Question 1
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As the provider, you are looking at genetic testing for your patient who you have diagnosed with depression. You know that the most noteworthy genes in MDD are (select all that apply):
Answer
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MTHFR
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SLC6A4
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BDNF
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ANK3
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CYP2D6
Question 2
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Label the 5 major regions of dysfunction in depressed brains.
Question 3
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The [blank_start]insula[blank_end] is a structure that sits on top of the caudate-putamen and interacts with amygdala, and plays a major role in the perception of pain.
Question 4
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What functional processes in the brain, exacerbate PAIN in persons with MDD?
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White matter abnormalities
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Decreased volume in the hippocampus and PFC
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Altered regional blood flow
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emotion-related brain activation is shifted to the dorsal anterior insula
Question 5
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T or F. The most current Monoamine Hypothesis posits that there are depleted monoamine levels (5HT, NE, DA) and these deficiencies can be measured in the plasma, CSF and brain tissue.
Question 6
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The NT Receptor hypothesis posits that abnormalities in the receptors for monoamine NT's leads to [blank_start]depression[blank_end]. Further, deficient activity of monoanime NT's causes [blank_start]upregulation[blank_end] of postsynaptic NT receptors.
Question 7
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Which important signal conduction cascades are triggered by neurotransmitters?
Question 8
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In the Second Messenger Malfunction Theory, problems in the [blank_start]2nd[blank_end] messenger system can [blank_start]impair[blank_end] neurotransmitter function [blank_start]without[blank_end] changes in monoamine levels or receptor numbers. This results in a [blank_start]downstream[blank_end] impact on gene expression.
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2nd
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1st
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impair
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increase
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without
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with
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downstream
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upstream
Question 9
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Serotonin is a monoamine, specifically an [blank_start]indoleamine[blank_end].
Question 10
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5HT is produced in the [blank_start]raphe[blank_end] nuclei.
Question 11
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Disruption to the normal connection of serotonergic nuclei to this system, is thought to contribute to depression?
Question 12
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Match the monoamine circuit to its function(s):
5HT:
[blank_start]Affect[blank_end]
[blank_start]Anxiety[blank_end]
[blank_start]Distress[blank_end]
[blank_start]Behavioral Inhibition[blank_end]
NE
[blank_start]Arousal[blank_end]
[blank_start]Responsiveness[blank_end]
[blank_start]Alerting Signals[blank_end]
DA
[blank_start]Reward[blank_end]
[blank_start]Interest[blank_end][blank_start]Motivation[blank_end]
Answer
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Affect
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Anxiety
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Distress
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Behavioral Inhibition
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Arousal
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Responsiveness
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Alerting Signals
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Reward
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Interest
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Motivation
Question 13
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The PMHNP is explaining to her patient the role of 5HT in depression, specifically the "Behavioral Inhibition" system. What is the best explanation of this system below?
Answer
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It is linked to pleasure and reward, and this becomes overactive in depression, decreasing inhibition.
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It is linked to the stimulus of the PFC, and subsequently behavioral arousal
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It is tuned to responding to fear or anxiety producing stimuli
Question 14
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NE is a monoamine, specifically a [blank_start]catecholamine[blank_end].
Question 15
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NE in the CNS is produced in the [blank_start]nucleus[blank_end] [blank_start]locus[blank_end] [blank_start]ceruleus[blank_end].
Question 16
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Put the correct statement below:
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NE stimulates the NA, then the PFC and then the VTA
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NE stiumulates the PFC, then the VTA and then the NA
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NE stimulates the VTA, then the PFC and then the NA
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NE stimulates the PFC, then the amygdala and the the NA
Question 17
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NE is modulated by which part of the brain?
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PFC
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Nucleus Accumbens
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Locus Coeruleus
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Amygdala
Question 18
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Dopamine is a monoamine, specifically a [blank_start]cathecolamine[blank_end].
Question 19
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The [blank_start]mesolimbic[blank_end] pathway is involved in pleasure and reward; stimulation of this pathway results in a sense of pleasure.
Question 20
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The [blank_start]mesocortical[blank_end] pathway is involved in motivational behavior, and is tied to pleasure and reward.
Question 21
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Monoamine Hypothesis Made Simple for Patient Education-Label the functions with the correct neurotrasmitter.
Answer
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Alertness, Energy
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Attention, Motivation, Pleasure, Reward
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Obsessions and Compulsions
Question 22
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The most used neurotransmitter in the nervous system is [blank_start]glutamate[blank_end].
Question 23
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What is the MOA of ketamine, and the reason why it may be useful in the treatment of depression?
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It activates glutamate in the limbic system, mitigating the resulting dysfunction in the balance of glutamate receptor activation
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It blocks the excitatory post synaptic response of glutamate.
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NMDA is one of the main receptors for glutamate, and ketamine is an NMDA receptor blocker.
Question 24
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Label the HPA Axis diagram sequentially with the correct parts of the brain:
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Hypothalamus
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Anterior Pituitary
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Adrenal Cortex
Question 25
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Chronic exposure to stress & high levels of [blank_start]glucocorticoids[blank_end] leads to neuronal atrophy and death.
Answer
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glucocorticoids
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cytokeines
Question 26
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T of F. One of the effects of chronic stress is decreased neurogenesis and hippocampal atrophy.
Question 27
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Cytokines can (select all that apply):
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Induce changes in mood and CNS function
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impact neurotrasmitter metabolism
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can cross the blood-brain barrier to have neurotoxic effects causing neuronal death
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Cause psyhcosis
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Play a not yet fully understood role in OCD
Question 28
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Two the likely risk genes in Bipolar are the [blank_start]CACNA1C[blank_end] and [blank_start]ANK3.[blank_end]
Answer
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CACNA1C
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SLC6A4
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ANK3.
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BDNF
Question 29
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T or F. Genes = Probabilism not determinism.
Question 30
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In bipolar disorder, there is thought to be decreased size and activity in the [blank_start]PFC[blank_end] (use the abbreviation) and [blank_start]limbic[blank_end] hyperactivity.
Question 31
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In bipolar disorder, hippocampus volume is [blank_start]decreased[blank_end].
Question 32
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In mania frontal activity is most [blank_start]decreased[blank_end] and limbic activity is most [blank_start]increased.[blank_end]
Question 33
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In bipolar mania, which neurotransmitter have greater activity (select all that apply)?
Question 34
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What is the Kindling Theory of Bipolar?
Answer
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Your brain is like a slow, burning pile of smoldering sticks
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Easily combustible small sticks or twigs used for starting a fire.
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A process by which a brain event is both initiated and its recurrence made more likely. Essentially more vulnerable to future episodes.
Question 35
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This is a nice graphic for neurocircuitry of depression
Question 36
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Nice graphic for Bipolar.
Question 37
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Additional helpful graphic
Question 38
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Simple Neurotransmitter Explanation
Question 39
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Neurotransmitter Imbalance Chart
Question 40
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Last one...there were just so many helpful charts out there!