NUNP 6630 Psychopharmacologic
Approaches to Trends in
Psychopathology
Midterm Exam Review
(Questions & Solutions)
2025
©2025
, 1. Case: A 32‑year‑old woman with a major depressive disorder who
has not achieved remission after several trials of SSRIs is being
considered for augmentation therapy with an atypical antipsychotic (e.g.,
aripiprazole).
Question: Which pharmacologic property of aripiprazole most
contributes to its efficacy as an augmentation agent in
treatment‑resistant depression?
a) Potent blockade of dopamine D2 receptors only
b) Partial agonism at dopamine D2 and serotonin 5‑HT1A receptors
combined with 5‑HT2A antagonism
c) Nonselective monoamine oxidase inhibition
d) Pure serotonin receptor antagonism
Correct ANS: b) Partial agonism at dopamine D2 and serotonin
5‑HT1A receptors combined with 5‑HT2A antagonism
Rationale: Aripiprazole’s unique receptor activity modulates both
dopaminergic and serotonergic neurotransmission, providing
augmentation benefits when standard antidepressant therapy alone is
insufficient.
---
2. Case: A 28‑year‑old man with bipolar I disorder is started on lithium
for mood stabilization.
Question: What is the primary mechanism by which lithium is believed
to stabilize mood?
a) Inhibition of serotonin reuptake
b) Modulation of second messenger systems via inhibition of inositol
monophosphatase
c) Blockade of dopamine D2 receptors
d) Enhancement of gamma‐aminobutyric acid (GABA) receptor function
Correct ANS: b) Modulation of second messenger systems via
©2025
,inhibition of inositol monophosphatase
Rationale: Lithium’s mood‑stabilizing effects are chiefly attributed to its
interference with intracellular signaling (e.g., inositol recycling), which
alters second messenger pathways implicated in mood regulation.
---
3. Case: A 40‑year‑old patient with schizophrenia experiencing
significant extrapyramidal side effects (EPS) on a high‑dose typical
antipsychotic is considered for a switch in medication.
Question: Which alternative strategy minimizes EPS while still
controlling psychotic symptoms?
a) Increase the current high‑potency typical antipsychotic’s dose
b) Continue the same medication and add benzodiazepines
c) Switch to an atypical antipsychotic with a lower risk of EPS
d) Augment with a selective serotonin reuptake inhibitor
Correct ANS: c) Switch to an atypical antipsychotic with a lower risk of
EPS
Rationale: Atypical antipsychotics offer a receptor-profile that reduces
the incidence of EPS (by favoring serotonin over dopamine blockade in
motor pathways) while effectively managing psychosis.
---
4. Case: A 35‑year‑old woman diagnosed with generalized anxiety
disorder is prescribed an SSRI as first‑line therapy.
Question: What is the principal mechanism by which SSRIs alleviate
anxiety symptoms?
a) Inhibition of norepinephrine reuptake
b) Blockade of the N‑methyl‑D‑aspartate (NMDA) receptor
c) Inhibition of serotonin reuptake
d) Activation of GABA‑A receptors
Correct ANS: c) Inhibition of serotonin reuptake
©2025
, Rationale: SSRIs increase the availability of serotonin in the synaptic
cleft by blocking its reuptake, which is thought to reduce both depressive
and anxiety symptoms over time.
---
5. Case: A 17‑year‑old male with depressive symptoms is initiated on
SSRI therapy.
Question: Which of the following is a critical safety concern when
starting SSRIs in adolescents?
a) Cardiovascular toxicity
b) Increased risk of suicidal ideation
c) High abuse potential
d) Extrapyramidal symptoms
Correct ANS: b) Increased risk of suicidal ideation
Rationale: SSRIs carry a black‑box warning for heightened suicidal
ideation in pediatric and adolescent populations, making close
monitoring during early treatment phases imperative.
---
6. Case: A 28‑year‑old woman with bipolar II disorder is being
considered for treatment with lamotrigine.
Question: What is the key advantage of using lamotrigine in bipolar
disorder management?
a) Rapid control of acute mania
b) Prevention of depressive episodes with a favorable side‑effect profile
c) Strong dopamine receptor antagonism
d) Significant weight gain as a beneficial side effect
Correct ANS: b) Prevention of depressive episodes with a favorable
side‑effect profile
Rationale: Lamotrigine is especially effective in preventing bipolar
depression and is generally well tolerated, making it a strategic choice in
©2025
Approaches to Trends in
Psychopathology
Midterm Exam Review
(Questions & Solutions)
2025
©2025
, 1. Case: A 32‑year‑old woman with a major depressive disorder who
has not achieved remission after several trials of SSRIs is being
considered for augmentation therapy with an atypical antipsychotic (e.g.,
aripiprazole).
Question: Which pharmacologic property of aripiprazole most
contributes to its efficacy as an augmentation agent in
treatment‑resistant depression?
a) Potent blockade of dopamine D2 receptors only
b) Partial agonism at dopamine D2 and serotonin 5‑HT1A receptors
combined with 5‑HT2A antagonism
c) Nonselective monoamine oxidase inhibition
d) Pure serotonin receptor antagonism
Correct ANS: b) Partial agonism at dopamine D2 and serotonin
5‑HT1A receptors combined with 5‑HT2A antagonism
Rationale: Aripiprazole’s unique receptor activity modulates both
dopaminergic and serotonergic neurotransmission, providing
augmentation benefits when standard antidepressant therapy alone is
insufficient.
---
2. Case: A 28‑year‑old man with bipolar I disorder is started on lithium
for mood stabilization.
Question: What is the primary mechanism by which lithium is believed
to stabilize mood?
a) Inhibition of serotonin reuptake
b) Modulation of second messenger systems via inhibition of inositol
monophosphatase
c) Blockade of dopamine D2 receptors
d) Enhancement of gamma‐aminobutyric acid (GABA) receptor function
Correct ANS: b) Modulation of second messenger systems via
©2025
,inhibition of inositol monophosphatase
Rationale: Lithium’s mood‑stabilizing effects are chiefly attributed to its
interference with intracellular signaling (e.g., inositol recycling), which
alters second messenger pathways implicated in mood regulation.
---
3. Case: A 40‑year‑old patient with schizophrenia experiencing
significant extrapyramidal side effects (EPS) on a high‑dose typical
antipsychotic is considered for a switch in medication.
Question: Which alternative strategy minimizes EPS while still
controlling psychotic symptoms?
a) Increase the current high‑potency typical antipsychotic’s dose
b) Continue the same medication and add benzodiazepines
c) Switch to an atypical antipsychotic with a lower risk of EPS
d) Augment with a selective serotonin reuptake inhibitor
Correct ANS: c) Switch to an atypical antipsychotic with a lower risk of
EPS
Rationale: Atypical antipsychotics offer a receptor-profile that reduces
the incidence of EPS (by favoring serotonin over dopamine blockade in
motor pathways) while effectively managing psychosis.
---
4. Case: A 35‑year‑old woman diagnosed with generalized anxiety
disorder is prescribed an SSRI as first‑line therapy.
Question: What is the principal mechanism by which SSRIs alleviate
anxiety symptoms?
a) Inhibition of norepinephrine reuptake
b) Blockade of the N‑methyl‑D‑aspartate (NMDA) receptor
c) Inhibition of serotonin reuptake
d) Activation of GABA‑A receptors
Correct ANS: c) Inhibition of serotonin reuptake
©2025
, Rationale: SSRIs increase the availability of serotonin in the synaptic
cleft by blocking its reuptake, which is thought to reduce both depressive
and anxiety symptoms over time.
---
5. Case: A 17‑year‑old male with depressive symptoms is initiated on
SSRI therapy.
Question: Which of the following is a critical safety concern when
starting SSRIs in adolescents?
a) Cardiovascular toxicity
b) Increased risk of suicidal ideation
c) High abuse potential
d) Extrapyramidal symptoms
Correct ANS: b) Increased risk of suicidal ideation
Rationale: SSRIs carry a black‑box warning for heightened suicidal
ideation in pediatric and adolescent populations, making close
monitoring during early treatment phases imperative.
---
6. Case: A 28‑year‑old woman with bipolar II disorder is being
considered for treatment with lamotrigine.
Question: What is the key advantage of using lamotrigine in bipolar
disorder management?
a) Rapid control of acute mania
b) Prevention of depressive episodes with a favorable side‑effect profile
c) Strong dopamine receptor antagonism
d) Significant weight gain as a beneficial side effect
Correct ANS: b) Prevention of depressive episodes with a favorable
side‑effect profile
Rationale: Lamotrigine is especially effective in preventing bipolar
depression and is generally well tolerated, making it a strategic choice in
©2025
