Psych 7 Flashcards

A 42-year-old with depression shows little spontaneous movement and sits nearly motionless through the interview. Which observable sign is most often described in depression?
A. Psychomotor agitation
B. Akathisia
C. Generalized psychomotor retardation
D. Catatonic posturing

A depressed patient repeatedly wrings her hands and pulls at her hair while answering questions. This behavior best reflects:
A. Psychomotor agitation
B. Psychomotor retardation
C. Thought blocking
D. Catatonic stupor

A patient with depression speaks quietly, gives single-word answers, and rarely elaborates. Which speech change best fits?
A. Circumstantial speech
B. Pressured speech
C. Clanging speech
D. Decreased rate and volume

A patient understands questions but answers only after long latency pauses. The clinician documents:
A. Flight of ideas
B. Delayed responses
C. Tangentiality
D. Echolalia

In major depression, which complaint is reported by ~97% of patients?
A. Terminal insomnia
B. Weight gain
C. Reduced energy
D. Thought blocking

About 80% of depressed patients report which complaint?
A. Increased libido, multiple awakenings
B. Grandiose beliefs, multiple awakenings
C. Racing thoughts, multiple awakenings
D. Terminal insomnia, multiple awakenings

A depressed patient consistently awakens at 4:00 AM and cannot fall back asleep. The best term is:
A. Terminal insomnia
B. Sleep-onset insomnia
C. Hypersomnia
D. Fragmented sleep only

The most typical somatic symptoms of depression are collectively called:
A. Dysphoria
B. Neurovegetative symptoms
C. Thought-disorder symptoms
D. Mood-incongruent symptoms

A depressed patient has increased appetite, weight gain, and sleeps much longer than usual. These are best described as:
A. Typical neurovegetative symptoms
B. Catatonic features
C. Psychotic features
D. Reversed neurovegetative symptoms

Which feature most strongly supports typical neurovegetative symptoms rather than reversed features?
A. Decreased appetite, weight loss
B. Increased appetite, weight gain
C. Longer sleep duration
D. Multiple nighttime awakenings

A clinician wants a single term that covers feeling sad, blue, down, or depressed. The best term is:
A. Anhedonia
B. Dysphoria
C. Psychomotor agitation
D. Alexithymia

A patient says, “I can’t enjoy anything I used to.” This symptom is:
A. Dysphoria
B. Terminal insomnia
C. Anhedonia
D. Thought blocking

About 10% of depressed patients show marked thought-disorder symptoms, most often:
A. Loose associations, word salad
B. Neologisms, clang associations
C. Thought blocking, poverty content
D. Echolalia, perseveration

A patient stops mid-sentence, then continues with minimal meaningful detail despite prompting. This best indicates:
A. Flight of ideas
B. Thought blocking, poverty content
C. Tangentiality
D. Circumstantiality

A patient in a depressive episode reports auditory hallucinations and fixed false beliefs. This is most consistent with:
A. Brief psychotic disorder
B. Schizoaffective manic type
C. Hypomania with psychosis
D. Psychotic depression

Delusions or hallucinations consistent with a depressed mood are termed:
A. Mood-congruent
B. Mood-incongruent
C. Ego-syntonic
D. Overvalued ideas

Which delusional theme is most mood-congruent with depression?
A. Secret special powers
B. Divine royal lineage
C. Worthlessness and guilt
D. Alien mind control

A 29-year-old with MDD says, “I’m exhausted all day,” and struggles to complete basic tasks. Which finding best fits a common neurovegetative symptom of depression?
A. Menstrual irregularities
B. Worse depression in morning
C. Fatigue, low energy
D. Decreased libido

A depressed graduate student reports “spacing out in lectures” and missing details despite trying. Which common neurovegetative symptom is described?
A. Inattention
B. Decreased libido
C. Menstrual irregularities
D. Morning worsening

A patient with depression wakes at 4 AM daily and cannot return to sleep. Which common neurovegetative symptom is this?
A. Initial insomnia only
B. Hypersomnia with long sleep
C. Nightmares with awakenings
D. Insomnia, early morning awakening

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A 34-year-old with depression reports reduced sexual interest and performance. This symptom is sometimes included among neurovegetative symptoms. Which option matches?
A. Decreased libido, reduced performance
B. Increased libido, risky sex
C. Elevated mood, increased energy
D. Compulsive rituals, contamination fears

A 22-year-old with depression reports irregular periods since symptoms began. Which symptom is sometimes included among neurovegetative symptoms?
A. Hot flashes and night sweats
B. Dyspareunia with pelvic pain
C. Menstrual irregularities
D. Urinary urgency and frequency

Which symptom is sometimes included among neurovegetative symptoms?
A. Worse depression at night
B. Worse depression in morning
C. Worse depression after meals
D. Worse depression after exercise

A depressed patient reports “I can’t concentrate” and “my thinking feels slowed.” These complaints are best categorized as:
A. Neurovegetative symptoms
B. Catatonic symptoms
C. Psychotic symptoms
D. Cognitive symptoms

A severely pessimistic depressed patient wants to quit school and sell his car “because life is pointless.” Best guidance is:
A. Encourage immediate irreversible decisions
B. Use decisions to prove recovery
C. Avoid discussing decisions altogether
D. Delay major decisions until thinking normal

A patient insists, “Antidepressants never work for me,” but gives no details about dose or duration. A common clinical mistake is to:
A. Overinterpret one week response
B. Accept “failed trial” without probing
C. Start antipsychotic without symptoms
D. Assume depression is always bipolar

A 27-year-old was hospitalized last month for suicidal ideation. Compared with someone never hospitalized for suicidal ideation, this patient has:
A. Same lifetime completion risk
B. Lower completion risk afterward
C. Higher lifetime completion risk
D. Risk limited to first month

An inpatient has severe depression with psychotic guilt delusions and profound motor slowing. Regarding impulsive violence, the most accurate statement is:
A. Often lacks energy for impulsive acts
B. High risk sudden violence
C. Violence risk rises from agitation
D. Violence unrelated to energy

After starting treatment, a suicidal patient reports slightly improved energy and begins “making plans.” Suicide risk can increase:
A. During deepest retardation
B. During early improvement, energy returns
C. During full remission
D. Only before any treatment

A patient has severe anhedonia, early morning awakening, weight loss, and intense guilt over minor mistakes. The best descriptor is:
A. Persistent depressive disorder
B. Atypical depression
C. Minor depressive disorder
D. Melancholia

Which feature most strongly supports melancholia rather than other depressive presentations?
A. Guilt over trivial events
B. Mood reactivity to good news
C. Increased appetite with cravings
D. Marked rejection sensitivity

Melancholia is associated with changes in which physiologic systems?
A. Renal and hepatic changes
B. Immune and lymphatic changes
C. Autonomic and endocrine changes
D. Muscular and skeletal changes

A depressed patient is stuporous, withdrawn, blunted, and resists instructions with negativism; marked psychomotor retardation is present. This syndrome is:
A. Akathisia
B. Delirium
C. Melancholia
D. Catatonia

Which finding is a hallmark symptom of catatonia?
A. Distractibility
B. Negativism
C. Flight of ideas
D. Auditory hallucinations

Compared with major depressive disorder, dysthymia is typically:
A. More severe than MDD
B. Brief and episodic course
C. Less severe but more chronic
D. Requires psychotic features

The most typical feature of dysthymia is:
A. Mood only on weekends
B. Mood shifts hourly
C. Mood absent most days
D. Depressed mood most day, continuous

Which history most strongly supports dysthymia over major depressive disorder?
A. First episode after childbirth
B. Always depressed since adolescence
C. Distinct two-week episodes
D. Sudden onset with psychosis

A patient has discrete episodes of depressive symptoms that are less severe than those seen in major depressive disorder. The best diagnosis is:
A. Dysthymic disorder
B. Melancholia
C. Minor depressive disorder
D. Cyclothymic disorder

The primary difference between dysthymia and minor depressive disorder is:
A. Minor depression is episodic
B. Dysthymia includes psychosis
C. Minor depression lasts decades
D. Dysthymia requires weight loss

A 30-year-old has discrete low-grade depressive episodes and returns to baseline between them. Which diagnosis is characterized by euthymic mood between episodes?
A. Dysthymia
B. Minor depressive disorder
C. Major depressive disorder
D. Melancholia

A patient reports repeated depressive episodes that fully resolve between episodes. Each episode lasts 9–12 days. Which duration best fits recurrent brief depressive disorder?
A. At least 2 months
B. At least 6 months
C. Exactly 1 month
D. Less than 2 weeks

A patient meets criteria for MDD and also has long-standing dysthymic symptoms. This combination is most often called:
A. Atypical depression
B. Melancholic depression
C. Double depression
D. Recurrent brief depression

You select a clinician-rated scale with 24 total items for depression severity. Which instrument fits?
A. Raskin Depression Scale
B. Zung Self-Rating Scale
C. Hamilton Rating Scale (HAM-D)
D. PHQ-9

A patient completes a 20-item self-report depression scale. Which instrument matches?
A. HAM-D
B. Zung Self-Rating Scale
C. Raskin Depression Scale
D. MADRS

The Zung scale is described as providing a global index of depressive intensity, including:
A. Catatonic motor signs
B. Psychotic delusions
C. Affective expression
D. Neurocognitive decline

A clinician chooses a scale that integrates the patient’s report and the physician’s observations. Which scale is this?
A. Zung scale
B. Raskin scale
C. HAM-D
D. Beck Anxiety Inventory

The Raskin Depression Scale rates three dimensions. Which set matches those dimensions?
A. Sleep, appetite, libido
B. Thought, insight, judgment
C. Anxiety, panic, obsession
D. Verbal, behavior, secondary symptoms

A 16-year-old with depressive symptoms has fever, sore throat, and fatigue. Which medical condition should be tested for in adolescents?
A. Mononucleosis
B. Viral pneumonia
C. Adrenal dysfunction
D. Hypothyroidism

A depressed patient is markedly underweight with fatigue and low mood. Which medical issues should be screened in overweight or underweight patients?
A. Viral pneumonia, HIV
B. Mononucleosis, HIV
C. Dementia, epilepsy
D. Adrenal and thyroid dysfunctions

An older adult develops depressive symptoms with cough and malaise. Which condition is specifically noted to test for in older patients?
A. Mononucleosis
B. Viral pneumonia
C. Parkinson disease
D. Cerebrovascular disease

A patient develops depressive symptoms after starting multiple new medications. In substance-induced mood disorder, a reasonable rule of thumb is:
A. Ignore non-psychiatric drugs
B. Blame only illicit substances
C. Assume one drug is causative
D. Consider any drug a factor

A 71-year-old with masked facies and bradykinesia develops depressive symptoms. Which neurologic condition is listed as commonly manifesting depression?
A. Myasthenia gravis
B. Parkinson disease
C. Amyotrophic lateral sclerosis
D. Guillain-Barré syndrome

A stroke patient develops prominent depressive symptoms. Depression is more common with lesions in which location?
A. Anterior rather than posterior
B. Posterior rather than anterior
C. Cerebellar rather than cortical
D. Brainstem rather than cortical

A patient with new depression is found to have a brain tumor. Tumors in which regions are especially linked to depressive symptoms?
A. Occipital and parietal regions
B. Cerebellar and pontine regions
C. Diencephalic and temporal regions
D. Medullary and spinal regions

An older adult presents with memory complaints plus self-reproach and marked day-to-day variability. Which feature favors depression over primary dementia?
A. Gradual progressive onset
B. Sudden onset
C. Persistent steady decline
D. No mood symptoms

A patient’s cognitive complaints fluctuate predictably across the day alongside depressed mood. Which feature supports depression over primary dementia?
A. Aphasia without mood changes
B. Apraxia without mood changes
C. Constant deficits all day
D. Diurnal variation

During a cognitive screen, a patient shrugs and refuses to attempt answers, saying “Why bother?” Which feature supports depression over primary dementia?
A. Doesn’t try to answer
B. Confabulates confidently
C. Fluent aphasia present
D. Persistent anosognosia

A patient initially performs poorly on recall but improves with encouragement and cueing. Which feature supports depression over primary dementia?
A. Irreversible encoding failure
B. Rapid forgetting despite cues
C. Coaching improves remembering
D. Prominent visuospatial neglect

Which pair includes only disorders listed as frequent comorbidities with depression?
A. Alcohol use and panic disorder
B. OCD and schizophrenia
C. PTSD and ADHD
D. GAD and bipolar I

Which substances are specifically noted as used by depressed patients?
A. Benzodiazepines and barbiturates
B. Cocaine and amphetamines
C. LSD and psilocybin
D. Cannabis and nicotine

Which statement best matches the provided comparison between mania and depression?
A. Manic patients often use stimulants
B. Depressed patients avoid all drugs
C. Manic patients seldom use sedatives
D. Depressed patients avoid stimulants

A patient has years of heavy substance use and a chronic low-grade depressive picture indistinguishable from one disorder. Which disorder is specifically noted?
A. Dysthymia
B. Melancholia
C. Catatonia
D. Recurrent brief depression

A 26-year-old has an untreated major depressive episode with persistent symptoms and no remission. What is the typical duration of an untreated episode?
A. 2 to 6 weeks
B. 2 to 3 months
C. 6 to 13 months
D. 18 to 24 months

A patient with MDD starts effective pharmacotherapy and improves steadily. Most treated episodes last about:
A. About 3 months
B. About 6 months
C. About 9 months
D. About 12 months

A patient feels better after 6 weeks on an SSRI and stops it abruptly at 8 weeks. Most likely outcome?
A. Sustained remission is typical
B. Switch to hypomania is likely
C. No change in symptoms expected
D. Symptoms almost always return

A 48-year-old has had five prior depressive episodes. Compared with earlier illness, which course pattern is expected?
A. Longer intervals, milder episodes
B. Shorter intervals, worse episodes
C. Shorter intervals, milder episodes
D. Longer intervals, worse episodes

A patient is discouraged after 10 days on an SSRI with no change. How long can antidepressants take for significant effects?
A. Up to 3 to 4 weeks
B. Up to 5 to 7 days
C. Up to 48 hours
D. Up to 6 to 8 months

A patient tolerates an SSRI with minimal side effects but limited improvement. Best next dosing strategy?
A. Lower dose and wait
B. Switch immediately to another SSRI
C. Max dose, hold 4–5 weeks
D. Stop drug and reassess later

After 2–3 weeks on an antidepressant, a patient reports no benefit. Best clinician action?
A. Add benzodiazepine augmentation
B. Check plasma level if possible
C. Diagnose treatment resistance now
D. Discontinue and start ECT

For most patients starting pharmacotherapy for depression, clinicians usually begin with:
A. First-generation antidepressants
B. Antipsychotic monotherapy
C. Benzodiazepine monotherapy
D. Second- and third-generation agents

Among second- and third-generation agents, the most commonly used class is:
A. MAOIs
B. SSRIs
C. TCAs
D. Lithium salts

A patient with MDD reaches remission on medication. Minimum continuation duration should be:
A. Two weeks after remission
B. One month after remission
C. At least 6 months or longer
D. Stop once sleep normalizes

A stable patient is discontinuing an antidepressant. Best discontinuation approach?
A. Taper over 1 to 2 weeks
B. Stop immediately at full dose
C. Alternate-day dosing for months
D. Replace with stimulants abruptly

A patient has recurrent depressive episodes occurring 2 years apart. What is recommended?
A. PRN antidepressant use only
B. Prophylactic treatment recommended
C. Discontinue after each remission
D. Avoid long-term medication entirely

A patient has melancholic depression with profound anhedonia and weight loss. Which antidepressant profile may be more effective?
A. Pure serotonergic action only
B. Pure noradrenergic action only
C. Dopaminergic agonist monotherapy
D. Dual serotonergic and noradrenergic

A patient with MDD has mood-congruent delusions and hallucinations. Pharmacotherapy often requires:
A. Antidepressant plus atypical antipsychotic
B. SSRI monotherapy only
C. Lithium monotherapy only
D. Stimulant monotherapy only

A patient has psychotic depression with severe functional decline. Which intervention also has evidence for this indication?
A. Exposure therapy
B. Bright light therapy
C. ECT
D. Buspirone monotherapy

A patient has atypical features (hypersomnia, weight gain). Which medication class has strong evidence?
A. TCAs
B. MAOIs
C. Typical antipsychotics
D. Benzodiazepines

For atypical features, which additional agents are also useful?
A. SSRIs and bupropion
B. Clozapine and olanzapine
C. Valproate and carbamazepine
D. Haloperidol and chlorpromazine

A patient has MDD plus panic disorder. Which medications are preferred for both?
A. MAOIs and lithium
B. Bupropion and mirtazapine
C. Quetiapine and aripiprazole
D. Tricyclics and SSRIs

A patient has depression plus a significant comorbid condition. In general, what dictates treatment selection?
A. Depression severity alone
B. Patient age alone
C. Nonmood disorder dictates choice
D. Sleep symptoms dictate choice

A patient has partial response to an SSRI. Which augmentation options have best evidence?
A. Quetiapine and aripiprazole
B. Buspirone and propranolol
C. Gabapentin and clonidine
D. Haloperidol and benztropine

A patient on an SSRI has inadequate response. Which augmentation is noted for SSRIs and TCAs?
A. Short-term antihistamines
B. Dopamine agonist therapy
C. Acetylcholinesterase inhibitors
D. Lithium augmentation

A patient’s depression remains resistant despite adequate trials. Which augmentation option is listed?
A. Dextromethorphan monotherapy
B. Melatonin nightly dosing
C. Thyroid hormone augmentation
D. Calcium channel blockers

A patient improves after 6 weeks and wants to stop at 10 weeks. Why is this risky?
A. Withdrawal causes permanent psychosis
B. Stopping increases mania risk
C. Stopping predicts later dementia
D. Stopping before 3 months relapses

A patient with treatment-resistant depression receives ketamine. What is its key mechanism?
A. Enhances GABA-A currents
B. Inhibits serotonin reuptake
C. Blocks dopamine transporter
D. Inhibits postsynaptic NMDA receptor

After ketamine infusion, when can a positive response appear?
A. After 3 to 4 weeks
B. Within 24 hours
C. After 6 months
D. After 6 to 13 months

A patient responds to ketamine but symptoms return soon. Typical duration of benefit is:
A. 2 to 7 days
B. 3 to 4 weeks
C. 6 to 13 months
D. 1 to 2 years

A clinician considers long-term ketamine maintenance. A major contraindication is:
A. Severe constipation risk
B. QT prolongation risk
C. Abuse potential
D. Weight gain risk

Why might ketamine help in major depressive disorder?
A. Enhances cholinergic signaling
B. Glutamatergic signaling abnormalities implicated
C. Corrects serotonin deficiency exclusively
D. Suppresses dopamine firing globally

A 28-year-old develops severe depressive symptoms 2 weeks after delivery. Which medication is an IV formulation of allopregnanolone used for this indication?
A. Brexanolone
B. Bupropion
C. Sertraline
D. Lithium

Brexanolone is best classified as which type of agent?
A. Atypical antipsychotic
B. Neuroactive steroid
C. Tricyclic antidepressant
D. NMDA antagonist

A postpartum patient receives brexanolone and improves rapidly. How quickly can symptoms reduce?
A. Within 2 to 7 days
B. Within 3 to 4 weeks
C. Within 24 hours
D. Within 6 to 13 months

After an effective brexanolone infusion, symptom benefit is reported to last at least:
A. 30 days
B. 7 days
C. 72 hours
D. 3 months

Brexanolone’s antidepressant effect most directly involves:
A. Serotonin transporter blockade
B. GABAA allosteric modulation
C. D2 receptor antagonism
D. NMDA receptor antagonism

Vagus nerve stimulation may reduce depressive symptoms partly because stimulation can trigger release of:
A. Steroid hormones
B. Monoamines
C. Peptides acting neurotransmitters
D. Endocannabinoids

The vagus nerve’s relevance to mood is partly related to its connection with the:
A. Basal ganglia
B. Enteric nervous system
C. Cerebellar cortex
D. Visual association cortex

A patient with unipolar depression reports transient mood improvement after staying awake all night. This finding aligns with:
A. Sleep deprivation may relieve depression
B. REM rebound worsens depression
C. Sleep deprivation causes catatonia
D. Sleep extension treats unipolar depression

A therapist targets selective attention to negatives and morbid inferences about consequences. Which approach is being used?
A. Family therapy
B. Behavior therapy
C. Interpersonal therapy
D. Cognitive therapy

Which is a cognitive distortion specifically highlighted in cognitive therapy for depression?
A. Flight of ideas
B. Selective attention to negatives
C. Compulsions for neutralization
D. Delusions of reference

Which is another cognitive distortion emphasized in cognitive therapy?
A. Unrealistically morbid inferences
B. Formal thought disorder
C. Echolalia
D. Loose associations

A therapist focuses on one or two current interpersonal problems and assumes they link to early dysfunctional relationships. This is:
A. Interpersonal therapy
B. Psychoanalysis
C. Behavior therapy
D. Exposure therapy

A key assumption of interpersonal therapy is that current interpersonal problems are:
A. Purely genetic traits
B. Unrelated to mood symptoms
C. Rooted in early dysfunction
D. Best treated with interpretation

Another core assumption of interpersonal therapy is that current interpersonal problems:
A. Improve only with medication
B. Precipitate or perpetuate depression
C. Never affect depressive symptoms
D. Are always delusional

A standard interpersonal therapy program usually consists of:
A. 3 to 6 weekly sessions
B. 6 to 8 weekly sessions
C. 20 to 30 weekly sessions
D. 12 to 16 weekly sessions

Which descriptor best characterizes interpersonal therapy delivery?
A. Passive, nondirective stance
B. Active therapeutic approach
C. Primarily dream interpretation
D. Focus on transference only

Behavior therapy for depression is based on the hypothesis that maladaptive behaviors lead to:
A. Excess positive reinforcement
B. Little feedback, social rejection
C. Increased insight, less distress
D. Stronger superego conflicts

The behavioral therapy goal is to modify maladaptive behaviors so patients:
A. Receive positive reinforcement
B. Increase unconscious conflicts
C. Suppress affective expression
D. Reduce family involvement

What differentiates short-term psychotherapy methods from psychoanalytically oriented approaches?
A. No goals, open-ended structure
B. Passive therapist role
C. Active directive therapist roles
D. Reliance on dream analysis

Another distinguishing feature of short-term psychotherapy is:
A. Undefined endpoints
B. Recognizable goals and endpoints
C. Years of intensive sessions
D. Focus on character restructuring

The primary goal of psychoanalytic psychotherapy is to:
A. Alleviate symptoms quickly
B. Change personality structure
C. Teach cognitive restructuring
D. Provide behavioral activation

Psychoanalytic psychotherapy often requires patients to experience:
A. Euphoria throughout therapy
B. Heightened anxiety and distress
C. No emotional discomfort
D. Immediate symptom relief

For major depressive disorder, which psychotherapy is usually first-line per the notes?
A. Cognitive therapy
B. Interpersonal therapy
C. Family therapy
D. Behavior therapy

Family therapy in depression primarily examines:
A. Medication adherence only
B. Role of family maintaining symptoms
C. Dream content and transference
D. Neurovegetative symptom triggers

Depressed patients typically show overactivity of which endocrine axis?
A. HPA axis
B. HPG axis
C. HPT axis
D. Renin-angiotensin axis

Compared with controls, depressed patients have increased 24-hour levels of:
A. Growth hormone
B. Cortisol
C. TSH
D. Prolactin

Depression-related hypercortisolemia is attributed to increased hypothalamic release of:
A. TRH
B. CRH
C. GnRH
D. GHRH

Hypercortisolemia also reflects decreased:
A. Dopamine synthesis
B. Feedback inhibition
C. Aldosterone clearance
D. TSH secretion

Disturbance of feedback inhibition in depression can be tested using:
A. ACTH stimulation test
B. TRH challenge test
C. Dexamethasone suppression test
D. Cosyntropin test

In the DST, depressed patients may initially show cortisol:
A. Increase, then normalize
B. Decrease, then escape upward
C. Remain unchanged throughout
D. Oscillate without pattern

In normal patients, dexamethasone produces a negative feedback loop that:
A. Increases cortisol
B. Leaves cortisol unchanged
C. Decreases cortisol
D. Abolishes ACTH release forever

Studies suggest increased hypothalamic ______ in depressed patients, likely from chronic stress.
A. Astrocytes
B. Neurons
C. Microglia
D. Oligodendrocytes

Hypercortisolemia in depression suggests which central disturbance?
A. Increased inhibitory serotonin tone
B. Decreased inhibitory serotonin tone
C. Increased hippocampal inhibition
D. Decreased CRH release

Hypercortisolemia also may reflect increased drive from which inputs?
A. NE, ACh, or CRH
B. Serotonin, GABA, endorphins
C. Histamine, glutamate, glycine
D. Oxytocin, prolactin, insulin

Another proposed contributor to hypercortisolemia is decreased feedback inhibition from the:
A. Amygdala
B. Basal ganglia
C. Hippocampus
D. Cerebellum

A patient with early childhood trauma later develops depression. This history is associated with increased activity of which axis?
A. HPT axis
B. HPA axis
C. HPG axis
D. Renin-angiotensin axis

Early trauma-associated increased HPA activity is linked to structural brain changes best described as:
A. Cortical atrophy, decreased volume
B. Cerebellar hypertrophy, increased volume
C. Basal ganglia calcification
D. Hippocampal tumor formation

About 5–10% evaluated for depression have previously undetected dysfunction in which system?
A. Adrenal
B. Pituitary
C. Thyroid
D. Parathyroid

20–30% of depressed patients show what response to TRH challenge?
A. Exaggerated TSH response
B. Blunted TSH response
C. Absent cortisol response
D. Increased GH response

The major therapeutic implication of a blunted TSH response is:
A. Lower relapse risk
B. Increased relapse risk
C. No clinical implication
D. Predicts psychotic features

Growth hormone secretion is stimulated by which neurotransmitters?
A. Serotonin and GABA
B. Histamine and glutamate
C. NE and dopamine
D. ACh and norepinephrine

A study compares CSF somatostatin across mood states. Which pattern matches the notes?
A. High depression, high mania
B. High depression, low mania
C. Low depression, low mania
D. Low depression, high mania

A neuroendocrine probe increases pituitary prolactin release primarily via which neurotransmitter?
A. Serotonin
B. GABA
C. Norepinephrine
D. Acetylcholine

BDNF is discussed as a growth factor protein. Its primary CNS role is best described as:
A. Rapid synaptic pruning
B. Acute seizure suppression
C. Ongoing neuronal maintenance
D. Peripheral myelin synthesis

Postmortem findings in suicide victims show lower average BDNF in which regions?
A. Cerebellum and pons
B. Occipital and parietal cortex
C. Thalamus and striatum
D. PFC and hippocampus

A patient with MDD responds robustly to antidepressants. Which biomarker change is most consistent with response?
A. Lower serum BDNF
B. Higher serum BDNF
C. Higher CSF somatostatin
D. Lower platelet serotonin sites

A polysomnogram in depression shows early loss of which sleep stage?
A. Deep slow-wave sleep
B. REM sleep entirely absent
C. Stage 1 predominance only
D. Continuous NREM without cycling

During overnight monitoring, which finding is one of the four arousal disturbances noted in depression?
A. Increased nocturnal awakenings
B. Increased sleep spindles
C. Prolonged REM latency
D. Increased slow-wave proportion

Another arousal-related PSG change in depression is:
A. Increased total sleep time
B. Reduced REM density
C. Reduction in total sleep time
D. Increased slow-wave duration

Which PSG finding is explicitly listed among the four arousal disturbances in depression?
A. Reduced phasic REM activity
B. Increased phasic REM sleep
C. Absent NREM cycling
D. Increased sleep efficiency

The notes list a fourth arousal disturbance in depression as:
A. Decreased core temperature
B. Increased sleep continuity
C. Increased delta power
D. Increased core body temperature

Which triad best matches the “typical” sleep disturbance profile in depression?
A. Longer REM latency, less REM
B. Reduced REM latency, more density
C. Increased slow-wave, fewer awakenings
D. Longer NREM, lower temperature

The earliest antidepressants shared which pharmacologic property?
A. NMDA receptor inhibition
B. Dopamine transporter blockade
C. Interfered with monoamine catabolism
D. Direct GABAA potentiation

This early pharmacology historically supported which etiologic assumption about depression?
A. Excess monoamines
B. Low monoamine levels
C. Excess acetylcholine only
D. Primary GABA excess

Antidepressant response correlates with downregulation or decreased sensitivity of which receptor type?
A. D2 receptors
B. NMDA receptors
C. GABAA receptors
D. β-adrenergic receptors

Those β-adrenergic receptor changes are most directly tied to which monoamine system?
A. Dopaminergic
B. Serotonergic
C. Noradrenergic
D. Cholinergic

Activating presynaptic β2 receptors has what effect on norepinephrine release?
A. More norepinephrine released
B. No change in norepinephrine
C. Less norepinephrine released
D. Reverses MAOI inhibition

Presynaptic β2 receptors on serotonergic neurons regulate the release of:
A. GABA
B. Norepinephrine
C. Acetylcholine
D. Serotonin

Mechanistically, most modern antidepressants act primarily on:
A. Norepinephrine signaling
B. Serotonin signaling
C. Acetylcholine signaling
D. Glutamate signaling

Comparing mood states, dopamine activity is generally:
A. High depression, high mania
B. High depression, low mania
C. Low both states
D. Low depression, high mania

A patient with Parkinson disease develops depressive symptoms. This supports which association?
A. Excess dopamine triggers depression
B. Dopamine depletion can cause depression
C. Serotonin excess causes suicidality
D. GABA excess causes anergia

Which paired intervention best matches agents noted to increase dopamine and reduce depressive symptoms?
A. Reserpine and haloperidol
B. Sertraline and fluoxetine
C. Tyrosine and amphetamine
D. Clonidine and propranolol

Acetylcholine neurons are distributed diffusely throughout the:
A. Cerebral cortex
B. Cerebellar vermis
C. Brainstem tegmentum only
D. Spinal cord gray matter

Cholinergic neurons are described as having reciprocal relationships with:
A. Only dopamine circuits
B. All three monoamine systems
C. Only serotonin pathways
D. Only norepinephrine pathways

In depressed patients, low levels of which compound have been found?
A. Choline
B. Cortisol
C. CRH
D. Somatostatin

Which neurotransmitter inhibits ascending monoamine pathways, especially mesocortical and mesolimbic systems?
A. Glutamate
B. Acetylcholine
C. GABA
D. Dopamine

A patient with MDD has reduced inhibitory tone across compartments. Which finding best matches the notes?
A. Increased plasma GABA
B. Normal CSF GABA
C. Reduced plasma and CSF GABA
D. Increased brain GABA levels

Chronic stress is most associated with what change in GABA over time?
A. Gradual GABA increase
B. GABA depletion over time
C. Acute GABA overproduction
D. Immediate irreversible GABA blockade

A platelet assay is ordered in a patient with suicidal impulses. Which result matches the notes?
A. Increased platelet serotonin uptake
B. Increased platelet dopamine uptake
C. Reduced platelet dopamine uptake
D. Low platelet serotonin uptake

GABA’s inhibitory action is noted as strongest on which monoamine-related pathways?
A. Nigrostriatal and tuberoinfundibular
B. Corticospinal and spinothalamic
C. Mesocortical and mesolimbic
D. Vestibulospinal and rubrospinal

Antidepressants are noted to upregulate which receptor type, and some drugs in that system have weak antidepressant effects?
A. Dopamine receptors
B. GABA receptors
C. NMDA receptors
D. Muscarinic receptors

In the CNS, which amino acid is described as the primary excitatory neurotransmitter?
A. Glycine
B. Glutamate
C. GABA
D. Aspartate

Which amino acid is described as the primary inhibitory neurotransmitter in the CNS (per the notes)?
A. Serotonin
B. Glycine
C. Dopamine
D. Glutamate

Glutamate and glycine bind to sites associated with which receptor?
A. AMPA receptor
B. NMDA receptor
C. GABAA receptor
D. D2 receptor

A neuroanatomist emphasizes dense NMDA receptor distribution. Where is NMDA receptor concentration described as high?
A. Hippocampus
B. Cerebellar vermis
C. Caudate tail
D. Occipital cortex

Severe recurrent depression is associated with hypercortisolemia and neurocognitive decline. Which amino acid may work with hypercortisolemia to mediate deleterious effects?
A. GABA
B. Glycine
C. Glutamate
D. Serotonin

Second messengers primarily regulate the function of neuronal membrane:
A. Transport vesicles
B. Ion channels
C. Ribosomes
D. Microtubules

Increasing evidence suggests mood-stabilizing drugs act on:
A. Monoamine catabolism
B. Second messengers
C. Platelet uptake sites
D. Cortical sulci

Depressive disorders are associated with which immunologic abnormality?
A. Increased mitogen lymphocyte proliferation
B. Decreased cellular immunity
C. Autoantibody excess only
D. T-cell lymphoma development

Lymphocytes can produce neuromodulators including CRF and:
A. GABA
B. Dopamine
C. Interleukins
D. Melatonin

Which cytokine is specifically noted as inducing gene activity for glucocorticoid synthesis?
A. Interleukin-1
B. Interleukin-6
C. TNF-alpha
D. Interferon-gamma

The notes associate clinical severity, hypercortisolism, and immune dysfunction with:
A. Increased sleep maintenance
B. Decreased anterior metabolism
C. Lymphocyte hyperactivity
D. Cytokine abnormalities

The most consistent neuroimaging abnormality in depressive disorders is:
A. Midbrain calcifications
B. Abnormal subcortical hyperintensities
C. Hippocampal hemorrhage
D. Cerebellar infarcts

Additional structural findings reported in some depressed patients include ventricular enlargement, cortical atrophy, and:
A. Sulcal widening
B. Pontine swelling
C. Increased white matter volume
D. Corpus callosum hypertrophy

Depressed patients may show reduced volumes of which structures?
A. Amygdala and putamen
B. Hypothalamus and pons
C. Hippocampus and caudate
D. Thalamus and cerebellum

Which structures are listed as reduced volume in depression due to neuronal loss and vulnerability from glutamatergic richness?
A. Caudate only
B. Hippocampus
C. Cerebellum only
D. PFC only

The hippocampal volume reduction is attributed to neuronal loss from increased:
A. Estrogen
B. Dopamine
C. Cortisol
D. Oxytocin

The hippocampus is described as especially susceptible because it is rich in:
A. Glutamatergic neurons
B. Cholinergic interneurons
C. Dopaminergic neurons
D. Serotonergic neurons

Besides hippocampus, which additional structures are listed as reduced volume in depression?
A. PFC, cingulate, cerebellum
B. Pons, medulla, midbrain
C. Putamen, globus, amygdala
D. Occipital, temporal, insula

The most widely replicated PET finding in depression is:
A. Increased posterior metabolism
B. Decreased anterior metabolism
C. Increased anterior metabolism
D. Decreased cerebellar metabolism

Decreased anterior metabolism is generally more pronounced on which side?
A. Left
B. Right
C. Bilateral equal
D. Dominant hemisphere only

Depression may cause a relative increase in activity of the:
A. Dominant hemisphere
B. Nondominant hemisphere
C. Cerebellar hemisphere
D. Brainstem reticular formation

In depression, reduced blood flow or metabolism is noted in dopaminergic tracts of which systems?
A. Nigrostriatal and tuberoinfundibular
B. Mesocortical and mesolimbic
C. Corticospinal and spinothalamic
D. Vestibular and rubrospinal

Glucose metabolism in several limbic regions in depressed patients is:
A. Decreased
B. Increased
C. Unchanged
D. Absent entirely

During depressive episodes, increased limbic glucose metabolism correlates with:
A. Catatonia severity
B. Intrusive ruminations
C. Appetite restoration
D. Psychotic hallucinations

Depressed patients show which pulvinar nucleus pattern?
A. Deactivation
B. Activation
C. No change
D. Necrosis

Depressed patients show a more significant response to negative stimuli in:
A. Dorsal striatum and dlPFC
B. Amygdala, insula, anterior cingulate
C. Primary motor cortex only
D. Occipital visual cortex only

Depressed patients show a lesser response in:
A. Dorsal striatum and dlPFC
B. Amygdala and insula
C. Pulvinar and thalamus
D. Hypothalamus and pituitary

The heritability of depression is higher in which gender?
A. Men
B. Women
C. Equal across genders
D. Nonbinary only

Shared environmental factors played what role in familial aggregation of depression?
A. Major role
B. Moderate role
C. No significant role
D. Exclusive role

Which gene is listed as potentially involved in depression mechanism?
A. HTR1A
B. CFTR
C. HBB
D. PCSK9

Which is listed as a serotonin transporter gene implicated?
A. DRD4
B. SLC6A3
C. SLC6A4
D. HTR1A

Which is listed as a dopamine receptor gene implicated?
A. COMT
B. DRD4
C. MAOA
D. SLC6A4

Which is listed as a dopamine transporter gene implicated?
A. SLC6A3
B. SLC6A4
C. HTR1A
D. DRD4

The bulk of genetic heritability for depression reflects:
A. Few genes, large effects
B. Many genes, small effects
C. One gene, deterministic effect
D. Two genes, moderate effects

Why is the monoamine hypothesis considered inadequate as a full explanation of depression etiology?
A. Antidepressants act immediately
B. CSF/postmortem show clear imbalance
C. Monoamines not involved in mood
D. Weeks-to-effect, no imbalance evidence

A patient asks why SSRIs aren’t “instant” if they raise serotonin quickly. Which critique of the monoamine hypothesis does this illustrate?
A. Monoamines irrelevant to symptoms
B. Therapeutic lag despite rapid changes
C. Depression caused by excess monoamines
D. CSF always shows high monoamines

A researcher measures CSF monoamine metabolites in depressed patients and finds no consistent abnormality. This supports which critique?
A. No convincing imbalance evidence
B. Monoamines rise too slowly
C. Antidepressants lower monoamines
D. Depression is purely endocrine

A 19-year-old has heightened vigilance to emotionally salient cues. Which limbic structure is a key “way station” for processing novel emotionally significant stimuli?
A. Amygdala
B. Hippocampus
C. Caudate nucleus
D. Cerebellum

In addition to processing novelty, the amygdala coordinates or organizes which responses?
A. Spinal reflex responses
B. Cortical responses
C. Pituitary trophic secretion
D. Renal sympathetic tone

Adjacent to the amygdala, which structure is most associated with learning and memory?
A. Nucleus accumbens
B. Thalamus
C. Hippocampus
D. Hypothalamus

Emotional or contextual learning is best linked to a direct connection between the:
A. ACC and thalamus
B. Hippocampus and amygdala
C. PFC and cerebellum
D. Putamen and caudate

The structure that holds representations of goals and appropriate responses to obtain them is the:
A. Anterior cingulate cortex
B. Prefrontal cortex
C. Amygdala
D. Hippocampus

Left-sided PFC activation is most associated with:
A. Avoidance and inhibition
B. Threat detection only
C. Goal-directed appetitive behavior
D. Motor learning and balance

Right-sided PFC activation is most associated with:
A. Appetitive pursuit
B. Avoidance and inhibition
C. Reward seeking only
D. Memory consolidation

PFC subregions are described as containing localized representations related to:
A. Language production only
B. Vision processing only
C. Reward and punishment behaviors
D. Sleep-wake regulation

The ACC is involved in attention, motivation, and exploration, and helps integrate:
A. Visuospatial and motor inputs
B. Attentional and emotional inputs
C. Pain and proprioceptive inputs
D. Auditory and vestibular inputs

The rostral/ventral ACC affective subdivision connects extensively with:
A. Limbic regions
B. Cerebellar regions
C. Brainstem nuclei only
D. Spinal cord segments

ACC activation may facilitate control of emotional arousal particularly when:
A. Sleeping after sleep deprivation
B. Achieving goals effortlessly
C. Thwarted goals meet novel problems
D. Memory consolidation is maximal

Neurogenesis hypotheses propose depression-related abnormalities stem from:
A. Too many newborn neurons
B. Excess oligodendrocyte formation
C. Atrophy of mature neurons only
D. Deficit of newborn neurons

Neuroplasticity hypotheses propose depression results because:
A. Atrophy of developed neurons
B. Lack of dopamine synthesis
C. Excess newborn neurons
D. Hypermyelination of cortex

In the neurogenesis hypothesis, glucocorticoids are known to:
A. Increase neurogenesis
B. Decrease neurogenesis
C. Increase BDNF expression
D. Block REM sleep

Adult neurogenesis is noted to continue particularly in the:
A. Cerebellum
B. Caudate nucleus
C. Amygdala
D. Hippocampus

Under the neurogenesis hypothesis, impaired hippocampal regulation of HPA leads to:
A. Lower glucocorticoids, more neurons
B. Higher glucocorticoids, less neurogenesis
C. Lower CRH, more cortisol escape
D. Higher serotonin, less arousal

In the neuroplasticity hypothesis, chronic stress elevates glucocorticoids causing:
A. Neuronal hypertrophy
B. Demyelination only
C. Neuronal atrophy
D. Increased neurogenesis

Chronic stress can also decrease expression of which neurotrophin essential for neuronal survival and differentiation?
A. GABA
B. BDNF
C. CRH
D. TSH

Preferential hippocampal atrophy helps account for which imaging finding in depression?
A. Increased caudate volume
B. Decreased hippocampal volume
C. Enlarged cerebellar volume
D. Increased thalamic volume

Stressful life events more often precede which mood disorder episodes?
A. First episodes
B. Subsequent episodes
C. Only manic episodes
D. Only psychotic episodes

Stress accompanying the first episode can cause long-lasting biologic changes leading to high risk of later episodes even without:
A. Medication
B. Psychotherapy
C. An external stressor
D. Sleep deprivation

Psychodynamic theory links vulnerability to depression to disturbances in the infant–mother relationship during which phase?
A. Anal phase
B. Oral phase
C. Phallic phase
D. Latency phase

Psychodynamic theory proposes depression can be linked to:
A. Only biologic lesions
B. Purely cognitive templates
C. Real or imagined object loss
D. Reinforcement without rejection

In psychodynamic theory, introjection of departed objects serves as a:
A. Defense mechanism
B. Sleep architecture change
C. Neuroendocrine marker
D. Dopamine depletion sign

Cognitive theory states depression results from:
A. Primary reward deficits only
B. Psychotic delusions only
C. Specific cognitive distortions
D. Excess cortisol only

The cognitive triad includes negative views about self, environment, and:
A. The past
B. Sleep
C. Food
D. The future

Learned helplessness theory connects depressive phenomena to:
A. Uncontrollable events experience
B. Excess positive reinforcement
C. Purely genetic vulnerability
D. Abnormal thyroid antibodies

Evolutionary theory frames depression as:
A. Pure metabolic failure
B. Adaptive threat response
C. Psychosis spectrum illness
D. Dopamine excess syndrome

In evolutionary theory, withdrawal in the face of threats may be:
A. Maladaptive always
B. Purely hormonal
C. Protective
D. Unrelated to fitness

Beyond physical harm, evolutionary theory highlights ______ threats such as exclusion or defeat.
A. Social
B. Dietary
C. Climatic
D. Financial

The depressive bias toward withdrawal and negative appraisal can be viewed as adaptive to:
A. Increase novelty seeking
B. Reduce risk, avoid failures
C. Increase dominance behaviors
D. Enhance appetite pursuits

Some evolutionary models propose mood variability is adaptive, but depression represents:
A. Enhanced mood flexibility
B. Total mood absence
C. Dysregulation of mood variation
D. Purely learned cognition

In the integrative approach, ______ vulnerability increases risk for depression.
A. Genetic
B. Infectious
C. Nutritional
D. Toxicologic

In the integrative model, vulnerability plus ______ precipitates downstream changes.
A. Mania
B. Stress
C. Sleep extension
D. Exercise

Stress in vulnerable persons produces ______ changes differing from normal stress responses.
A. Epigenetic
B. Neoplastic
C. Autoimmune
D. Hemorrhagic

The integrative model proposes subtle ______ loss.
A. Myelin
B. Neuronal
C. Vascular
D. Cartilage