Chapter 14 - Psychological Disorders

Question 1

What is major depressive disorder?

Answer 1

Person feels sad and helpless for days at a time. Changes in the synapse at the nucleus accumbens make it less responsive to reward. There is a moderate heritability for depression.

Question 2

What is the relationship between happiness and activity in the left PFC for normal people?

Answer 2

Normal people have a strong relationship between happiness and increased activity in the left PFC.

Question 3

What area of the brain do people with depression have decreased activity?

Answer 3

People with depression often have decreased activity in the left PFC.

Question 4

What are the three types of antidepressant drugs?

Answer 4

Tricyclics, Selective serotonin reuptake inhibitors (SSRI’s) and monoamine oxidase inhibitors (MAOI’s)

Question 5

How do tricyclics work?

Answer 5

They block proteins that reabsorb serotonin, dopamine and norepinephrine into the presynaptic neuron after their release. Tricyclic drugs block the protein so that it can’t reuptake. The result is to prolong the presence of the neurotransmitters in the synaptic cleft, where they continue to stimulate the postsynaptic cell.

Question 6

What are the side effects of tricyclics?

Answer 6

Tricyclics also block histamine receptors, acetylcholine receptors and certain sodium channels. Histamine produces drowsiness, acetylcholine leads to dry mouth and difficulty urinating and sodium causes heart irregularities.

Question 7

How do SSRIs work?

Answer 7

They are similar to tricyclics but they only work on serotonin. They produce similar results as tricyclics but with less side effects. Serotonin norepinephrine reuptake inhibitiors block the reuptake of serotonin and norepinephrine.

Question 8

How do MAOI’s work?

Answer 8

MAOI’s block monoamine oxidase (MAO) a presynaptic enzyme that metabolises catecholamines and serotonin into inactive forms. When MAOI’s block MAO there is more transmitter available for release at the presynaptic terminal.

Question 9

What do physicians prescribe patients?

Answer 9

They prescribe tricyclics and SSRI’s before MAOI’s.

Question 10

What food must people taking MAOI’s avoid?

Answer 10

People taking MAOI’s must avoid foods containing tyramine (cheese and raisin’s). Tyramine and MAOI’s together can cause an increase in BP.

Question 11

What are the levels of neurotransmitters and neurotrophins in people with depression?

Answer 11

People with depression often have normal or increased levels of neurotransmitters. Most people with depression have decreased levels of neuotrophins.

Question 12

What role do neurotrophins play in depression?

Answer 12

Neurotrophins aid in the survival and growth and connections of neurons. People with depression have a decreased levels of a neurotrophin called brain-derived neurotropic factor (BDNF) that is important for synaptic plasticity, learning and proliferation of new neurons in the hippocampus.

Question 13

What neurotrophin is linked to depression?

Answer 13

brain-derived neurotropic factor (BDNF)

Question 14

What role does the hippocampus play?

Answer 14

People with depression have a smaller hippocampus, impaired learning and reduced production of hippocampal neurons.

Question 15

What alternatives to drugs are there to treat depression?

Answer 15

CBT - psychotherapy is more likely to prevent relapses than drugs.
Exercise is an effective treatment when used with other methods.

Question 16

What is the most effective treatment plan for people with depression?

Answer 16

Patients receiving psychotherapy and antidepressants show greater improvement than people receiving only one.

Question 17

What is ECT?

Answer 17

Electroconvulsive therapy. Causes a person to have a seizure.

Question 18

How is ECT used in treatment of depression?

Answer 18

ECT relieves depression in many cases. Usually given to patients with severe depression. Applied every second day for 2 weeks. Patients given muscle relaxants or anaesthetics to minimise discomfort. Side effects can include memory impairment.

Question 19

How is sleep impacted by depression?

Answer 19

People with depression usually struggle to go to sleep and awaken early. They usually enter REM sleep within 45 minutes of going to sleep.

Question 20

How does sleep deprivation improve symptoms?

Answer 20

Sleep deprivation can relieve symptoms for one day.

Question 21

How can sleep patterns help with depression?

Answer 21

Altering the sleep schedule (i.e. going to bed earlier and awakening earlier) can have similar effects of sleep deprivation and last for a while.

Question 22

What is the symptoms of bipolar disorder?

Answer 22

Variation between two poles - depression and mania.

Question 23

What is mania?

Answer 23

Mania is characterised by restless activity, excitement, laughter and excessive self-confidence, rambling speech and loss of inhibitions. Usually onsets in teens or early 20s.

Question 24

What is Bipolar I disorder?

Answer 24

Full manic episodes.

Question 25

What is Bipolar II disorder?

Answer 25

mild or hypomanic episodes.

Question 26

What are the gender differences with bipolar disorder?

Answer 26

Men are more likely to have severe (bipolar I). Women are more likely to get treatment.

Question 27

What are treatments of bipolar disorder?

Answer 27

Lithium salts. They stabilise mood, preventing a relapse into mania or depression. Dose must be regulated carefully - a low dose is ineffective. High dose is toxic. Other drugs are valproate and carbamazepine. If ineffective, physicians can combine with antidepressants or antipsychotics.

Question 28

How does lithium, valproate and carbamazepine work?

Answer 28

They decrease the number of AMPA type glutamate receptors in the hippocampus. Excessive glutamate activity is responsible for some aspects of mania. They also block the synthesis of arachidonic acid - produced during brain inflammation. Effects of arachidonic acid are counteracted by omega-3 fatty acids (found in seafood). consistent sleep patterns also helps.

Question 29

What is seasonal affective disorder?

Answer 29

SAD is depression that reoccurs during a particular season (i.e. winter) especially near the poles where winter nights are long.

Question 30

How is sleep impacted by SAD?

Answer 30

People with SAD have phase-delayed sleep and temperature rhythms - they become sleepy and wakeful later than normal.

Question 31

How can SAD be treated?

Answer 31

By very bright lights.

Question 32

What evidence suggests two types of depression influenced by different genes?

Answer 32

Relatives of people with early-onset depression have a high risk of depression and many other psychological disorders. Relatives of people with late-onset disorder have a high probability of circulatory problems.

Question 33

What did Caspi and colleagues report to be the relationship between depression and the gene controlling the serotonin transporter protein?

Answer 33

People with the short form of the gene are more likely than other people to react to stressful experiences by becoming depressed. However, in the absence of stressful experiences, their probability is not increased.

Question 34

Some people offer to train you to use the right hemisphere of your brain more strongly and allegedly to increase creativity. If they were successful, can you see any disadvantages?

Answer 34

People with predominant right-hemisphere activity and decreased left-hemisphere activity show an increased tendency toward depression.

Question 35

What are the effects of tricyclic drugs?

Answer 35

They block the reuptake of serotonin and catecholamines. They also block histamine receptors, acetylcholine receptors and certain sodium channels, thereby producing unpleasant side effects.

Question 36

What are the effects of SSRIs?

Answer 36

SSRIs selectively inhibit the reuptake of serotonin.

Question 37

What are the effects of MAOIs?

Answer 37

MAOIs block the enzyme MAO, which breaks down catecholamines and serotonin. The result is the increased availability of these transmitters.

Question 38

In what way does the time course of antidepressants conflict with the idea that they improve mood by increasing neurotransmitter levels?

Answer 38

Antidepressants produce their effects on serotonin and other neurotransmitters quickly, but their behavioural benefits develop gradually over 2 to 3 weeks.

Question 39

As opposed to an interpretation in terms of neurotransmitter levels, what is an alternative explanation for the benefits of antidepressant drugs?

Answer 39

Antidepressant drugs increase production of BDNF, which gradually promotes growth of new neurons in the hippocampus and new learning.

Question 40

As depression becomes more severe, what happens to the percentage of patients showing improvements while taking antidepressant drugs or placebos?

Answer 40

For more severe cases, the percentage of patients who improve remains about the same for patients taking antidepressant drugs but fewer patients taking placebos show improvement.

Question 41

What is an advantage of psychotherapy over antidepressant drugs?

Answer 41

People who respond well to psychotherapy have a lower risk of later relapse than people who respond to antidepressant drugs. Also, antidepressant drugs produce unpleasant side effects.

Question 42

How can one decrease the memory loss associated with ECT?

Answer 42

ECT over just the right hemisphere produces less memory loss.

Question 43

What changes in sleep habits sometimes relieves depression?

Answer 43

Getting people with depression to go to bed earlier sometimes relieves depression.

Question 44

What are two common treatments for bipolar disorder?

Answer 44

The common treatments for bipolar disorder are lithium salts and certain anticonvulsant drugs - valproate and carbamazepine.

Question 45

What are the advantages of bright light treatment compared to antidepressant drugs for SAD?

Answer 45

It is cheaper, has no side effects and produces more benefits quickly.

Question 46

Which of the following is the most typical outcome after someone develops major depression? a) The person will remain seriously depressed for life. b) The depression will grow worse over time. c) The person will alternate between episodes of depression and periods of normal mood. d) The person will recover without any likelihood of returning to depression.

Answer 46

c) The person will alternate between episodes of depression and periods of normal mood.

Question 47

Relatives of people with late-onset depression have an increased probability of what type of disorder?

Answer 47

Circulatory problems.

Question 48

Which of the following is a likely reason why it has been difficult to identify a gene associated with depression? a) Depression does not have a genetic basis. b) Only early-onset depression has a genetic basis. c) Certain genes link to depression only in people who have undergone severe stress. d) Researchers have studied only animal models, not humans.

Answer 48

c) Certain genes link to depression only in people who have undergone severe stress.

Question 49

How do tricyclic drugs block the reuptake of serotonin and other neurotransmitters?

Answer 49

They lock the transporter protein into one position.

Question 50

What is the advantage of SSRIs compared to tricyclic drugs?

Answer 50

They produce milder side effects.

Question 51

What is the disadvantage of using St. John's wort as an antidepressant?

Answer 51

St. John's wort decreases the effectiveness of other drugs someone might be taking.

Question 52

Which of the following is evidence against the idea that antidepressant drugs relieve depression simply by elevating neurotransmitter levels? a) The dose of drug necessary for relieving depression is greater than the amount necessary to elevate neurotransmitter levels. b) The drugs quickly affect levels of serotonin and other neurotransmitters but take weeks to alter mood. c) The drugs become less and less effective in relieving depression after weeks of use. d) Several procedures other than antidepressant drugs are also effective in relieving depression.

Answer 52

b) The drugs quickly affect levels of serotonin and other neurotransmitters but take weeks to alter mood.

Question 53

If you are already in a normal mood, could you make yourself feel even better by taking antidepressant drugs? If not, why not?

Answer 53

No, you could not. Antidepressant drugs promote new learning that competes with depressed thoughts. Someone without depressed thoughts has little to gain.

Question 54

How does effectiveness of psychotherapy compare to that of antidepressant drugs?

Answer 54

Psychotherapy and antidepressant drugs help about an equal percentage of patients, and mostly the same patients.

Question 55

One important factor to consider when making judgments about the relative influence of genetics on schizophrenia is:

Answer 55

the mother's prenatal environment.

Question 56

According to the dopamine hypothesis, what causes schizophrenia?

Answer 56

excessive activity at dopamine synapses

Question 57

Lithium is most commonly prescribed for which disorder?

Answer 57

bipolar disorder

Question 58

Inappropriate emotions, bizarre behaviors, and thought disorders represent the:

Answer 58

disorganised cluster of positive symptoms

Question 59

On average, those with the short form of the ____ transporter gene and a history of stressful experiences reported more than average symptoms of depression.

Answer 59

serotonin

Question 60

Prolonged use of antidepressants not only increases the availability of neurotransmitters in the synapse but also:

Answer 60

increases the release of neurotrophins

Question 61

Which of the following are the most likely side effects of tricyclic antidepressants? a. cramping and diarrhea b. nausea and headaches c. drowsiness and dry mouth d. increased reaction to eating cheese

Answer 61

c. drowsiness and dry mouth

Question 62

The main advantage of psychotherapy over drug-therapy in the treatment of depression is that psychotherapy:

Answer 62

produces longer-lasting effects.

Question 63

Measuring the number of dopamine receptors occupied by a radioactive drug in people with schizophrenia led to the finding that:

Answer 63

excessive dopamine release occupies a greater number of D2 receptors.

Question 64

One potentially dangerous side effect of St. John's wort is that it:

Answer 64

decreases the effectiveness of other medications the person may be taking.

Question 65

The most severe episodes of depression generally occur:

Answer 65

after a traumatic event.

Question 66

ECT increases the proliferation of new neurons in the:

Answer 66

hippocampus

Question 67

Bipolar I disorder and bipolar II disorder differ with regard to:

Answer 67

whether they include full-blown manic phases.

Question 68

All of the following are antipsychotic drugs EXCEPT: a. Thorazine. b. L-Dopa. c. chlorpromazine. d. Haldol.

Answer 68

b. L-Dopa.

Question 69

Compared to non-depressed people, which of the following is true regarding depressed individuals? a. They react more to pleasant experiences. b. They react worse to unpleasant events. c. They have greater unpleasant events. d. They have fewer pleasant experiences.

Answer 69

d. They have fewer pleasant experiences.

Question 70

Electroconvulsive shock therapy is most likely to be used with patients:

Answer 70

who have not responded to drug therapy

Question 71

Most depressed people show ____ activity in the ____ prefrontal cortex.

Answer 71

decreased; left

Question 72

For which of the following is the drug treatment generally only a little better than a placebo?

Answer 72

mild to moderate depression

Question 73

MAOIs block the activity of the enzyme that:

Answer 73

breaks down catecholamines.

Question 74

Which is true when considering the role of genetics in depression? a. Late-onset depression has higher heritability than early-onset depression. b. Depression in males runs in families, depression in females does not. c. Adopted children who become depressed are more likely to have depressed biological relatives than depressed adoptive relatives. d. Adopted children who become depressed are more likely to have depressed adoptive relatives than depressed biological relatives.

Answer 74

c. Adopted children who become depressed are more likely to have depressed biological relatives than depressed adoptive relatives.

Question 75

An alternative to the dopamine hypothesis of schizophrenia is the proposal that schizophrenia may be due to a deficiency of activity of ____ synapses.

Answer 75

glutamate

Question 76

Of these treatments for depression--drugs, psychotherapy, and electroshock--which one (if any) usually produces benefits FASTEST?

Answer 76

electroshock

Question 77

An antidepressant drug operates by blocking reuptake of serotonin and catecholamines, but also blocks histamine receptors, acetylcholine receptors, and certain sodium channels. This drug would most likely be classified as a(n):

Answer 77

Tricyclic

Question 78

SSRIs work similarly to:

Answer 78

Tricyclics

Question 79

The cheapest and simplest antidepressant procedure is:

Answer 79

Regular nonstrenuous exercise

Question 80

Atypical antipsychotic drugs differ from standard neuroleptics like chlorpromazine in terms of:

Answer 80

which set of dopamine synapses they affect.

Question 81

Of the following treatments for depression - psychotherapy, drug therapy, and ECT - the one with the fastest benefits is ____ and the one with the longest lasting benefits is ____.

Answer 81

ECT; psychotherapy

Question 82

After ECT has relieved depression, the usual strategy to try to prevent a relapse includes all of the following EXCEPT: a. periodic ECT treatments. b. drug therapy. c. periodic transcranial magnetic stimulation. d. psychotherapy.

Answer 82

periodic ECT treatments

Question 83

In contrast to tricyclics, selective serotonin reuptake inhibitors (SSRIs):

Answer 83

block the reuptake of only serotonin.

Question 84

In certain cases, it is possible to relieve depression by changing a person's:

Answer 84

Sleeping schedule

Question 85

If someone has major depression, what is probably true of that person's relatives?

Answer 85

They have an increased risk of many other disorders.

Question 86

Long term use of antidepressants increases the proliferation of new neurons in the:

Answer 86

Hippocampus

Question 87

Prior to the 1950's, few schizophrenic patients who entered a mental hospital ever left. The discovery most responsible for alleviating that situation was the discovery of:

Answer 87

chlorpromazine.

Question 88

A first diagnosis of schizophrenia is usually made for a person in which age range?

Answer 88

20s

Question 89

Antidepressant drugs produce their effects on catecholamine and serotonin synapses within hours, but people need to take the drugs for two or more weeks before they experience any mood elevation. T or F

Answer 89

True

Question 90

A serious side effect that develops in some people after prolonged use of neuroleptic drugs is:

Answer 90

tardive dyskinesia.

Question 91

A restless, impulsive person whose speech rambles from one idea to another may fit which of these categories? a. autistic b. depressed c. narcoleptic d. manic

Answer 91

Manic

Question 92

Recent research discourages the use of antidepressant drugs, for which reason? a. The most effective drugs are the most expensive ones. b. The drugs' side effects grow worse and worse after repeated use. c. To get benefits, a person must find exactly the right dose to take. d. Placebos produce practically the same benefits as the drugs in mild to moderate depression.

Answer 92

d. Placebos produce practically the same benefits as the drugs in mild to moderate depression.

Question 93

Generally speaking, dopamine and glutamate have opposite effects in the prefrontal cortex. T or F

Answer 93

True

Question 94

The differences between ordinary and major depression depend on:

Answer 94

Intensity and duration.