module 7

Question 1

a neurotransmitter that helps regulate mood, arousal, and cognition.
secreted by the nuclei
-made by brainsterm: Raphe nuclei

Answer 1

serotonin

Question 2

• regulates mood, arousal, attention, and cognition
  -made by Brainstem: locus coeruleus

Answer 2

norepinephrine

Question 3

-neurotransmitter that regulates mood, arousal, cognition, and motor control
-made by brainstem: substantia nigra

Answer 3

Dopamine

made by the Dopaminergic diffuse modulatory systems arise from the substantia nigra and the ventral tegmental area

Question 4

helps regulate sleep, arousal, and attention
-made by basal forebrain: basal nucleus of Meynert

Answer 4

acetylcholine (ACh)

Answer 5

The medial septal nuclei and basal nucleus of Meynert project widely upon the cerebral cortex, including the hippocampus.
-Cholinergic diffuse modulatory systems arise from the basal forebrain and brainstem

Question 6

Low levels of serotonin, norepinephrine, and dopamine have been associated with

Answer 6

Depressive symptoms

Question 7

Low concentrations of serotonin with high levels of norepinephrine have been associated with

Answer 7

Anxiety symptoms

Question 8

Too much dopamine with low concentrations of serotonin in certain areas of the brain lead to symptoms of

Answer 8

psychosis and mania

Question 9

low concentration levels of acetylcholine.2

Answer 9

Dementia

Question 10

Common risk factors in patients with anxiety and related disorders include

Answer 10

family history of anxiety, personal history of anxiety or mood disorder, childhood stressful life events or trauma, being female, chronic medical illness, and behavioral inhibition.

Question 11

Obsessions which are repeated and unwanted thoughts that could lead to certain actions or habits (compulsions) could signify
- characterized by intrusive thoughts and ritualistic behavior

Answer 11

obsessive–compulsive disorder.

Question 12

may include thoughts of hurting someone else, sexual thoughts, excessive concern about contamination/germs/disease, and mental rituals (e.g., counting, praying, repeating).

Answer 12

obsessions

Question 13

can manifest as repetitive acts of washing, cleaning, checking (e.g., doors, locks, appliances), arranging, and repeating (e.g., counting, touching, praying) as well as hoarding, collecting, and saving.

Answer 13

compulsions

Question 14

Excessive worry persisting over a 4-week period suggests a possible

Answer 14

generalized anxiety disorder

Question 15

Hyperthyroidism, cardiopulmonary disorders, and traumatic brain injury (TBI) are common comorbid conditions that accompany

Answer 15

excessive or uncontrollable anxiety

Question 16

often presents with recurrent sudden episodes/spells/attacks of intense fear or discomfort that are unexpected or with intervening periods of living in fear or worrying of having another attack or facing the consequences of the attack.

Answer 16

panic disorder

Question 17

anticipatory anxiety in social situations.

Answer 17

social anxiety disorder

Question 18

Characterized by reexperiencing, avoidance, persistent negative alterations in cognition and mood, and alterations in arousal and reactivity.

Answer 18

ptsd

Question 19

personal history of a depressive episode, a family history of first-degree family members with depression, personal history of recent stressful life events or significant childhood adversity, chronic and/or disabling medical illness, and female gender.3

Answer 19

most common risk factor for depression

Question 20

characterized by at least 2 weeks of depressed/irritable mood, with at least four of the following: anhedonia, insomnia or hypersomnia, decreased self-esteem, low energy, poor concentration or indecision, changes in appetite, feeling slowed or restless, and thoughts of death or suicid

Answer 20

Major depressive disorder (MDD)

Question 21

little interest or pleasure in doing things

Answer 21

(anhedonia

Question 22

characterized by depressive/irritable mood lasting for at least 2 years with at least two of the aforementioned depressive symptoms

Answer 22

Persistent depressive disorder (PDD)

Question 23

present with both depressive episodes, such as in major depressive disorder (MDD), as well as manic or hypomanic episodes. Symptoms of manic episodes include euphoric/irritable mood, grandiosity, decreased need for sleep, talkativeness, racing thoughts, distractibility, increased goal-directed behavior or agitation, and an increase in reckless pleasure-seeking (having unprotected sex, spending excess money, foolish investments

Answer 23

bipolar disorder

Question 24

can be mimicked by medical conditions and substance use. Screening for heart disease, stroke, diabetes, thyroid problems, and alcohol/drug use is crucial to clarifying the diagnosis
-Parkinson disease, traumatic brain injury (TBI), recent myocardial infarction (MI) or stroke, and hypothyroidism may mimic depressive symptoms. Additionally, alcohol use and recent substance use may present in a similar way to depressive symptoms

Answer 24

depressive symptoms

Question 25

particularly recurrent/chronic depression, is frequently comorbid with anxiety, personality disorders, and substance use.

Answer 25

depression

Question 26

are concerning for major vascular neurocognitive disorders, wherein vascular occlusion damages structusres important for memory

Answer 26

Sudden-onset memory problem

Question 27

Rapid-onset memory problems after a head injury should raise suspicion for

Answer 27

a major neurocognitive disorder due to TBI.

Question 28

If the patient affirms one-sided hand tremor or difficulty starting movements, consider

Answer 28

Parkinson disease

Question 29

In a younger adult patient with unusual limb movements, you should assess the family history for .

Answer 29

Huntington disease

Question 30

If family members or caregivers have noticed personality changes in the patient

Answer 30

consider frontotemporal dementia

Question 31

A patient starting to have visual hallucinations may be suffering from .

Answer 31

Lewy body dementia

Question 32

The mental status examination consists of six components:

Answer 32

appearance and behavior; speech and language; mood; thoughts and perceptions; insight and judgment; and cognitive function

Question 33

The obtunded patient opens the eyes when tactile stimulus is applied and looks at you but responds to you slowly and is somewhat confused

Answer 33

Obtundation

Question 34

The stuporous patient arouses only after painful stimuli. Verbal responses are slow or even absent. The patient lapses into an unresponsive state when the stimulus ceases.

Answer 34

Stupor

Question 35

Watch for the anger, hostility, suspiciousness, or evasiveness of patients with paranoia; the elation and euphoria of mania; -the flat affect and remoteness of schizophrenia; the apathy (dulled affect with detachment and indifference) of dementia; and anxiety or depression. Hallucinations occur in schizophrenia, alcohol withdrawal, and systemic toxicity.

Answer 35

sx

Question 36

, in which phrases or sentences are substituted for a word the person cannot think of, such as “what you write with” for “pen”

Answer 36

Circumlocutions

Question 37

, in which words are malformed (“I write with a den”), incorrect (“I write with a bar”), or invented (“I write with a dar”).

Answer 37

Paraphasias

Question 38

Wernicke aphasia, with impaired comprehension with fluent speech' recessive

Answer 38

wernicke aphasia

Question 39

with preserved comprehension with slow,nonfluent speech expressive

Answer 39

Broca aphasia,

Question 40

struggle with naming emotions

Answer 40

(alexithymia

Question 41

Sudden interruption of speech in midsentence or before the idea is completed, attributed to “losing the thought.” Blocking occurs in normal people. -may be striking in schizophrenia.

Answer 41

blocking

Question 42

the mildest thought disorder, consisting of speech with unnecessary detail, indirection, and delay in reaching the point. Some topics may have a meaningful connection. Many people without mental disorders have circumstantial speech. -occurs in people with obsessions

Answer 42

Circumstantiality

Question 43

Speech with choice of words based on sound, rather than meaning, as in rhyming and punning. For example, “Look at my eyes and nose, wise eyes and rosy nose. Two to one, the ayes have it!” -occurs in schizophrenia and manic episodes

Answer 43

clanging

Question 44

Fabrication of facts or events in response to questions, to fill in the gaps from impaired memory -is seen in Korsakoff syndrome from alcoholism

Answer 44

Confabulation

Question 45

Tangential speech with shifting topics that are loosely connected or unrelated. The patient is unaware of the lack of association. - is seen in schizophrenia, manic episodes, and other psychotic disorders.

Answer 45

Derailment (loosening of associations)

Question 46

Repetition of the words and phrases of others -occurs in manic episodes and schizophrenia.

Answer 46

echolalia

Question 47

An almost continuous flow of accelerated speech with abrupt changes from one topic to the next. Changes are based on understandable associations, plays on words, or distracting stimuli, but ideas are not well connected. -is most frequently noted in manic episodes.

Answer 47

Flight of ideas

Question 48

Speech that is incomprehensible and illogical, with lack of meaningful connections, abrupt changes in topic, or disordered grammar or word use. Flight of ideas, when severe, may produce incoherence. -seen in severe psychotic disturbances (usually schizophrenia)

Answer 48

Incoherence

Question 49

Invented or distorted words, or words with new and highly idiosyncratic meanings. -are observed in schizophrenia, psychotic disorders, and aphasia.

Answer 49

Neologisms

Question 50

Persistent repetition of words or ideas -occurs in schizophrenia and other psychotic disorders.

Answer 50

Perseveration

Question 51

False fixed personal beliefs that are not amenable to change in light of conflicting evidence; types of delusions include: persecutory grandiose jealous -erotomanic—the belief that another person is in love with the individua -lsomatic—involves bodily functions or sensations -unspecified—includes delusions of reference without a prominent persecutory or grandiose component, or the belief that external events, objects, or people have a particular and unusual personal significance (e.g., commands from the radio or television)

Answer 51

Delusion

Question 52

Sense that one's self or identity is different, changed, unreal; lost; or detached from one's mind or body

Answer 52

Depersonalization

Question 53

Sense that the environment is strange, unreal, or remote

Answer 53

Derealization

Question 54

Persistent irrational fears accompanied by a compelling desire to avoid the provoking stimulus

Answer 54

phobias

Question 55

are sensory awareness of objects in the environment and their interrelationships (external stimuli). They also refer to internal stimuli such as dreams or hallucinations

Answer 55

perceptions

Question 56

Misinterpretations of real external stimuli, such as mistaking rustling leaves for the sound of voices. -may occur in grief reactions, delirium, acute and posttraumatic stress disorders, and schizophrenia.

Answer 56

illusions

Question 57

Perception-like experiences that seem real but, unlike illusions, lack actual external stimulation. The person may or may not recognize the experiences as false. Hallucinations may be auditory, visual, olfactory, gustatory, tactile, or somatic. False perceptions associated with dreaming, falling asleep, and awakening are not classified as hallucinations -may occur in delirium, dementia (less commonly), posttraumatic stress disorder, schizophrenia, and substance use.

Answer 57

Hallucinations