Psychotic and mood disorders

In a 50-year-old patient with schizophrenia, the size of the cerebral
ventricles, glucose utilization in the frontal lobes, and size of limbic
structures are most likely to be, respectively

A. increased, decreased, decreased
B. increased, decreased, increased
C. increased, increased, decreased
D. decreased, decreased, decreased
E. decreased, increased, decreased
F. decreased, increased, increased


 When compared with a man, the chances that a woman will develop major
depressive disorder, dysthymic disorder, or bipolar disorder over the course
of her lifetime are, respectively:

A. higher, higher, equal
B. higher, higher, lower
C. higher, equal, higher
D. higher, higher, higher
E. equal, higher, equal
F. equal, higher, lower
G. equal, equal, equal


A 65-year-old woman, who was diagnosed with advanced lung cancer 3 months
ago, has lost 18 pounds, wakes frequently during the night, and has very little
energy. Over the past month she has been preoccupied with feelings of guilt about
“people I have hurt in my life” and expresses concern that she will die in pain. The
sign or symptom most likely to indicate that this patient is experiencing a major
depressive episode rather than a normal reaction to life-limiting illness is

(A) weight loss
(B) decreased energy
(C) difficulty sleeping
(D) preoccupation with feelings of guilt
(E) concern about dying in pain


A 22-year-old male college student is taken to the emergency department
by police because he tried to enter a state office building to “have a
conference with the governor” about conducting a fund drive to “finance
my cure for cancer.” When police prevent him from entering the building,
he becomes irritable and hostile and resists attempts to restrain him.
The most appropriate diagnosis for this patient is

(A) dysthymic disorder
(B) major depressive disorder
(C) bipolar disorder
(D) hypochondriasis
(E) cyclothymic disorder

A 22-year-old male college student is taken to the emergency department
by police because he tried to enter a state office building to “have a
conference with the governor” about conducting a fund drive to “finance
my cure for cancer.” When police prevent him from entering the building,
he becomes irritable and hostile and resists attempts to restrain him.
This college student has two brothers. The first is his monozygotic twin;
the second is two years younger. The risks that his first and second
brothers will develop bipolar disorder are respectively about

(A) 75% and 60%
(B) 75% and 20%
(C) 60% and 12%
(D) 50% and 12%
(E) 12% and 1%


For the past few months, a 28-year-old woman has seemed full of energy
and optimism for no obvious reason. Although she gets only about 6
hours of sleep a night, she has been very productive at work. She is
talkative and gregarious and relates that she belongs to four clubs and
two different sports teams. A few years previously, friends say she was
often pessimistic and seemed tired and “washed out.” During that period,
she continued to work but did not seek out social activities and had little
interest in sex. There is no evidence of a thought disorder and the patient
denies suicidality or hopelessness. Physical examination including body
weight is normal.

This patient shows evidence of
(A) dysthymic disorder
(B) major depressive disorder
(C) bipolar disorder
(D) hypochondriasis
(E) cyclothymic disorder

The most effective long-term treatment for this patient is

(A) a heterocyclic antidepressant
(B) lithium
(C) electroconvulsive therapy
(D) psychotherapy
(E) a monoamine oxidase inhibitor

A 62-year-old woman whose husband died 6 months ago tells her
physician that she believes killing herself would end her suffering.
Physical examination is unremarkable.
Of the following signs and symptoms, which is most likely to be seen in
this patient?

(A) Weight gain
(B) Flight of ideas
(C) Auditory hallucinations
(D) Feeling better in the morning than in the evening
(E) Poor grooming

A 62-year-old woman whose husband died 6 months ago tells her
physician that she believes killing herself would end her suffering.
Physical examination is unremarkable.
Analysis of neurotransmitter availability in the brain of this patient is
most likely to reveal

(A) increased dopamine
(B) decreased histamine
(C) increased acetylcholine
(D) decreased acetylcholine
(E) decreased serotonin

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