MSN 671 : Psychopathopharmacology I -Module 4 quiz 4
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Free MSN 671 : Psychopathopharmacology I -Module 4 quiz 4 Questions
Jaqueline is an 18-year-old patient who was diagnosed with ADHD when she was 9 years old. She has recently graduated high school and is scheduled to start college next month. As individuals with ADHD progress into adulthood, they generally experience:
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A worsening of inattentive symptoms
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No change in symptoms
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Cognitive decline
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A decline in impulsive and hyperactive symptoms
Explanation
Correct Answer:
D. A decline in impulsive and hyperactive symptoms
Explanation:
As ADHD patients mature into adulthood, impulsive and hyperactive symptoms usually decrease, while inattentive symptoms often persist. Adults with ADHD may feel less physically restless than children but still struggle with disorganization, distractibility, and difficulty sustaining attention. This developmental trajectory is consistent with clinical observations and longitudinal studies. Thus, hyperactivity and impulsivity tend to fade, while inattention remains the most impairing symptom in adulthood.
Why Other Options Are Wrong:
A. A worsening of inattentive symptoms
This is incorrect because inattentive symptoms often persist rather than worsen with age. They may remain stable or become more noticeable as academic and occupational demands increase, but not truly worsen biologically.
B. No change in symptoms
This is incorrect because the symptom profile changes: hyperactive and impulsive symptoms generally decline, while inattentive symptoms persist.
C. Cognitive decline
This is incorrect because ADHD is not associated with a progressive neurodegenerative decline. Cognitive difficulties in ADHD are long-standing and related to attention regulation, not neurodegeneration.
The positive symptoms of schizophrenia are most strongly linked to which pathway dysfunction?
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Nigrostriatal pathway
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Mesolimbic pathway
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Mesocortical pathway
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Tuberoinfundibular pathway
Explanation
Correct Answer:
B. Mesolimbic pathway
Explanation:
Positive symptoms of schizophrenia, including delusions and hallucinations, are strongly associated with dopamine hyperactivity in the mesolimbic pathway. This pathway projects from the ventral tegmental area (VTA) to the nucleus accumbens and other limbic structures, and its overactivation produces the abnormal salience attribution that drives psychosis.
Why Other Options Are Wrong:
A. Nigrostriatal pathway
This is incorrect because the nigrostriatal pathway is primarily involved in motor control. D2 blockade here causes extrapyramidal side effects, not psychotic symptoms.
C. Mesocortical pathway
This is incorrect because mesocortical dopamine hypofunction is associated with negative symptoms (apathy, flat affect) and cognitive impairment, not positive symptoms.
D. Tuberoinfundibular pathway
This is incorrect because this pathway regulates prolactin secretion. D2 blockade here leads to hyperprolactinemia, not hallucinations or delusions.
Which neurotransmitter is the major excitatory “master switch” of the brain?
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Dopamine
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Norepinephrine
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Glutamate
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Serotonin
Explanation
Correct Answer:
C. Glutamate
Explanation:
Glutamate is the primary excitatory neurotransmitter in the central nervous system and is often called the brain’s “master switch.” It activates nearly all neurons and is critical for learning, memory, and synaptic plasticity through receptors such as NMDA, AMPA, and kainate. Dysregulation of glutamate transmission is implicated in conditions such as schizophrenia, epilepsy, and excitotoxicity.
Why Other Options Are Wrong:
A. Dopamine
This is incorrect because dopamine primarily modulates reward, motivation, and motor pathways but is not the brain’s main excitatory neurotransmitter.
B. Norepinephrine
This is incorrect because norepinephrine functions mainly as a neuromodulator involved in arousal and the stress response, not as the central excitatory switch.
D. Serotonin
This is incorrect because serotonin regulates mood, sleep, and appetite, but it is not the primary excitatory neurotransmitter.
Which anxiolytic acts as a 5HT1A partial agonist and has no risk of dependence?
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Lorazepam
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Hydroxyzine
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Buspirone
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Clonazepam
Explanation
Correct Answer:
C. Buspirone
Explanation:
Buspirone is an anxiolytic that works as a partial agonist at 5HT1A receptors. Unlike benzodiazepines, it does not act on GABA-A receptors and therefore carries no risk of dependence, tolerance, or withdrawal. It is especially useful in treating generalized anxiety disorder (GAD), though it takes several weeks for therapeutic effects to appear.
Why Other Options Are Wrong:
A. Lorazepam
This is incorrect because lorazepam is a benzodiazepine that enhances GABA-A receptor activity and carries a risk of dependence.
B. Hydroxyzine
This is incorrect because hydroxyzine is an antihistamine (H1 antagonist) used for anxiety and sedation, but it does not act as a 5HT1A partial agonist.
D. Clonazepam
This is incorrect because clonazepam is another benzodiazepine, associated with dependence and withdrawal risks, not 5HT1A receptor activity.
There are neurodevelopmental delays in the prefrontal cortical synaptic connections that are associated with ADHD causing subsequent inefficient "tuning" of information processing in prefrontal circuits. There are 2 neurotransmitters that regulate processing in the prefrontal circuits. What are they?
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Dopamine and norepinephrine
-
Serotonin and norepinephrine
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Serotonin and dopamine
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Dopamine and glutamate
Explanation
Correct Answer:
A. Dopamine and norepinephrine
Explanation:
The prefrontal cortex, which regulates attention, working memory, and executive function, relies heavily on the balance of dopamine and norepinephrine signaling. In ADHD, disruptions in these neurotransmitters impair the fine-tuning of prefrontal cortical circuits, leading to difficulties in sustaining attention, impulse control, and organization. Medications such as stimulants (e.g., methylphenidate, amphetamines) work by enhancing dopamine and norepinephrine activity in the prefrontal cortex, improving symptoms.
Why Other Options Are Wrong:
B. Serotonin and norepinephrine
This is incorrect because serotonin modulates mood and anxiety more than attention regulation in prefrontal circuits.
C. Serotonin and dopamine
This is incorrect because while dopamine is critical, serotonin is not the second key neurotransmitter for prefrontal cortical tuning in ADHD.
D. Dopamine and glutamate
This is incorrect because glutamate is the major excitatory neurotransmitter, but prefrontal "tuning" deficits in ADHD are more directly linked to dopamine and norepinephrine dysregulation.
Which antipsychotic is unique for treating both schizophrenia and Parkinson’s disease psychosis without worsening motor symptoms?
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Haloperidol
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Clozapine
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Risperidone
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Pimavanserin
Explanation
Correct Answer:
D. Pimavanserin
Explanation:
Pimavanserin is a selective 5HT2A inverse agonist that treats psychosis in both schizophrenia and Parkinson’s disease psychosis. Unlike other antipsychotics, it does not block D2 receptors, so it does not worsen motor symptoms in Parkinson’s patients. This makes it unique and especially valuable where dopamine blockade would otherwise exacerbate movement problems.
Why Other Options Are Wrong:
A. Haloperidol
This is incorrect because haloperidol strongly blocks D2 receptors, effectively treating positive symptoms but significantly worsening motor symptoms in Parkinson’s disease.
B. Clozapine
This is incorrect because clozapine can treat psychosis in both schizophrenia and Parkinson’s disease, but its use is limited by the risk of agranulocytosis and the need for regular blood monitoring. Pimavanserin is safer for motor function.
C. Risperidone
This is incorrect because risperidone blocks D2 receptors, which can worsen Parkinsonian motor symptoms, making it unsuitable for Parkinson’s psychosis.
Which of the following interconnected pathways are theoretically linked to hallucinations and delusions? (Select all that apply)
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Dopamine hyperactivity at D2 receptors in the mesolimbic/mesostriatal pathway, which extends from the ventral tegmental area/mesostriatum integrated hub to the ventral striatum
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NMDA receptor hypoactivity at GABAergic interneurons with loss of GABAergic inhibition in the prefrontal cortex
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Serotonin hyperactivity/imbalance at 5HT2A receptors on glutamate neurons in the cerebral cortex
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Epinephrine hyperactivity at D2 receptors in the mesolimbic/nigrostriatal pathway, which extends from the ventral tegmental area/mesostriatum integrated hub to the ventral striatum
Explanation
Correct Answers:
A. Dopamine hyperactivity at D2 receptors in the mesolimbic/mesostriatal pathway
B. NMDA receptor hypoactivity at GABAergic interneurons with loss of GABAergic inhibition in the prefrontal cortex
C. Serotonin hyperactivity/imbalance at 5HT2A receptors on glutamate neurons in the cerebral cortex
Explanation:
Hallucinations and delusions in psychotic disorders are linked to multiple interacting pathways:
Dopamine hypothesis: Overactivity of dopamine at D2 receptors in the mesolimbic pathway is strongly associated with positive symptoms (hallucinations and delusions).
Glutamate hypothesis: NMDA receptor hypofunction on GABAergic interneurons in the cortex leads to reduced GABAergic inhibition, resulting in cortical disinhibition and downstream dysregulation of dopamine signaling.
Serotonin hypothesis: Excessive 5HT2A receptor stimulation on cortical glutamate neurons contributes to distorted perception and thought, as seen with hallucinogens.
Why Other Option Is Wrong:
D. Epinephrine hyperactivity at D2 receptors in the mesolimbic/nigrostriatal pathway
This is incorrect because epinephrine is not the neurotransmitter driving psychotic symptoms in these circuits. Dopamine, glutamate, and serotonin are the key players.
NMDA receptor activation requires which of the following?
-
Glutamate only
-
Glycine only
-
Glutamate and glycine
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Glutamate, glycine, and magnesium binding
Explanation
Correct Answer:
C. Glutamate and glycine
Explanation:
NMDA receptors are a subtype of glutamate receptors that require both glutamate and glycine (or D-serine) to bind for activation. These two act as co-agonists at distinct receptor sites. At resting potential, the channel pore is blocked by magnesium, which prevents ion flow. Depolarization removes this magnesium block, but magnesium is not an activating ligand—it is an inhibitory block. Therefore, true activation depends on glutamate and glycine.
Why Other Options Are Wrong:
A. Glutamate only
This is incorrect because glutamate alone cannot open the NMDA receptor; glycine is also required.
B. Glycine only
This is incorrect because glycine alone cannot activate the receptor without glutamate binding.
D. Glutamate, glycine, and magnesium binding
This is incorrect because magnesium does not activate NMDA receptors; it blocks the ion channel until depolarization removes it.
Which benzodiazepine is preferred in patients with liver disease due to its metabolism via conjugation rather than oxidation?
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Diazepam
-
Lorazepam
-
Clonazepam
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Chlordiazepoxide
Explanation
Correct Answer:
B. Lorazepam
Explanation:
Lorazepam is metabolized primarily through glucuronidation (conjugation) rather than hepatic oxidation. Because glucuronidation is less affected by liver dysfunction, lorazepam is safer in patients with hepatic impairment, including those with cirrhosis. This is why lorazepam is often preferred for managing alcohol withdrawal or acute anxiety in patients with compromised liver function.
Why Other Options Are Wrong:
A. Diazepam
This is incorrect because diazepam undergoes extensive hepatic oxidation and has active metabolites, leading to prolonged effects in liver disease.
C. Clonazepam
This is incorrect because clonazepam is metabolized by hepatic oxidation and is not ideal for patients with liver impairment.
D. Chlordiazepoxide
This is incorrect because chlordiazepoxide also requires hepatic oxidation and has active metabolites, making it unsafe in severe liver disease.
Which test measures selective attention by requiring naming the ink color of a word instead of reading the word?
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ADHD Rating Scale
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Stroop Task
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Vanderbilt Assessment Scale
-
Wender Utah Rating Scale
Explanation
Correct Answer:
B. Stroop Task
Explanation:
The Stroop Task is a neuropsychological test that measures selective attention, inhibitory control, and cognitive flexibility. In this task, a person must state the ink color of a word (e.g., the word “blue” written in red ink) instead of reading the word itself. This creates a conflict between automatic reading and controlled processing, making it especially useful for detecting executive dysfunction, as seen in ADHD.
Why Other Options Are Wrong:
A. ADHD Rating Scale
This is incorrect because it is a symptom checklist based on DSM criteria, not a performance-based test of attention.
C. Vanderbilt Assessment Scale
This is incorrect because it is a behavioral rating scale filled out by parents or teachers, not a neurocognitive attention test.
D. Wender Utah Rating Scale
This is incorrect because it is a retrospective self-report questionnaire for adults recalling ADHD symptoms from childhood, not a selective attention task.
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