Pregunta 1
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Anxiety disorders facts:
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Age of onset for anxiety disorders is
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Which of the following is NOT a medical rule out for anxiety
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DSM Anxiety Disorders include [blank_start]anxiety[blank_end] disorders, [blank_start]obsessivecompulsive[blank_end] disorders and [blank_start]trauma or stressor related[blank_end] disorders
Pregunta 5
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Eustress vs. Distress: remember stress isn't always negative
[blank_start]Eustress:[blank_end] Motivating, short-term, exciting
[blank_start]Distress:[blank_end] Short- or long-term, perceived as beyond coping ability, unpleasant
Respuesta
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Eustress:
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Distress:
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Eustress:
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Distress:
Pregunta 6
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“Anxiety and fear are cousins but not twins. [blank_start]Fear[blank_end] sees a threat. [blank_start]Anxiety[blank_end] imagines one.” – Max Lucado
Pregunta 7
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Neuroanatomy of anxiety. Which parts of the brain are involved.
[blank_start]Prefrontal cortex[blank_end] [blank_start]orbitofrontal cortex[blank_end] [blank_start]ventromedial prefrontal cortex[blank_end] [blank_start]limbic system[blank_end]
Pregunta 8
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In neuroanatomy of anxiety, what is the function of the prefrontal cortex
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Executive functioning, planning, decision making
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Predicting consequences
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Understanding social behavior
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Control impuses and regulates mood
Pregunta 9
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In the neuroanatomy of anxiety, the [blank_start]orbitofrontal[blank_end] cortex controls impulses, regulates mood, and drives moral judgment
Pregunta 10
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Which is not a feature of the limbic system
Respuesta
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Structures between the cerebral hemisphere and the brainstem
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Not a discrete “system” but rather a collection of anatomically-related structures with varying functions
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Center for emotional responsiveness, motivation, memory, olfaction, safety
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Phylogenetically ancient, paleomammalian brain
-
Controls moral judgement and controls impulses
Pregunta 11
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[blank_start]Ventromedial prefrontal[blank_end] cortex is in charge of reward processing – think and visceral response to emotions
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[blank_start]Hippocampus[blank_end] -Spatial navigation. Memory formation/storage
[blank_start]Amygdala[blank_end] – Processes emotional stimuli. Receives information about physical needs. Initiates behavioral response
[blank_start]Hypothalamus[blank_end] – Receives unprocessed sensory input. Connects endocrine system to nervous system via pituitary gland
[blank_start]Thalamus[blank_end] – sensory processing. Hub of information transfer. Directs sensory input for processing
Respuesta
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Hippocampus
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Amygdala
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Hypothalamus
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Thalamus
Pregunta 13
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The [blank_start]hippocampus[blank_end]:
Shifts short-term memory to long-term memory
Encodes our memory with emotions by interacting with amygdala
Interacts with amygdala to encode emotional memories
Active in imaging studies during fearful situations
Pregunta 14
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Neuroanatomy of the hippocampus in anxiety
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Seahorse-shaped structure in medial temporal lobe
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Receives input from neurotransmitter systems and sends output to the rest of the brain
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Memory formation and storage
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Related to stress sensitivity and resiliency
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Structures between the cerebral hemisphere and the brainstem
Pregunta 15
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The hippocampus is related to stress sensitivity and resiliency. A [blank_start]large[blank_end] hippocampus is protective agains anxiety disorders. A [blank_start]small[blank_end] hippcampus has increased risk of PTSD in the context of trauma
Pregunta 16
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The amygdala has three groups, a medial group, a basal-lateral group, and a central group. Which group has connections with the hypothalamus and the brain stem, cues the endocrine system response, and influences expression of emotion, and triggers the autonomic nervous system?
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Medial
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Basal-lateral
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Central group
Pregunta 17
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Neuroendocrine pathways for the HPA (hypothalamic-pituitary-adrenal) axis. Let's review as this is probably an exam question:
Activated by [blank_start]stress[blank_end]
Hypothalamus releases [blank_start]corticotropin-releasing factor (CRF)[blank_end]
CRF binds to receptors on [blank_start]anterior pituitary gland[blank_end]
[blank_start]Adrenocorticotropic hormone (ACTH)[blank_end] is released
ACTH binds to receptors on [blank_start]adrenal cortex[blank_end]
[blank_start]Cortisol and adrenaline[blank_end] are released!
Pregunta 18
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Function of the HPA axis is SAFETY & PROTECTION
Pregunta 19
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Released for several hours after exposure to stressor
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Increases glucose in the bloodstream and enhances the brain’s use of glucose
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Suppresses nonessential functions such as digestion, reproduction, and growth processes
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At sufficient concentrations, cortisol exerts negative feedback to hypothalamus and homeostasis returns
-
Lasts for only minutes after exposure to stressor
-
Decreases glucose in the bloodstream
Pregunta 20
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Adrenaline Increases [blank_start]heart[blank_end] rate, [blank_start]blood[blank_end] pressure, respiratory [blank_start]rate,[blank_end] and [blank_start]carbohydrate[blank_end] metabolism
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heart
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blood
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rate,
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carbohydrate
Pregunta 21
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Chronic/prolonged stress = repeated/sustained HPA axis activation
Pregunta 22
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[blank_start]Calming NT[blank_end]: γ-amino-butyric-acid (GABA)
[blank_start]Excitatory NT:[blank_end] Glutamate
[blank_start]Monoaminergic neurotransmitters[blank_end]
Serotonin
Norepinephrine
Dopamine
Pregunta 23
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Excessive [blank_start]glutamate[blank_end] activity causes anxiety, agitation, and seizures
Pregunta 24
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Benzodiazepines increase [blank_start]GABA[blank_end] activity at amygdala and PFC
Pregunta 25
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[blank_start]GABA[blank_end] Principal inhibitory neurotransmitter
[blank_start]Glutamate[blank_end] Principal excitatory neurotransmitter
[blank_start]GABA[blank_end] Decreases neurons’ electrical excitability
[blank_start]Glutamate[blank_end] Increases neurons’ electrical excitability
[blank_start]Glutamate[blank_end] Necessary for attention/coordination
[blank_start]GABA[blank_end] Calm, relaxation, sleep
Respuesta
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GABA
-
Glutamate
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GABA
-
Glutamate
-
GABA
-
Glutamate
-
Glutamate
-
GABA
-
Glutamate
-
GABA
-
GABA
-
Glutamate
Pregunta 26
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Enhancing 5-HT input to the amygdala can [blank_start]reduce[blank_end] anxiety/fear
Pregunta 27
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Primarily found in GI tract, blood platelets, and CNS
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Involved in regulation of mood, appetite, sleep, memory, learning
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Inhibitory effect on some amygdalar outputs
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Excitatory effect on some aygdalar outputs
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Primarily found in the brain
Pregunta 28
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Mobilizes the brain and body for action
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Lowest during sleep, rises during wakefulness
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NE output from locus coeruleus enhances memory, attention, arousal
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Peaks during fight-or-flight: Increases heart rate/BP, release of glucose from energy stores, inhibits GI motility
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NE output from ventral tegmental area enhances memory, attention, arousal
Pregunta 29
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Significant in reward-motivated behavior
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Pleasurable experiences cause dopamine release: sex, food/appetite, addictive substances
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Involved in some motor control, GI motility, insulin production, and hormone regulation
Pregunta 30
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Catecholamine-O-methyltransferase (COMT) met genetic allele:
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Enzyme which degrades dopamine and norepinephrine
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COMT genotypes implicated in expression of anxiety and depression
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Enzyme degraded serotonin and dompamine
Pregunta 31
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Met genotype: [blank_start]Lower[blank_end] COMT activity = [blank_start]higher[blank_end] NT levels = [blank_start]excessive[blank_end] NT release under stress = WORRIER
Val genotype: [blank_start]Higher[blank_end] COMT activity = [blank_start]lower[blank_end] NT levels = [blank_start]decreased[blank_end] NT release under stress = WARRIOR
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Lower
-
Higher
-
higher
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lower
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excessive
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decreased
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Higher
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Lower
-
lower
-
higher
-
decreased
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excessive
Pregunta 32
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Which gene regulates the HPA axis and monoaminergic signaling
Respuesta
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5-HTTLPR: Serotonin transporter
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Catecholamine-O-methyltransferase (COMT)
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Methylenetetrahydrofolate reductas
Pregunta 33
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The [blank_start]short (S)[blank_end] allele of 5-HTTLPR: Serotonin transporter puts a patient as risk for anxiety
Pregunta 34
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What environmental factors play a part in increasing anxiety?
Pregunta 35
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Substance-Induced Anxiety Disorders can be caused by the following drugs except
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Sympathomimetics (pseudophedrine)
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Stimulants (Methylphenidate, Amphetamines)
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Benzodiazepines
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System and anabolic steroids
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Drugs of abuse (cocaine, amphetamaines, hallucinogens, substance withdrawal)
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Atypical antipsychotics
Pregunta 36
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Panic disorder usually starts before the age of 24 and usually has lots of comorbidities as patients try to self-medicate
Pregunta 37
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DSM-5 Criteria for Panic Disorder include recurrent UNEXPECTED panic attacks, followed by 1 month of:
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Persistent concern
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Worry about implications or consequences of panic attacks
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Maladaptive changes in behavior
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Walks on the beach doing yoga
Pregunta 38
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Agoraphobia is fear of situations with
Pregunta 39
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Neuroanatomy of panic disorder includes:
[blank_start]Elevated[blank_end] glucose uptake in amygdala, hippocampus, and thalamus
[blank_start]Decreased[blank_end] frontal lobe activity
Pregunta 40
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Neurotransmitter pathways in panic disorder:
[blank_start]Decreased[blank_end] GABA concentrations, elevated glutamatergic signaling
[blank_start]Decreased[blank_end] serotonin receptor binding, increased norepinephrine concentration
Respuesta
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Decreased
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Increased
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Decreased
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Increased
Pregunta 41
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Panic disorder is the most heritable of all anxiety disorders with first-degree relatives of patient with panic DO means that patient has 7X increased risk
Pregunta 42
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Neuroendocrine pathways in panic disorder include:
(on exam study guide)
Respuesta
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Elevated baseline cortisol = anticipatory anxiety
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Hypersensitive to situations that trigger HPA axis activation
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Decreased baseline cortisol = anticipatory anxiety
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Hyposensitive to situations that trigger HPA axis activation
Pregunta 43
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Specific phobia (like clowns) is the most common anxiety disorder, women twice as likely to suffer as men, and typical age of onset is childhood to adolescence
Pregunta 44
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Specific phobia is a persistent fear of clearly discernible objects or situations that provoke immediate anxiety and cause social or occupational impairement
Pregunta 45
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Specific Phobia
Neuroanatomy: activation of [blank_start]amygdala[blank_end], decreased [blank_start]prefrontal cortex response[blank_end]
Pregunta 46
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Social anxiety disorder is twice as likely in women as men, onset is childhood or adolescence and is often seen with MDD or substance abuse disorders
Pregunta 47
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DSM 5 criteria for social anxiety disorder is a persistent fear of situations in which exposure to unfamiliar people o scrutiny is possible. Fear that actions will expose anxiety or possible humiliation or embarrassment.
Pregunta 48
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Neuroanatomy of Social Anxiety Disorder:
[blank_start]Hyperactive[blank_end] prefrontal cortex - misinterpreting social cues
[blank_start]Hyperreactive[blank_end] amygdala - receives sensory information before analysis and signals the sympathetic nervous system
Respuesta
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Hyperactive
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Hypoactive
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Hyperreactive
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Hypoactive
Pregunta 49
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Genetics of social anxiety disorder involve Serotonin transporter (5-HTT) which governs reuptake of serotonin into the neuron. The [blank_start]short[blank_end] allele is involved in increased risk of anxiety and depression in context of stressful environment, Increased startle response and a stronger amygdala activation in response to angry faces
Pregunta 50
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Generalized anxiety disorder has the youngest age of onset for an anxiety disorder
Pregunta 51
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Excessive worries/anxiety for at least [blank_start]6 month[blank_end]s. Worry about a number of events, situations, activities. Difficulty controlling the worry.
Three or more of the following:
Restless/on edge
Easily fatigued
Difficulty concentrating
Irritability
Muscle tension
Sleep disturbance
Pregunta 52
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Neuroendocrine pathways of generalized anxiety disorder include all the following EXCEPT:
Respuesta
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Perception of sustained threat
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Chronic activation of HPA axis
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Acute activation of HPA axis
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More physiologically dysregulated state at baseline
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Exaggerated physiological reactivity to fearful stimuli
Pregunta 53
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5-HTTLPR [blank_start]short[blank_end]-allele carriers are highly sensitive to environmental threats. Hypervigilance
Pregunta 54
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The following are all forms of obsessive-compulsive disorders:
Respuesta
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Body dysmorphic disorder - fixated on a part of their body they hate
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Trichotillomania – hair pulling compulsion and anxiety. A lot with trauma
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Hoarding Disorder – afraid that they might need something
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Cookiewinemania - an unnatural obsession with wanting cookies and wine
Pregunta 55
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Tourette's Syndrome is a frequent comorbidity of obsessive compulsive disorder
Pregunta 56
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The following are all true about OCD DSM-5 criteria
Respuesta
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Recurrent obsessive thoughts - Persistent ideas, thoughts, images, impulses that are perceived as intrusive and distressing
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Compulsive behaviors - Repetitive behaviors or mental acts that are meant to reduce stress NOT bring pleasure
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Time-consuming, cause impairment
Pregunta 57
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OCD is real anatomical issue
Pregunta 58
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In obsessive compulsive disorder there is [blank_start]orbitofrontal[blank_end] cortex overactivity but smaller volume which leads to context-related processing and response inhibition
Pregunta 59
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In obsessive compulsive disorder there is abnormal activity in [blank_start]cortico-striatal-thalamo-cortical (CSTC)[blank_end] feedback loop. These circuits use “direct” (excitatory) or “indirect” (inhibitory) routes from cortex through [blank_start]basal ganglia[blank_end] to [blank_start]thalamus.[blank_end]
Pregunta 60
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CSTC or "worry" loop is involved in obsessive compulsive disorder. It includes the [blank_start]basal ganglia[blank_end] which nuclei grouped together based on interconnected roles in movement and cognition. It includes Includes [blank_start]globus pallidus[blank_end], putamen, caudate nucleus. Specifically the striatum Includes [blank_start]putamen[blank_end] and caudate nucleus.
Respuesta
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basal ganglia
-
globus pallidus
-
putamen
Pregunta 61
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In obsessive compulsive disorder, the CSTC loop receives input to [blank_start]basal ganglia[blank_end] from [blank_start]cortex[blank_end] and [blank_start]thalamus[blank_end]
Respuesta
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basal ganglia
-
cortex
-
thalamus
Pregunta 62
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In obsessive compulsive disorder, the CSTC or "worry" loop has two pathways. The "direct" basal ganglia and the "indirect' basal ganglia pathway that are antagonistic to each other
Pregunta 63
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“Direct” basal ganglia pathway:
Direct projections from [blank_start]striatum[blank_end] to [blank_start]globus pallidus[blank_end]
Increases [blank_start]excitatory[blank_end] thalamic input to the cortex
Turns [blank_start]up[blank_end] motor activity
Respuesta
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striatum
-
globus pallidus
-
excitatory
-
inhibitory
-
up
-
down
Pregunta 64
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The [blank_start]"direct"[blank_end] basal ganglia pathway is involved in the activation of tics, compulsions, and obsessions. It is [blank_start]overactive[blank_end] in OCD.
Respuesta
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"direct"
-
"indirect"
-
overactive
-
underactive
Pregunta 65
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“Indirect” basal ganglia pathway has [blank_start]Indirect[blank_end] projections from [blank_start]striatum[blank_end] to [blank_start]globus pallidus[blank_end]
[blank_start]Inhibitory[blank_end] effect on [blank_start]thalamus[blank_end] and frontal cortex
Respuesta
-
Indirect
-
striatum
-
globus pallidus
-
Inhibitory
-
excitatory
-
thalamus
-
hippocampus
Pregunta 66
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"Direct" basal ganglia pathway is the "gas" and the "indirect" basal ganglia is the brake when it comes to motor activity
Pregunta 67
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OCD occurs when delicate balance between inhibition and excitation of basal ganglia pathway is disrupted
Pregunta 68
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Neuroanatomy of OCD involves Increased activity in CSTC circuit running from [blank_start]frontal cortex[blank_end] to [blank_start]striatum[blank_end] to [blank_start]globus pallidus[blank_end] to [blank_start]thalamus[blank_end] and back to [blank_start]cortex[blank_end]
Respuesta
-
frontal cortex
-
striatum
-
globus pallidus
-
thalamus
-
cortex
Pregunta 69
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In OCD, there is increased Increased activity in prefrontal cortex, basal ganglia, and [blank_start]amygdala[blank_end]
Pregunta 70
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What is the treatment for OCD
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Surgical intervention where the CSTC loop is cut off via a cingulotomy. This disrupts the transmission from the frontal cortex
-
Very aggressive and high doses of SSRI
-
Talking common sense into the patient and telling the patient that the fears aren't real
Pregunta 71
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Serotonin, dopamine and glutamate are involved in OCD. There are [blank_start]reduced[blank_end] serotonin transporters in midbrain. There is [blank_start]increased[blank_end] dopamine. There is [blank_start]increased[blank_end] glutamate.
Respuesta
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reduced
-
increased
-
increased
-
decreased
-
increased
-
decreased
Pregunta 72
Pregunta
Considering what we know about 5HT, DA, and Glu in OCD, which drugs are most effective
Respuesta
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5HT drugs
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DA antagonists
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Antipsychotics
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Stimulants
Pregunta 73
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A patient with OCD will be in a hyperglutamatergic state in prefrontal regions and have
elevated glutamate in cerebrospinal fluid
Pregunta 74
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An [blank_start]earlier[blank_end] onset of OCD is indicative of a higher risk of heritability
Pregunta 75
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Of the following comorbidities with seen OCD, which has the highest incidence of PTSD
Pregunta 76
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DSM 5 criteria for PTSD involve exposure to [blank_start]trauma[blank_end], [blank_start]re-experiencing,[blank_end] [blank_start]avoidance[blank_end], [blank_start]negative alterations in mood/cognition[blank_end], and [blank_start]increased arousal.[blank_end]
Pregunta 77
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The neuroanatomy of the PTSD involves:
[blank_start]Reduced[blank_end] volume of hippocampus and frontal cortex
Amygdala [blank_start]hyperresponsiveness[blank_end]
[blank_start]Decreased[blank_end] activity in PFC
Respuesta
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Reduced
-
Increased
-
hyperresponsiveness
-
hyporesponsiveness
-
Decreased
-
Increasedp
Pregunta 78
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The following NT are involved in PTSD EXCEPT:
Respuesta
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Dopamine
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Norepinephrine
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Serotonin
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Glutamate
Pregunta 79
Pregunta
Which drug exhibits inhibitory effects on glutamate transmission and thus is good for PTSD
Respuesta
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Topiramate
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Aripiprazole
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Venlafaxine
Pregunta 80
Respuesta
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Role in hippocampal-related learning and amygdala- related emotional processing
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Processing distortion related to inappropriate glutamate signaling
-
Elevated glucose uptake in amygdala, hippocampus, and thalamus
Pregunta 81
Pregunta
What medication should you not give to PTSD because of the unremitting elevation in NE in the CSF of patients with PTSD?
Respuesta
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Bupropion
-
Citalopram
-
Venlafaxine
-
Fluoxetine
Pregunta 82
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In PTSD, patients have a [blank_start]decreased[blank_end] cortisol concentrations and a/n [blank_start]flattened[blank_end] cortisol slope
Respuesta
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decreased
-
increased
-
flattened
-
elevated
Pregunta 83
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Treatment for anxiety disorders include:
Pregunta 84
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MOA of BZ in anxiety involves BZ [blank_start]increasing[blank_end] the efficiency of GABA to [blank_start]decrease[blank_end] the excitability of neurons. BZ bind to the y sub-unit of the [blank_start]GABA-A[blank_end] receptor. Binding causes a structural modification of the receptor that results in an increasein GABA-A activity. The result is an [blank_start]increase[blank_end] in the frequency of the [blank_start]Cl-[blank_end] channel (making the cell more negative) and [blank_start]inhibiting[blank_end] the action potential.
Respuesta
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increasing
-
decrease
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GABA-A
-
increase
-
Cl-
-
inhibiting
Pregunta 85
Pregunta
Chronic/prolonged stress = repeated/sustained HPA axis activation which causes:
[blank_start]Musculoskeletal:[blank_end] Chronic muscle tension, tension headaches, migraines
[blank_start]Respiratory:[blank_end] Exacerbation of existing conditions (asthma, emphysema, etc.)
[blank_start]Cardiovascular:[blank_end] Increased risk of heart attack, hypertension, stroke
[blank_start]Endocrine:[blank_end] Increased risk of diabetes in vulnerable populations
[blank_start]Gastrointestinal:[blank_end] Acid reflux, ulcers, diarrhea, constipation, nausea/vomiting
Reproductive:
[blank_start]Male:[blank_end] Impaired testosterone production and sperm maturation, impotence
[blank_start]Female:[blank_end] Irregular menstrual cycles, impaired sexual desire
Respuesta
-
Musculoskeletal:
-
Respiratory:
-
Cardiovascular:
-
Endocrine:
-
Gastrointestinal:
-
Male:
-
Female: