as increased pleasure and motivation may be explained by changes in a. the sensitivity of the reward system in the brain. b. dopamine. c. serotonin. d. tryptophan. Answer:AType: Factual Page: 242 34. Pleasure, motivation, and energy decrease in depression and increase in mania. This suggests neurological changes in the a. amygdala. b. second messengers. c. HPAaxis. d. reward system. Answer: D Type: Factual Page: 242 35. In both animals and humans, too much cortisol a. causes Cushing’s syndrome. b. produces manic symptoms. c. produces depressive symptoms. d. damages the HPA axis. Answer: C Type: Factual Page: 242 36. Among individuals who are depressed a. cortisol levels are often poorly regulated. b. most have Cushing’s syndrome as well. c. levels of desxamethasone are dysregulated. d. All of the above are correct. Answer:AType: Factual Page: 242 37. Cortisol levels in depressed individuals appear too according to research. a. high b. low c. variable d. steady Answer:AType: Factual Page: 242 38. Stressful life events a. are only related to the first episode of depression. b. are important in triggering episodes of depression. c. play little role in the onset of depressive episodes. d. mediate the relationship between genetics and environment. Answer: B Type: Factual Page: 244 39. After a stressful life event, most people a. become depressed. b. will have another stressful life event. c. do not become depressed. d. experience a reduction in social support. Answer: C Type: Factual Page: 244 40. Stressful life events appear to be a causal factor in depression based on research showing that a. depressed people experience more losses of marriages and jobs. b. people report life stresses before they become depressed. c. depression rates increase after major disasters. d. lab induced stress leads to increased depression. Answer: B Type: Factual Page: 244 41. An example of a diathesis in depression is a. losing one’s job. b. a best friend dying suddenly. c. breaking up with one’s partner. d. lack of social support. Answer: D Type: Factual Page: 244 42. Which of the following statements is true? a. Low levels of expressed emotion predicts relapse in depression. b. Depressive symptoms are usually a result of expressed emotion. c. Symptoms of depression can create relationship problems. d. People with depression often elicit positive reactions from people around them because they tend to keep to themselves. Answer: C Type: Factual Page: 244 43. Research has demonstrated a relationship between ________________ and depression, which is moderated by ________________. a. loss; I.Q. b. life stress; social support c. diet; exercise d. overly optimistic cognitions; intelligence Answer: B Type: Factual Page: 244 44. Interactions with depressed individuals typically result in a. longer interactions than with non-depressed individuals. b. the depressed person eliciting negative feedback. c. the depressed person feeling less depressed. d. more depression even if there is an effort to reduce the depression in the conversation. Answer: B Type: Factual Page: 245 45. The early psychoanalytic theory of depression, as formulated by Freud, emphasized a. anger that develops in response to loss. b. attribution errors committed during particular situations. c. introjections of loss or an interpersonal disappointment. d. an unresolved crisis during the anal stage. Answer: C Type: Factual Page: 245 46. According to Freud's theory, a depressed person is fixated in which stage of development? a. oral b. anal c. genital d. phallic Answer:AType: Factual Page: 245 47. According to Freud’s theory of depression, orally fixated people who experience a loss a. are overwhelmed by grief. b. refuse to admit their grief. c. turn their anger inward. d. become angry at their loss. Answer: C Type: Factual Page: 245 48. Research demonstrating that depressed people often express intense anger and hostility toward others provides evidence a. in support of Freud's theory of depression. b. that contradicts Freud's theory of depression. c. in support of Beck's theory of depression. d. that contradicts Beck's theory of depression. Answer: B Type:Applied Page: 246 49. What are examples of somatic arousal? a. fast heart rate, heavy breathing, sweaty palms b. itchiness, irritation c. lethargy, lack of motivation d. lots of energy Answer AType: Factual Page: 246 50. Current personality research conceptualizes depression and anxiety along which of the following dimensions? a. positive affect, negative affect and autonomic arousal b. affect and somatic arousal c. positive and negative affect d. positive affect, negative affect and somatic arousal Answer: D Type: Factual Page: 246 51. Which of the following involve negative affect? a. anxiety and depression b. depression c. anxiety d. hypomania Answer:AType: Factual Page: 246 52. Which of the following personality traits has been most strongly associated with depress
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