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Chapter 7: Mood Disorders and Suicide Multiple-Choice Questions 1. What do all mood disorders have in common? a. The presence of a negative mood state. b. They are at least 6 months in duration. c. The presence of irrational thoughts. d. They are characterized by emotional extremes. Answer: d. They are characterized by emotional extremes. 2. What are the two key moods involved in mood disorders? a. Anger and depression b. Sadness and anxiety c. Mania and depression d. Anger and mania Answer: c. Mania and depression 3. Which of the following is true of major depressive episode? a. It does not begin until adolescence. b. It is equally common in men and women. c. It occurs five times as often in elderly people as in middle-aged adults. d. It is the most prevalent mood episode. Answer: d. It is the most prevalent mood episode. 4. In order to meet the criteria for a major depressive episode, a person MUST have a. a depressed mood or loss of pleasure most of the day for at least 2 weeks. b. significant weight loss. c. intense irritability. d. insomnia. Answer: a. a depressed mood most of the day for at least 2 weeks. 5. "Normal"feelings of depression becomes a mood disorder when a. there is no identifiable cause for it. b. the degree of impairment is judged severe enough to warrant a diagnosis. c. it lasts for more than a month. d. it ceases to be justified and adaptive. Answer: b. the degree of impairment is judged severe enough to warrant a diagnosis. 6. Two months after her husband's death, Connie was still not herself. She often forgot to feed the dog, was late for work on a regular basis, and had not yet thrown out his clothes. Which of the following diagnoses could apply to Connie according to the DSM-5? a. adjustment disorder with depressed mood b. dysthymia c. postpartum depression d. major depressive disorder Answer: d. major depressive disorder 7. "Postpartum blues" are a. a serious disorder. b. common, usually brief, and not a disorder. c. a subtype of Major Depressive Disorder. d. serious, brief, and a type of unipolar depression. Answer: b. common, usually brief, and not a disorder. 8. In which of the following disorders must symptoms be present for at least 2 years in order for a diagnosis to be made? a. Dysthymia b. Bipolar I disorder c. Major depressive disorder d. Bipolar II disorder Answer: a. Dysthymia 9. How does dysthymia compare to major depressive disorder? a. Symptoms are much more severe than in major depressive disorder. b. Symptoms change from day to day, with lots of days with normal functioning in between dysthymic episodes. c. There are many more symptoms required to meet dysthymia than to meet major depressive disorder. d. Symptoms are mild to moderate but last for much longer than in major depressive disorder. Answer: d. Symptoms are mild to moderate but last for much longer than in major depressive disorder. 10. What is the most important characteristic used to distinguish dysthymia from major depression? a. the length of time the person has had the symptoms b. how severe the symptoms are c. whether there are occasional brief periods of normal moods during the disorder d. the types of symptoms the person has Answer: c. whether there are occasional brief periods of normal moods during the disorder 11. Sean describes himself as having hardly ever being happy. He occasionally feels okay, but it never lasts more than a day or so. He has trouble sleeping, doesn't eat much, and feels like nothing will ever change in his life. He says this has been going on for as long as he can remember. The best diagnosis for Sean is a. cyclothymia. b. dysthymia. c. major depressive disorder. d. bipolar II. Answer: b. dysthymia. 12. Which of the following is a symptom of major depressive disorder? a. Checking and rechecking things b. appetite and weight loss c. Running thoughts d. Impulsive spending Answer: b. appetite and weight loss 13. George, a 22-year-old mechanic, always seems to have a cloud over his head. For the past three weeks, he has had problems sleeping and he has little appetite or enjoyment of food. While he may sometimes seem to be relatively content for short periods of time, this happens very rarely and it never lasts for more than a week. If George were to seek help for his negative mood state, which of the following diagnoses would he most likely receive? a. Adjustment disorder with depressed mood b. Chronic adjustment disorder with depressed mood c. Bipolar II d. Major depressive disorder Answer: d. Major depressive disorder 14. Brittany came to a therapist complaining that she just doesn't enjoy life lately. She says that for the past couple of months, she finds she just doesn't feel like doing the things that she used to love to do. She has also lost a lot of weight and sleeps much more than usual but still feels tired all the time. She says she just can't concentrate on anything. However, she denies feeling sad. Brittany's most likely diagnosis is a. dysthymic disorder. b. bipolar II disorder. c. major depressive disorder. d. no disorder. Answer: c. major depressive disorder. 15. Depression a. can occur even in infants and very young children. b. is extremely rare in childhood. c. cannot occur in childhood. d. can occur in childhood in females but not in males. Answer: a. can occur even in infants and very young children. 16. Depression during adolescence a. is much rarer than during childhood. b. has little effect on adult functioning. c. can affect a person into young adulthood. d. is decreasing in prevalence. Answer: c. can affect a person into young adulthood. 17. Herbert awakens early in the morning and feels more depressed in the morning than the evening. He has lost all interest in activities and derives no pleasure from things that used to please him. If he is suffering from major depression, Herbert's symptoms suggest the subtype called a. mood-congruent. b. melancholic. c. dysthymic. d. postpartum. Answer: b. melancholic. 18. A person who shows psychotic depression that involves mood-congruent thinking a. is diagnosed as having "double depression." b. usually responds rapidly to anti-depressant medications. c. rarely shows the symptoms of melancholia. d. has a poorer prognosis than others with major depression. Answer: d. has a poorer prognosis than others with major depression. 19. Sam has been diagnosed with major depressive disorder. He tells you that he is certain the world will end next Tuesday because everyone in it is so wicked. He refuses to consider that he might be wrong. Sam has a. mood congruent delusions. b. mood incongruent delusions. c. atypical features. d. melancholic features. Answer: a. mood congruent delusions. 20. What is meant by the phrase "double depression"? a. Symptoms are consistent with two different subtypes of major depression. b. The individual has been diagnosed with an anxiety disorder and a mood disorder. c. Symptoms of both typical and atypical depression are exhibited. d. An individual with dysthymia later develops major depressive disorder as well. Answer: d. An individual with dysthymia later develops major depressive disorder as well. 21. Kerry suffers from depression. He is experiencing delusions that his brain is deteriorating and that he is aging quickly. These delusions a. clearly suggest a diagnosis of schizophrenia. b. are typical of depressive delusions because they are mood congruent. c. suggest that he is suffering from a bipolar rather than a unipolar disorder. d. are most likely to persist after the depression remits. Answer: b. are typical of depressive delusions because they are mood congruent. 22. Margaret has been suffering with dysthymia for several years and has sought treatment on several occasions. About one month ago she developed more severe symptoms of depression, which have been maintained almost daily. The condition she is experiencing is best described as a. double depression. b. chronic melancholia. c. adjustment disorder with bipolar features. d. recurring melancholic depression. Answer: a. double depression. 23. Deena has major depressive disorder. Most days she feels very sad, but when her sister came and told Deena she was going to be an aunt, Deena felt happy for a little while. She has been gaining weight and sleeping much of the day. Deena most likely has a. melancholic features. b. double depression. c. atypical features. d. psychotic features. Answer: c. atypical features. 24. A recurrent depressive episode a. is preceded by one or more previous episodes. b. suggests that chronic major depression has developed. c. typically lasts 2-3 weeks. d. is characteristic of all forms of bipolar disorder. Answer: a. is preceded by one or more previous episodes. 25. The average duration of an untreated episode of depression is a. 6-9 months. b. 1 year. c. 2 years. d. unknown as individuals not seeking treatment haven't been studied. Answer: a. 6-9 months. 26. Which of the following is a true statement about the recurrence of depressive symptoms? a. If a recurrence is not experienced within 1 year after an initial depressive episode, recurrence is highly unlikely. b. Most individuals diagnosed with major depression will exhibit a recurrence. c. Those with depression with psychotic features are less likely to experience a recurrence. d. Clients are usually asymptomatic between depressive episodes. Answer: b. Most individuals diagnosed with major depression will exhibit a recurrence. 27. A rapid return of symptoms immediately after drug treatment is terminated is a common example of ________; a return to depressive symptoms after a period of spontaneous remission of symptoms is called a ________. a. melancholia; recurrence b. recurrence; relapse c. relapse; recurrence d. mood-congruent depression; mood-incongruent depression Answer: c. relapse; recurrence 28. Seasonal affective disorder is best described as a ___________ depressive disorder. a. mood-congruent b. minor c. psychotic d. recurrent Answer: d. recurrent 29. Over the past two years, Kelly has experienced depressive episodes three different times. Two of the three episodes occurred in the winter and the third occurred last fall. It is now winter and Kelly's depressive symptoms once again are consistent with major depressive disorder. Which of the following diagnoses should she be given? a. dysthymic disorder b. chronic major depressive disorder c. recurrent major depressive disorder d. recurrent major depressive disorder with a seasonal pattern Answer: d. recurrent major depressive disorder with a seasonal pattern 30. Which of the following statements is supported by research on the role of genetic influences in unipolar disorder? a. The more severe the depressive disorder, the greater the genetic contribution. b. Twin studies do not consistently find evidence of an inherited susceptibility to depression. c. Genes play a more significant causal role in bipolar disorders than they do in unipolar disorders. d. Bipolar and unipolar disorders are equally heritable. Answer: a. The more severe the depressive disorder, the greater the genetic contribution. 31. The finding that people with one type of serotonin transporter gene and childhood maltreatment had higher rates of depression than either those without the gene or those with the gene without the maltreatment suggests that a. childhood maltreatment causes depression. b. only one type of gene causes depression. c. either or a gene or certain environmental factors need to be present to cause depression. d. both a gene and certain environmental factors need to be present to cause depression. Answer: d. both a gene and certain environmental factors need to be present to cause depression. 32. Which of the following is true about the monoamine hypothesis of depression? a. Alternative theories have replaced this theory. b. It has not been replaced by a compelling alternative. c. This theory remains the standard of current and accurate information. d. This theory has been continuously updated to meet current research. Answer: b. It has not been replaced by a compelling alternative 33. Drugs that alter the availability of norepinephrine and serotonin are not clinically effective in the treatment of depression for several weeks. Which of the following does this finding suggest? a. These neurotransmitters are not involved in depression. b. It is overactivity of these neurotransmitters that underlies depression, not underactivity. c. That the effectiveness of antidepressants is a placebo effect, as opposed to a result of a biochemical manipulation. d. Changes in neurotransmitter function, as opposed to neurotransmitter level, cause depression. Answer: d. Changes in neurotransmitter function, as opposed to neurotransmitter level, cause depression. 34. Individuals who do not show a decrease in cortisol levels in response to an injection of dexamethasone a. have a severe form of depression. b. are likely to be suffering from both major depression and a personality disorder. c. will not respond well to pharmacological treatment. d. have an HPA axis that is not functioning normally. Answer: d. have an HPA axis that is not functioning normally. 35. Which of the following is most likely to be seen in children who are at risk for depression? a. decreased left hemisphere activity b. decreased right hemisphere activity c. increased serotonin levels d. increased GABA levels Answer: a. decreased left hemisphere activity 36. Which of the following is a brain area that has been found to exhibit abnormalities in depressed patients? a. amygdala b. basal ganglia c. posterior cingulate cortex d. medulla oblangata Answer: a. amygdala 37. Many people who are depressed a. show very little REM sleep, instead they spend large amounts of time in the deeper stages (3 and 4) of sleep. b. do not enter REM sleep until much later in the night than normal and have smaller amounts of REM sleep throughout the night than normal. c. enter REM sleep earlier than normal and have larger amounts of REM sleep early in the night. d. enter REM sleep at a normal time, but have very slow and mild rapid eye movements and have less overall time in REM sleep than normal. Answer: c. enter REM sleep earlier than normal and have larger amounts of REM sleep early in the night. 38. The fact that bright light may be an effective treatment for seasonal affective disorder suggests that a. this is a not a real form of depression as any response to light is merely a placebo effect. b. this form of depression is produced by a malfunctioning biological clock that needs resetting. c. changes in circadian rhythms underlie most forms of depression. d. seasonal affective disorder is a unique entity that should not be categorized with other forms of unipolar depression. Answer: b. this form of depression is produced by a malfunctioning biological clock that needs resetting. 39. Independent life events are those that a. only affect one area of a client's functioning. b. are out of the client's control. c. are linked causally to the behavior or personality of the client. d. affect the client and not those around him or her. Answer: b. are out of the client's control. 40. John's erratic behavior finally ruined his marriage. What kind of life event would this be described as? a. acute b. chronic c. dependent d. independent Answer: c. dependent 41. Which of the following is true? a. Most first time episodes of depression are preceded by a very stressful life event. b. Both first time and recurrent episodes of depression are usually preceded by a very stressful life event. c. Even mildly stressful events are associated with the onset of episodes of depression. d. Mildly stressful events are only associated with the onset of first time depression, not with recurrent episodes. Answer: a. Most first time episodes of depression are preceded by a very stressful life event. 42. A review of several studies found that ___________ increased the likelihood of developing a more severe depression. a. experiencing a stressful life event b. being in an intimate relationship c. working outside of the home d. having religious faith Answer: a. experiencing a stressful life event 43. Which of the following is an example of a COGNITIVE diathesis for depression? a. neuroticism b. optimism c. attributing negative events to internal causes d. attributing negative events to external causes Answer: c. attributing negative events to internal causes 44. Which of the following reactions to poor test performance suggests a cognitive diathesis for depression? a. I'll do better next time. b. I'll never understand this. c. Why didn't I study more? d. That test was way too hard. Answer: b. I'll never understand this. 45. Joanne tends to blow up at people and then feel guilty. She worries a lot. She complains that she just doesn't really find anything exciting and life is boring. a. shows evidence of neuroticism and low positive affectivity, and has a high risk of developing depression. b. shows evidence of neuroticism and has a moderate risk of developing depression. c. shows evidence of introversion, and has a mild risk of developing depression. d. shows no evidence of any kind that would increase her risk for developing depression. Answer: a. shows evidence of neuroticism and low positive affectivity, and has a high risk of developing depression. 46. Parental loss only results in a vulnerability to depression when a. the loss is due to death. b. poor parental care is a consequence of the loss. c. the loss is not explained adequately to the child. d. both parents are lost at an early age. Answer: b. poor parental care is a consequence of the loss. 47. According to Freud, depression a. and grief are the same thing. b. must be treated with introjection. c. is a consequence of loss. d. reflects fixation in the anal stage. Answer: c. is a consequence of loss. 48. Freud suggested that depression a. was actually a healthy adaptation to stress. b. was a result of overly high self-esteem. c. involved the anal stage of development. d. was anger turned inward. Answer: d. was anger turned inward. 49. Which of the following is a behavioral explanation for depression? a. lack of environmental reinforcers b. insecure attachment c. pessimistic tendencies d. reliance on depressogenic schemas Answer: a. lack of environmental reinforcers 50. Depressogenic schemas a. are inherited. b. predispose a person to develop depression. c. serve a protective function and are readily modified by positive life experiences. d. ensure that a low rate of reinforcement will be experienced. Answer: b. predispose a person to develop depression. 51. A therapist with a ___________ orientation would emphasize the depressed person's need to improve his or her social skills. a. interpersonal b. psychodynamic c. cognitive d. sociocultural Answer: a. interpersonal 52. Beck's negative cognitive triad involves feeling negatively about a. helplessness, hopelessness, and sorrow. b. one's self, one's experiences, and one's future. c. one's past, one's present, and one's future. d. one's family, one's self, and one's friends. Answer: b. one's self, one's experiences, and one's future. 53. Debbie receives her paper back from her instructor. It is marked with an A grade and has several positive comments. The instructor also suggested Debbie reword one small section. Debbie becomes extremely upset and tells her friends her instructor hated the paper and wants her to redo it. This is an example of a. selective abstraction. b. dichotomous thinking. c. arbitrary inference. d. learned helplessness. Answer: a. selective abstraction. 54. Selective abstraction a. is a tendency to think in extremes. b. is a tendency to jump to conclusions based on little or no evidence. c. is part of Beck's cognitive triad. d. is a tendency to focus on one negative detail of a situation while ignoring other aspects. Answer: d. is a tendency to focus on one negative detail of a situation while ignoring other aspects. 55. Which of the following is an example of arbitrary inference? a. Life is so unfair. b. If she won't go out with me, I'll die. c. She looked at me funny. She hates me. d. Why should I even try? She'll definitely reject me. Answer: c. She looked at me funny. She hates me. 56. While there is much support for some elements of Beck's cognitive theory, a. treatments based on his view of depression are not effective. b. findings supporting it as a causal hypothesis are limited. c. it does not account for the known biological aspects of depression. d. is does not account for sex differences in depression. Answer: b. findings supporting it as a causal hypothesis are limited. 57. No matter what prisoners try to do, they cannot escape. Eventually, they become passive and depressed. This illustrates the central idea in the ___________ theory of depression. a. attribution b. depressogenic schema c. learned helplessness d. behavioral Answer: c. learned helplessness 58. Jacob and Matt both flunk their math test. Jacob says to his friends that there is no point in his continuing in the course because, although Jacob feels highly about himself, he suspects that the teacher just doesn't like him. Matt says he is going to drop the course because he is just stupid in math. According to the reformulated learned helplessness theory, a. Matt is more likely to become depressed than Jacob. b. Matt is more likely to feel helpless than Jacob. c. Jacob is more likely to become depressed than Matt. d. Jacob is more likely to feel helpless than Matt. Answer: a. Matt is more likely to become depressed than Jacob. 59. Which of the following is the type of attribution that is most likely to cause depression? a. I am never going to make it through this course because it is too early in the morning and I'm having trouble getting up. b. I am never going to make it through this course because I'm stupid and I just can't learn the material. c. I am never going to make it through this course because the professor is unfair. d. I am never going to make it through this course because I just don't feel like studying lately. Answer: b. I am never going to make it through this course because I'm stupid and I just can't learn the material. 60. Abramson revised the learned helplessness theory to suggest that a. the worldview dimension of attributions is the most important to depression. b. hopelessness is needed to produce depression, helplessness is not important. c. the number of negative life events someone experiences is more important than his or her attributions for those events. d. the pessimistic attributional style people have about negative events produces depression. Answer: d. the pessimistic attributional style people have about negative events produces depression. 61. Which of the following statements about rumination is true, according to the ruminative response styles theory? a. Rumination is a protective factor against depression. b. People who ruminate a great deal tend to have more lengthy periods of depressive symptoms. c. Gender differences in depression are explained by ruminative styles. d. Biological factors have been most clearly linked to the development of rumination in those who do not have a family history of mood disorders. Answer: b. People who ruminate a great deal tend to have more lengthy periods of depressive symptoms. 62. When a nondepressed student lives with a depressed roommate, which of the following often results? a. frequent verbal fights, which may even become physical b. increased depression and hostility in the roommate who was not originally depressed c. a decrease in depression in the depressed roommate d. increased caretaking by the nondepressed roommate, but only after the nondepressed roommate becomes depressed Answer: b. increased rejection and hostility in the roommate who was not originally depressed 63. Which of the following is a major risk factor for panic disorder, depression, and other anxiety disorders? a. the presence of neuroticism b. the presence of positive affect c. the presence of helplessness d. the presence of rumination Answer: a. the presence of neuroticism 64. A relationship between depression and marital dissatisfaction a. has yet to be established. b. only exists due to the submissive behavior of depressed wives. c. is only seen when depression leads to substance abuse. d. is well-established. Answer: d. is well-established. 65. Which statement best describes the relationship between mood disorders and domestic distress? a. Critical comments trigger negative affect in the spouse. b. Women who are depressed avoid their partners. c. Whenever there is a problem, it is caused by a man who, in a manic episode, is unaware of the nature of his behavior or even who he is attacking. d. Men become violent as a way of protecting themselves when their wives, who suffer from depressive episodes, become impulsively aggressive. Answer: a. Critical comments trigger negative affect in the spouse. 66. Childhood depression a. has been clearly linked to genetic factors. b. is more likely in children with a depressed parent. c. has not been associated with parental depression. d. can usually be causally related to marital discord. Answer: b. is more likely in children with a depressed parent. 67. A hypomanic episode is best described as a a. mild manic episode. b. short manic episode. c. manic episode characterized by inactivity. d. manic episode followed by symptoms of a mild depression. Answer: a. mild manic episode. 68. The main difference between a manic episode and a hypomanic episode is a. whether the person also experiences depression. b. the number of symptoms the person has. c. whether the person has irritable mood. d. the amount of social and occupational impairment. Answer: d. the amount of social and occupational impairment. 69. Bipolar disorder is to major depression as ___________ is to ___________. a. dysthymia; cyclothymia b. cyclothymia; dysthymia c. mania; hypomania d. hypomania; mania Answer: b. cyclothymia; dysthymia 70. Which of the following is necessary for a diagnosis of cyclothymia? a. The occurrence of two or more episodes of major depression b. Unremitting symptoms for a period of at least two years c. Clinically significant distress or impairment d. The occurrence of at least one episode of anxiety Answer: c. clinically significant distress or impairment 71. Which of the following would eliminate a potential diagnosis of cyclothymia? a. Gil had been showing both hypomanic and depressed symptoms for over three years. b. Carol was absolutely convinced that her mother wanted to kill her, although there was no evidence for this. c. Bob's most recent hypomanic episode lasted 3 days. d. Between her more recent episodes, Carla functioned quite well for 3 weeks. Answer: b. Carol was absolutely convinced that her mother wanted to kill her, although there was no evidence for this. 72. Lori has periods of dejection and apathy that are not as severe as are seen in major depression. She also has periods when she abruptly becomes elated and has little need for sleep. Her symptoms never reach the level of psychosis, but the mood swings have been recurrent for over four years. The best diagnosis for Lori is a. schizoaffective disorder. b. bipolar I disorder. c. recurrent dysthymia. d. cyclothymia. Answer: d. cyclothymia. 73. Which of the following is necessary for a diagnosis of bipolar I disorder? a. the occurrence of two or more episodes of major depression b. unremitting symptoms for a period of at least two years c. symptoms of psychosis d. the occurrence of at least one manic episode Answer: d. the occurrence of at least one manic episode 74. Although bipolar I disorder is described as "bipolar," a. a depressed episode is not necessary for a diagnosis. b. few patients show both manic and depressed symptoms. c. both depressed and manic symptoms typically occur simultaneously. d. a year or two commonly passes between manic and depressed episodes. Answer: a. a depressed episode is not necessary for a diagnosis. 75. A diagnosis of bipolar I disorder indicates that the person has met DSM-5 criteria for a. an episode of mania. b. an episode of mania or major depression. c. an episode of hypomania and a major depression. d. an episode of mania and psychois. Answer: a. an episode of mania. 76. Angela has had several periods of extremely "up" moods. They last for a couple of weeks and she has gotten into trouble several times. During those times she doesn't sleep, spends way too much money, gets involved in bad business decisions, talks quickly and thinks even more quickly and believes she can do anything. The best diagnosis for Angela is a. manic disorder. b. bipolar II disorder. c. bipolar I disorder. d. cyclothymic disorder. Answer: c. bipolar I disorder. 77. Which statement about bipolar I disorder is accurate? a. The depressive phase is more likely to involve psychotic features than in major depressive disorder. b. The onset of bipolar symptoms are never associated with seasons of the year as they are in unipolar depression. c. Single episodes of the disorder are extremely rare. d. Manic and depressive phases are always separated by lengthy intervals of normal mood. Answer: c. Single episodes of the disorder are extremely rare. 78. A diagnosis of bipolar II disorder indicates that the person has experienced a. an episode of mania. b. an episode of mania or major depression. c. an episode of hypomania and an episode of major depression. d. an episode of mania and an episode of major depression. Answer: c. an episode of hypomania and an episode of major depression. 79. Carleen comes to therapy because she is feeling sad. Carleen says her she has often had periods of extreme sadness in the past and they typically last between 6 and 8 months. During those times she overeats, has trouble sleeping, feels exhausted all the time, and thinks a lot about dying. At other times, however, Carleen says she feels wonderful. During those times, which last about a week, she gets a lot done, feels as if she could do anything, talks a lot and quickly, doesn't sleep, but doesn't feel tired. Carleen says her "up" times are great and have never caused her any trouble. Carleen's most likely diagnosis is a. major depressive disorder. b. dysthymia. c. bipolar I. d. bipolar II. Answer: d. bipolar II. 80. Which of the following is a true statement about rapid cycling in bipolar disorders? a. It is seen in men more than women. b. It occurs in only those with Bipolar II disorder. c. Lithium may trigger a cycling episode. d. It is seen in 5-10 percent of those with bipolar disorder. Answer: d. It is seen in 5-10 percent of those with bipolar disorder. 81. Why is it not wise to treat an individual who has a bipolar disorder with a tricyclic antidepressant? a. The unpleasant side effects cause many to stop taking them. b. Individuals with bipolar disorder may or may not exhibit symptoms of depression. c. The drugs used to treat unipolar disorders do not alter the activity of the neurotransmitters that are affected in bipolar disorder. d. The combination of antidepressants and lithium is likely to be lethal. Answer: a. The unpleasant side effects cause many to stop taking them. 82. The National Comorbidity Survey-Replication indicated ________ percent of people with mood disorders receive no treatment or inadequate care. a. 40 b. 50 c. 60 d. 70 Answer: c. 60 83. Which of the following is true? a. Neither unipolar nor bipolar disorder have a strong genetic contribution. b. Unipolar and bipolar disorders have an equally strong genetic contribution. c. Unipolar disorder is more strongly inherited than bipolar disorder. d. Bipolar disorder is more strongly inherited than unipolar disorder. Answer: d. Bipolar disorder is more strongly inherited than unipolar disorder. 84. Efforts to find the gene or genes that underlie bipolar disorder suggest that a. multiple genes are involved. b. the underlying gene is on the Y chromosome. c. the underlying gene is on the X chromosome. d. there is a genetic basis for bipolar disorder, but not for cyclothymia. Answer: a. multiple genes are involved. 85. Which of the following neurochemical profiles has been associated with manic episodes? a. High serotonin, high norepinephrine, high dopamine b. Low serotonin, high norepinephrine, high dopamine c. Low serotonin, low norepinephrine, high dopamine d. Low serotonin, high norepinephrine, low dopamine Answer: b. Low serotonin, high norepinephrine, high dopamine 86. Knowing what we know about the neurotransmitter imbalances in bipolar disorder, a physician should give which of the following pieces of advice? a. "Eat lots of foods that are rich in norepinephrine." b. "Don't take drugs that increase dopamine levels because they can produce manic-like behavior." c. "Stay away from drugs that include lithium because bipolar is associated with excessive lithium activity." d. "If you can keep your serotonin levels normal, you do not have to worry about having a manic episode." Answer: b. "Don't take drugs that increase dopamine levels because they can produce manic-like behavior." 87. Reynaldo has been diagnosed with bipolar disorder. The most effective drug for him is a. one that will increase his dopamine levels. b. one that will counteract the effect of sodium in his nerve cells. c. lithium. d. dexamethasone. Answer: c. lithium. 88. The effectiveness of lithium in the treatment of bipolar disorder a. supports the hypothesized role of serotonin in this disorder. b. is inconsistent with the established effects of dopamine on mood states. c. supports the role of dopamine in mania. d. suggests that it is not neurotransmitter function that is disrupted in bipolar disorder, but neurotransmitter levels. Answer: c. supports the role of dopamine in mania. 89. Which of the following is a hormonal abnormality associated with both bipolar disorder and unipolar depression? a. decreased thyroid hormone levels b. increased thyroid hormone levels c. decreased cortisol levels d. increased cortisol levels Answer: d. increased cortisol levels 90. Stressful life events a. do not trigger manic episodes. b. appear to increase the time to recovery from a manic episode. c. do not generally precipitate an initial manic episode, but tend to play more of a role over time. d. play no role in the development or progression of bipolar II disorder. Answer: b. appear to increase the time to recovery from a manic episode. 91. A sophisticated prospective study of the role of stressful life events in bipolar disorder by Ellicott, Hammen, and colleagues found that a. low levels of stress protected an individual against manic episodes. b. stress did not play a lesser role with the occurrence of more episodes. c. high levels of stress were not associated with the occurrence of manic or depressive episodes. d. low levels of stress protected an individual against depressive episodes. Answer: b. stress did not play a lesser role with the occurrence of more episodes. 92. Recent research on relapse among bipolar patients suggests that a. stressful life events have very little influence. b. personality styles interact with stress to increase the likelihood of relapse. c. relapse is most likely among those with unrealistically positive attributional styles. d. the more frequently a person has bipolar episodes, the less likely stressful events are able to induce a relapse. Answer: b. personality styles interact with stress to increase the likelihood of relapse. 93. Cross-cultural studies of mood disorders are made difficult due to a. the variability in the prevalence of bipolar disorders. b. the variability in the prevalence of unipolar disorders. c. the lack of clear-cut distinctions between bipolar and unipolar disorders. d. differences in diagnostic practices. Answer: d. differences in diagnostic practices. 94. Which of the following might explain why rates of depression are low in China and Japan? a. Mental illnesses are not stigmatized, thus those who are depressed receive much social support and do not seek treatment. b. The heavy emphasis on the individual decreases the likelihood of blaming the self for failure. c. Symptoms of depression tend to be discussed as somatic. d. Blunted emotions characterize Asian peoples, so both positive and negative emotional extremes are rare. Answer: c. Symptoms of depression tend to be discussed as somatic. 95. Selective serotonin reuptake inhibitors a. were the first antidepressants to be developed. b. are more effective than the tricyclic antidepressants. c. may lead to sexual problems. d. act to stabilize the mood swings of those with bipolar disorder. Answer: c. may lead to sexual problems. 96. Jill's marriage has suffered ever since the birth of her second child. Since the birth, she has been depressed and has had little interest in intimacy with her husband. Jill feels unattractive with the additional weight she carries since the birth and has been rejecting her husband's advances. After discussing her feelings with Dr. Tora, Dr. Tora has decided to prescribe her an antidepressant. Considering the problems she has been having in her marriage, which of the following is Dr. Tora most likely to prescribe? a. imipramine b. Prozac c. bupropion d. venlafaxine Answer: c. bupropion 97. Lithium a. is more effective than antidepressants at treating bipolar depression. b. has both antimanic and antidepressant effects. c. is an anticonvulsant. d. is well-tolerated by most bipolar patients. Answer: b. has both antimanic and antidepressant effects. 98. Quentin is severely depressed and presents an immediate and serious suicidal risk. In the past he has not responded to tricyclics. A wise course of action is to treat him with a. Prozac because it can reduce symptoms in 12-24 hours. b. electroconvulsive therapy because it can rapidly reduce symptoms. c. lithium because suicide is almost always accompanied by manic episodes. d. anticonvulsants such as carbamazepine and valproate because they can prevent future depressions. Answer: b. electroconvulsive therapy because it can rapidly reduce symptoms. 99. Transcranial magnetic stimulation a. is a biological test for altered brain waves in bipolar disorder. b. is a noninvasive biological test for changes in brain function in depression. c. is a noninvasive biological treatment for manic episodes. d. is a noninvasive biological treatment for depression. Answer: d. is a noninvasive biological treatment for depression. 100. Nadia has been depressed for several months. She is considering cognitive therapy. What advice would you give her? a. "Cognitive therapy is much less effective than interpersonal therapy and takes much longer, too." b. "Many studies have shown the usefulness of cognitive therapy and it seems to prevent relapse." c. "Drug treatment is much more effective than cognitive therapy and has less likelihood of relapse." d. "The only way that cognitive therapy is of any value is if it is coupled with family therapy." Answer: b. "Many studies have shown the usefulness of cognitive therapy and it seems to prevent relapse." 101. Behavior activation treatment a. focuses on implementing cognitive changes. b. combines pharmacotherapy and behavioral therapy. c. combines interpersonal therapy and behavioral methodology. d. emphasizes activity and involvement in interpersonal relationships. Answer: d. emphasizes activity and involvement in interpersonal relationships. 102. Diane's treatment for depression included training in meditation techniques that helped her become aware of her unwanted negative thoughts and to accept them as just thoughts. She was undergoing a. mindfulness-based cognitive therapy. b. psychodynamic therapy. c. behavioral activation therapy. d. transcranial magnetic stimulation. Answer: a. mindfulness-based cognitive therapy. 103. One factor that is especially likely to produce depression relapse is a. family members ignoring the depressed behavior expressed by the depressed individual. b. excessive attention from family members. c. family members discussing the depressed individual's negative thoughts and feelings with him or her. d. behavior by a spouse that can be interpreted as criticism. Answer: d. behavior by a spouse that can be interpreted as criticism. 104. Which statement about the risk of suicide is true? a. Depressed people are no more likely to commit suicide than nondepressed people. b. The risk of suicide is greatest at the lowest point in a depression. c. About half of people who complete suicide do so in the recovery phase of a depressive episode. d. Suicide is most likely when a person in a manic episode is getting "high." Answer: c. About half of people who complete suicide do so in the recovery phase of a depressive episode. 105. Which of the following is most likely to attempt suicide? a. A 25-year-old single man b. A 25-year-old single woman c. A 25-year-old divorced man d. A 25-year-old divorced woman Answer: d. a 25-year-old divorced woman 106. The majority of individuals who ATTEMPT suicide are ___________ and the majority of those who COMPLETE suicide are ________. a. women and people between age 18 and 24; men and people over age 65 b. men and people over age 65; women and people between age 18 and 24 c. adolescents; the elderly d. the elderly; adolescents Answer: a. women and people between age 18 and 24; men and people over age 65 107. The director of a city health department wants to know who is most likely to complete suicide in her city. The group with the highest risk is a. teenagers, especially depressed girls. b. elderly men with chronic physical illnesses. c. young women who were recently separated or divorced. d. college-educated people. Answer: b. elderly men with chronic physical illnesses. 108. Childhood suicide a. is common. b. has been declining since the early 1950s. c. is the third most common cause of death in the US for 15 to19 year-olds d. most commonly is seen in victims of early onset schizophrenia. Answer: c. is one of the top ten causes of death for children in the United States. 109. Which of the following is most likely to attempt, but not complete, suicide? a. 14-year-old Joan who has been depressed since her parent's divorce b. Charlie, a 16-year-old with a history of petty crimes c. 12-year-old Paul who receives constant rejection from the girls at school and has an overprotective mother d. Crystal, a 14-year-old substance abusing teen who has been diagnosed with attention deficit disorder Answer: a. 14-year-old Joan who has been depressed since her parent's divorce 110. Melissa is severely depressed and wants to commit suicide. If she is typical of most individuals who commit suicide, a. she is determined to kill herself and will choose a lethal means such as a gun to ensure that she is successful. b. she is ambivalent about committing suicide. c. she will change her mind at the last minute and reexamine her problems in a more objective fashion. d. she will show no outward signs of her distress. Answer: b. she is ambivalent about committing suicide. 111. According to your textbook, which of the following statements is true about the relationship between religion and rate of suicide? a. Suicide rates in Catholic countries are high but are low in Islamic countries. b. Suicide rates in Catholic countries are low but are high in Islamic countries. c. Suicide rates in both Catholic and Islamic countries are low. d. Suicide rates in both Catholic and Islamic countries are high. Answer: c. Suicide rates in both Catholic and Islamic countries are low. Fill-in-the-Blank Questions 1. Two types of mood disorders are __________ and bipolar depressive disorders Answer: unipolar 2. The diagnosis of __________ occurs when symptoms are similar to a manic episode but are milder. Answer: hypomanic episode 3. A major depressive episode is considered to be __________ when the symptoms do not remit for over 2 years. Answer: chronic 4. The hormone __________ has been found to be elevated in most patients hospitalized with major depressive disorder. Answer: cortisol 5. A different kind of depression related to the total amount of light a person receives is often called __________. Answer: seasonal affective disorder Short Answer Questions 1. What are the four phases of the grieving process? Answer: The normal response to the loss of spouse or close family member begins with a numbing and disbelief. This is followed by a yearning for the person that may possibly last for months. Eventually, despair is seen and then, finally, some adaptation and reorganization such that life can continue without the departed loved one. 2. What is anaclitic depression? Answer: Anaclitic depression or despair is a form of depression seen in infants separated from their attachment figure for a prolonged period of time. There is some debate, however, as to whether the behavior displayed is merely a normal reaction to loss. 3. What type of psychotic symptoms might be seen in someone suffering from major depression? Answer: The presence of psychotic symptoms indicate that a break with reality has occurred and involves the presence of hallucinations and/or delusions. The psychotic symptoms seen in depression are mood-congruent, they are symptoms that are consistent with being depressed. The depressed individual, for example, might believe that their friends and family want them dead. 4. What changes in sleep are seen in depression? Answer: Over half of depressed patients experience some form of insomnia. In addition to having problems getting to sleep or staying asleep, the sleep of the depressed is not normal. More time is spent in REM sleep and REM sleep is entered more quickly, leading to a reduction in the amount of time spent in other forms of deep sleep. The observed alterations in sleep suggest a general disturbance in biological rhythms. 5. What are independent and dependent life events? What is their importance? Answer: Independent - stressful events that are not a result of a person's behavior or character, dependent - are a result of those things, at least partly. Dependent events are especially important in the onset of major depression. 6. Describe the hopelessness theory of depression. Answer: Having a pessimistic attributional style along with negative life events is not enough to produce depression. A state of hopelessness is needed as well. Hopelessness expectancy is the perception that one has no control over a situation that is about to occur as well as an absolute belief that what is going to happen is going to be bad. 7. What is the difference between bipolar I and bipolar II disorder? Answer: A diagnosis of bipolar I is made when there has been a manic episode. This diagnosis is made with or without the occurrence of a bout of major depression. In bipolar II, there is at least one episode of major depression and a hypomanic episode. If the individual with bipolar II exhibits a manic episode, a diagnosis of bipolar I is warranted. 8. In what way do the symptoms of depression in Western and non-Western societies differ? Answer: While the Western constellation of depressive symptoms is primarily psychological, in many cultures the symptoms tend to be more somatic. In those cultures in which there is great stigma associated with mental illness and/or a lack of emotional expressiveness, depression may manifest itself in symptoms such as weight loss, sleep disturbances, and sexual dysfunction. In addition, the feelings of guilt and worthlessness that characterize depression in individualistic cultures may not be seen in more communal cultures. 9. Discuss the risk factors for adolescent suicide. Answer: Mood disorders, conduct disorder and substance abuse all increase the risk of both nonfatal and fatal suicide attempts. If the adolescent has 2 or more of these, the risk for completion of suicide is extremely high. Antidepressant medications slightly increase the risk as well. 10. What are the warning signs of student suicide in college or university? Answer: Marked change in mood and behavior, especially withdrawal, decline in self-esteem, not taking care of personal hygiene, uncharacteristically impulsive behaviors, not attending classes. Many students communicate their impulses. Often the behavior is a reaction to the break-up of a romance. Essay Questions 1. What are the two main forms of mood disorder? How are these disorders further characterized? Answer: The two main forms of mood disorder are unipolar, in which a person only experiences depression, and bipolar, in which a person has mood swings that range from hypomania or mania to depression. A person with bipolar disorder, however, may not exhibit any depression. The mood disorders are differentiated in terms of severity — the number of areas of life that are impaired and the degree of impairment, and duration — whether the disorder is acute, chronic, or intermittent. In addition, each type of mood disorder is further divided into multiple subtypes. 2. Discuss Beck's cognitive theory of depression. Answer: Beck's theory is that thinking preceded and caused depression. First, people hold dysfunctional beliefs that predispose them to depression. These are rigid, extreme, and unhelpful beliefs about the world. They create automatic, negative thoughts that center around the cognitive triad - the self, the world, and the future. Negative beliefs and feelings about the triad are maintained by cognitive errors such as all or none reasoning and arbitrary inference. This theory has been well supported as an explanation for many aspects of depression, but evidence confirming it as a cause of depression is mixed. 3. Distinguish between cyclothymic disorder, bipolar I disorder and bipolar II disorder. How are these disorders alike and how are they different? Answer: Cyclothymia is best described as a less severe, yet chronic, version of bipolar disorder. While the individual with bipolar I disorder exhibits a full manic state, the individual with cyclothymia exhibits hypomania. People with bipolar II have full major depressive episodes, people with cyclothymia have depressive symptoms but not full episodes. In cyclothymia the lows and the highs do not rise to the level that is needed for a diagnosis of major depressive episode or manic episode, respectively. The disorders differ in that there need not be any depressive symptoms in bipolar I disorder, although this is usually the case as pure mania is rare. Only bipolar I involves manic episodes. Test Bank for Abnormal Psychology: DSM 5 James N. Butcher, Jill M. Hooley, Susan M. Mineka 9780205965090, 9780205944286

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