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Neurobiology of Childhood Maltreatment

Stress Systems and Early Adversity

1. Studies have reported a rise in cortisol levels across the day for maltreated children with:

A. Post-traumatic stress disorder

B. Depression

C. Dissociative identity disorder

D. Antisocial behavior

2. A history of childhood abuse has been found to be the strongest predictor of _____ responsiveness, and is amplified by the experience of further trauma in adulthood.

A. Adrenocortico-trophic hormone

B. Cortisol

C. Acetylcholine

D. All of the above

3. A recent systemic review and meta-analysis supports the view that PTSD is associated with a general pattern of hypercortisolism, with increased cortisol levels in the afternoon.

A. True

B. False

4. It appears that childhood maltreatment may lead to atypical responsiveness of the HPA axis to stress, which in turn predisposes to psychiatric vulnerability in later life.

A. True

B. False

Structural Brain Differences Associated with Maltreatment

5. The vulnerability hypothesis posits that a smaller hippocampal volume in individuals with PTSD is a:

A. Consequence of stress.

B. Predisposing risk factor for the disorder present in some individuals prior to any traumatic experience.

C. Both (A) and (B).

D. None of the above.

6. It appears that _____ exposure to maltreatment has a weaker impact on amygdala volume.

A. Less severe

B. Time-limited

C. Developmentally later

D. All of the above

7. Which of the following has been shown to be particularly susceptible to structural change following abuse during the adolescent period?

A. The hippocampus

B. The corpus callosum

C. The frontal cortex

D. All of the above

8. Structural differences in the _____ may be linked to degree of social difficulty in physically abused children even in the absence of PTSD.

A. Orbitofrontal cortex

B. Prefrontal cortex

C. Both (A) and (B)

D. None of the above

Functional Brain Differences Associated with Maltreatment

9. During the retrieval component of a verbal declarative memory task, youths with PTSS exhibited reduced left hippocampal activity, which is associated with greater severity of avoidance and numbing symptoms.

A. True

B. False

10. It has been demonstrated that school-aged children who have been exposed to physical abuse allocate more attention to _____ faces and require more attentional resources to disengage from such stimuli leading to problems with emotional regulation that may predispose to anxiety.

A. Sad

B. Negative

C. Angry

D. Fearful

11. Group differences indicate that heightened amygdala response to sad faces is not a characteristic of individuals with depression, but rather of those with a significant history of maltreatment.

A. True

B. False

12. Adults with a history of childhood maltreatment, relative to peers with no history of adversity:

A. Reported higher depressive symptoms.

B. Rated reward-predicting cues as less positive.

C. Exhibited a blunted brain response to reward cues in the left pallidus.

D. All of the above.

The Genetics of Resilience and Vulnerability

13. There is demonstrable heritable influences that prove there are genes for PTSD, depression, and antisocial behavior.

A. True

B. False

14. Linkage and association studies have implicated variants within which of the following genes in the etiology of PTSD, depression, and antisocial behavior?

A. Monoamine oxidase-A

B. Brain-Derived Neurotrophic Factor

C. Serotonin transporter

D. All of the above

15. An interaction of a measured genotype (MAOA) and environment (maltreatment) for a psychiatric outcome demonstrated that individuals who are carriers of the low activity allele (MAOA-l), but not of the high activity allele (MAOA-H), are at an increased risk for _____ following maltreatment.

A. Post-traumatic stress disorder

B. Depression

C. Antisocial behavior disorders

D. All of the above

16. Imaging genetic studies have found that the risk, MAOA-l, genotype is related to:

A. Hypo-responsivity of the the brain’s threat detection system.

B. Reduced activation in emotion regulation circuits.

C. Structural differences in females in key regulatory regions such as OFC.

D. All of the above.

17. GxE research has suggested that positive environmental influences, such as social support, can buffer genetic and environmental risk for psychopathology and promote resiliency.

A. True

B. False

Clinical Implications

18. It has been shown that corpus callosum volume is reduced in association with childhood sexual abuse at ages:

A. 3 to 5 years

B. 9 to 10 years

C. 11 to 13 years

D. 14 to 16 years

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