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Psych 7

front 1

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

back 1

C. Generalized psychomotor retardation

front 2

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

back 2

A. Psychomotor agitation

front 3

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

back 3

D. Decreased rate and volume

front 4

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

back 4

B. Delayed responses

front 5

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

back 5

C. Reduced energy

front 6

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

back 6

D. Terminal insomnia, multiple awakenings

front 7

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

back 7

A. Terminal insomnia

front 8

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

back 8

B. Neurovegetative symptoms

front 9

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

back 9

D. Reversed neurovegetative symptoms

front 10

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

back 10

A. Decreased appetite, weight loss

front 11

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

back 11

B. Dysphoria

front 12

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

back 12

C. Anhedonia

front 13

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

back 13

C. Thought blocking, poverty content

front 14

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

back 14

B. Thought blocking, poverty content

front 15

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

back 15

D. Psychotic depression

front 16

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

back 16

A. Mood-congruent

front 17

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

back 17

C. Worthlessness and guilt

front 18

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

back 18

C. Fatigue, low energy

front 19

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

back 19

A. Inattention

front 20

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

back 20

D. Insomnia, early morning awakening

front 21

del

back 21

del

front 22

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

back 22

A. Decreased libido, reduced performance

front 23

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

back 23

C. Menstrual irregularities

front 24

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

back 24

B. Worse depression in morning

front 25

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

back 25

D. Cognitive symptoms

front 26

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

back 26

D. Delay major decisions until thinking normal

front 27

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

back 27

B. Accept “failed trial” without probing

front 28

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

back 28

C. Higher lifetime completion risk

front 29

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

back 29

A. Often lacks energy for impulsive acts

front 30

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

back 30

B. During early improvement, energy returns

front 31

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

back 31

D. Melancholia

front 32

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

back 32

A. Guilt over trivial events

front 33

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

back 33

C. Autonomic and endocrine changes

front 34

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

back 34

D. Catatonia

front 35

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

back 35

B. Negativism

front 36

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

back 36

C. Less severe but more chronic

front 37

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

back 37

D. Depressed mood most day, continuous

front 38

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

back 38

B. Always depressed since adolescence

front 39

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

back 39

C. Minor depressive disorder

front 40

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

back 40

A. Minor depression is episodic

front 41

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

back 41

B. Minor depressive disorder

front 42

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

back 42

D. Less than 2 weeks

front 43

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

back 43

C. Double depression

front 44

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

back 44

C. Hamilton Rating Scale (HAM-D)

front 45

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

back 45

B. Zung Self-Rating Scale

front 46

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

back 46

C. Affective expression

front 47

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

back 47

B. Raskin scale

front 48

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

back 48

D. Verbal, behavior, secondary symptoms

front 49

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

back 49

A. Mononucleosis

front 50

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

back 50

D. Adrenal and thyroid dysfunctions

front 51

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

back 51

B. Viral pneumonia

front 52

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

back 52

D. Consider any drug a factor

front 53

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

back 53

B. Parkinson disease

front 54

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

back 54

A. Anterior rather than posterior

front 55

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

back 55

C. Diencephalic and temporal regions

front 56

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

back 56

B. Sudden onset

front 57

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

back 57

D. Diurnal variation

front 58

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

back 58

A. Doesn’t try to answer

front 59

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

back 59

C. Coaching improves remembering

front 60

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

back 60

A. Alcohol use and panic disorder

front 61

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

back 61

B. Cocaine and amphetamines

front 62

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

back 62

C. Manic patients seldom use sedatives

front 63

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

back 63

A. Dysthymia

front 64

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

back 64

C. 6 to 13 months

front 65

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

back 65

A. About 3 months

front 66

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

back 66

D. Symptoms almost always return

front 67

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

back 67

B. Shorter intervals, worse episodes

front 68

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

back 68

A. Up to 3 to 4 weeks

front 69

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

back 69

C. Max dose, hold 4–5 weeks

front 70

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

back 70

B. Check plasma level if possible

front 71

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

back 71

D. Second- and third-generation agents

front 72

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

back 72

B. SSRIs

front 73

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

back 73

C. At least 6 months or longer

front 74

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

back 74

A. Taper over 1 to 2 weeks

front 75

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

back 75

B. Prophylactic treatment recommended

front 76

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

back 76

D. Dual serotonergic and noradrenergic

front 77

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

back 77

A. Antidepressant plus atypical antipsychotic

front 78

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

back 78

C. ECT

front 79

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

back 79

C. Typical antipsychotics

front 80

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

back 80

A. SSRIs and bupropion

front 81

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

back 81

D. Tricyclics and SSRIs

front 82

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

back 82

C. Nonmood disorder dictates choice

front 83

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

back 83

A. Quetiapine and aripiprazole

front 84

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

back 84

D. Lithium augmentation

front 85

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

back 85

C. Thyroid hormone augmentation

front 86

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

back 86

D. Stopping before 3 months relapses

front 87

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

back 87

D. Inhibits postsynaptic NMDA receptor

front 88

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

back 88

B. Within 24 hours

front 89

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

back 89

A. 2 to 7 days

front 90

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

back 90

C. Abuse potential

front 91

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

back 91

B. Glutamatergic signaling abnormalities implicated

front 92

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

back 92

A. Brexanolone

front 93

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

back 93

B. Neuroactive steroid

front 94

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

back 94

C. Within 24 hours

front 95

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

back 95

A. 30 days

front 96

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

back 96

B. GABAA allosteric modulation

front 97

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

back 97

C. Peptides acting neurotransmitters

front 98

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

back 98

B. Enteric nervous system

front 99

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

back 99

A. Sleep deprivation may relieve depression

front 100

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

back 100

D. Cognitive therapy

front 101

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

back 101

B. Selective attention to negatives

front 102

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

back 102

A. Unrealistically morbid inferences

front 103

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

back 103

A. Interpersonal therapy

front 104

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

back 104

C. Rooted in early dysfunction

front 105

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

back 105

B. Precipitate or perpetuate depression

front 106

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

back 106

D. 12 to 16 weekly sessions

front 107

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

back 107

B. Active therapeutic approach

front 108

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

back 108

B. Little feedback, social rejection

front 109

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

back 109

A. Receive positive reinforcement

front 110

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

back 110

C. Active directive therapist roles

front 111

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

back 111

B. Recognizable goals and endpoints

front 112

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

back 112

B. Change personality structure

front 113

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

back 113

B. Heightened anxiety and distress

front 114

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

back 114

C. Family therapy

front 115

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

back 115

B. Role of family maintaining symptoms

front 116

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

back 116

A. HPA axis

front 117

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

back 117

B. Cortisol

front 118

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

back 118

B. CRH

front 119

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

back 119

B. Feedback inhibition

front 120

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

back 120

C. Dexamethasone suppression test

front 121

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

back 121

B. Decrease, then escape upward

front 122

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

back 122

C. Decreases cortisol

front 123

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

back 123

B. Neurons

front 124

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

back 124

B. Decreased inhibitory serotonin tone

front 125

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

back 125

A. NE, ACh, or CRH

front 126

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

back 126

C. Hippocampus

front 127

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

back 127

B. HPA axis

front 128

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

back 128

A. Cortical atrophy, decreased volume

front 129

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

back 129

C. Thyroid

front 130

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

back 130

B. Blunted TSH response

front 131

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

back 131

B. Increased relapse risk

front 132

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

back 132

C. NE and dopamine

front 133

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

back 133

D. Low depression, high mania

front 134

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

back 134

A. Serotonin

front 135

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

back 135

C. Ongoing neuronal maintenance

front 136

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

back 136

D. PFC and hippocampus

front 137

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

back 137

B. Higher serum BDNF

front 138

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

back 138

A. Deep slow-wave sleep

front 139

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

back 139

A. Increased nocturnal awakenings

front 140

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

back 140

C. Reduction in total sleep time

front 141

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

back 141

B. Increased phasic REM sleep

front 142

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

back 142

D. Increased core body temperature

front 143

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

back 143

B. Reduced REM latency, more density

front 144

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

back 144

C. Interfered with monoamine catabolism

front 145

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

back 145

B. Low monoamine levels

front 146

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

back 146

D. β-adrenergic receptors

front 147

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

back 147

C. Noradrenergic

front 148

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

back 148

A. More norepinephrine released

front 149

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

back 149

D. Serotonin

front 150

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

back 150

B. Serotonin signaling

front 151

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

back 151

D. Low depression, high mania

front 152

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

back 152

B. Dopamine depletion can cause depression

front 153

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

back 153

C. Tyrosine and amphetamine

front 154

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

back 154

A. Cerebral cortex

front 155

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

back 155

B. All three monoamine systems

front 156

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

back 156

A. Choline

front 157

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

back 157

C. GABA

front 158

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

back 158

C. Reduced plasma and CSF GABA

front 159

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

back 159

B. GABA depletion over time

front 160

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

back 160

D. Low platelet serotonin uptake

front 161

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

back 161

C. Mesocortical and mesolimbic

front 162

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

back 162

B. GABA receptors

front 163

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

back 163

B. Glutamate

front 164

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

back 164

B. Glycine

front 165

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

back 165

B. NMDA receptor

front 166

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

back 166

A. Hippocampus

front 167

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

back 167

C. Glutamate

front 168

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

back 168

A. Transport vesicles

front 169

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

back 169

B. Second messengers

front 170

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

back 170

B. Decreased cellular immunity

front 171

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

back 171

C. Interleukins

front 172

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

back 172

A. Interleukin-1

front 173

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

back 173

D. Cytokine abnormalities

front 174

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

back 174

B. Abnormal subcortical hyperintensities

front 175

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

back 175

A. Sulcal widening

front 176

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

back 176

C. Hippocampus and caudate

front 177

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

back 177

B. Hippocampus

front 178

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

back 178

C. Cortisol

front 179

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

back 179

A. Glutamatergic neurons

front 180

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

back 180

A. PFC, cingulate, cerebellum

front 181

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

back 181

B. Decreased anterior metabolism

front 182

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

back 182

A. Left

front 183

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

back 183

B. Nondominant hemisphere

front 184

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

back 184

B. Mesocortical and mesolimbic

front 185

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

back 185

B. Increased

front 186

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

back 186

B. Intrusive ruminations

front 187

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

back 187

B. Activation

front 188

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

back 188

B. Amygdala, insula, anterior cingulate

front 189

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

back 189

A. Dorsal striatum and dlPFC

front 190

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

back 190

B. Women

front 191

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

back 191

C. No significant role

front 192

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

back 192

A. HTR1A

front 193

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

back 193

C. SLC6A4

front 194

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

back 194

B. DRD4

front 195

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

back 195

A. SLC6A3

front 196

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

back 196

B. Many genes, small effects

front 197

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

back 197

D. Weeks-to-effect, no imbalance evidence

front 198

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

back 198

B. Therapeutic lag despite rapid changes

front 199

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

back 199

A. No convincing imbalance evidence

front 200

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

back 200

A. Amygdala

front 201

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

back 201

B. Cortical responses

front 202

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

back 202

C. Hippocampus

front 203

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

back 203

B. Hippocampus and amygdala

front 204

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

back 204

B. Prefrontal cortex

front 205

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

back 205

C. Goal-directed appetitive behavior

front 206

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

back 206

B. Avoidance and inhibition

front 207

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

back 207

C. Reward and punishment behaviors

front 208

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

back 208

B. Attentional and emotional inputs

front 209

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

back 209

A. Limbic regions

front 210

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

back 210

C. Thwarted goals meet novel problems

front 211

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

back 211

D. Deficit of newborn neurons

front 212

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

back 212

A. Atrophy of developed neurons

front 213

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

back 213

B. Decrease neurogenesis

front 214

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

back 214

D. Hippocampus

front 215

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

back 215

B. Higher glucocorticoids, less neurogenesis

front 216

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

back 216

C. Neuronal atrophy

front 217

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

back 217

B. BDNF

front 218

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

back 218

B. Decreased hippocampal volume

front 219

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

back 219

A. First episodes

front 220

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

back 220

C. An external stressor

front 221

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

back 221

B. Oral phase

front 222

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

back 222

C. Real or imagined object loss

front 223

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

back 223

A. Defense mechanism

front 224

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

back 224

C. Specific cognitive distortions

front 225

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

back 225

D. The future

front 226

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

back 226

A. Uncontrollable events experience

front 227

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

back 227

B. Adaptive threat response

front 228

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

back 228

C. Protective

front 229

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

back 229

A. Social

front 230

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

back 230

B. Reduce risk, avoid failures

front 231

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

back 231

C. Dysregulation of mood variation

front 232

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

back 232

A. Genetic

front 233

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

back 233

B. Stress

front 234

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

back 234

A. Epigenetic

front 235

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

back 235

B. Neuronal