Schizophrenia 1

Question 1

Psychiatric conditions associated with psychosis include bipolar, MDD, Schcizophrenia/schizoaffective disorder as well as _____ (4).

Answer 1

1. Schizophreniform Disorder
2. Delusional Disorder
3. Brief Psychotic Disorder
4. Shared Psychotic Disorder

Question 2

Differential diagnosis for psychosis include Panic Disorder, Depersonalization Disorder, Obsessive-compulsive Disorder as well as _____ (3).

Answer 2

1. Personality Disorders (eccentric cluster)
2. Autistic Disorder
3. Substance abuse or withdrawal

Question 3

Medical conditions associated with psychosis include brain trauma, CVA, tumor, epilepsy as well as _____(4).

Answer 3

1. Metabolic disorder
2. Vitamin deficiency
3. Infection
4. Toxic illness

Question 4

Drugs that are associated with psychosis (3):

Answer 4

1. Recreational drugs (stimulants, hallucinogen)
2. Meds (anticholinergic, L-dopa/DA agonists, Ioniazid: anti-fungal)
3. Withdrawal (EtOH, barbituates)
4. Toxicity (Digitalis)

Question 5

Prevalence of schizophrenia

Answer 5

0.5 - 1%

Question 6

Schizophrenia age of onset

Answer 6

• 18-25 years old in men
• 21-30 years old in women

Question 7

What are some risk factors for schizophrenia and development?

Answer 7

1. Maternal age, stress, drug use, medical conditions
2. High childhood insulin levels
3. Low socioeconomic status

(schiz accounts for about 3% of all healthcare cost)

Question 8

Schizophrenia genetics

Answer 8

Question 9

Describe the course of schizophrenia

Answer 9

Psychotic break → accruing morbidity (first 10 years)

(Patients do not return to previous level of functioning after each additional break)

Question 10

Schizophrenia: physical changes to the brain (2)

Answer 10

1. cortical gray matter loss
2. enlargement of the third and lateral ventricles

Question 11

Schizophrenia monthly relapse rate

Answer 11

• 3.5% per month on maintenance medication
• 12% per month for patients who have discontinued antipsychotic therapy

(74% are non-compliant w/tx)

Question 12

Schizophrenia risk factor for cardiovascular disease (5)

Answer 12

1. Sedentary lifestyle: 72%
2. Smoking: 70%
3. Obesity: 50%
4. Hypertension: 20%
5. Elevated cholesterol: >18%

Question 13

What are the five core symptoms of schizophrenia (must have at least two for at least one month)?

Answer 13

1. Delusions
2. Hallucinations
3. Disorganized speech
4. Grossly disorganized or catatonic behavior
5. Negative symptoms (diminished affect & speech, avolition)

Question 14

4 diagnostic criteria of social and occupational dysfunction in schizophrenia:

Answer 14

1. Self-care
2. Occupation functioning
3. Interpersonal relations
4. Academic achievement

(seen since the onset of disturbance)

Question 15

Continuous signs of schizophrenia disturbance last for at least _______

Answer 15

6 months

Question 16

Positive symptoms of schizophrenia (4)

Answer 16

1. Delusions
2. Hallucinations
3. Disorganized speech
4. Catatonia

(Likely related to mesolimbic dopamine tract in the brain (excessive stimulation))

Question 17

Negative symptoms of schizophrenia

(hint: the 4 A’s of negative symptoms)

Answer 17

1. Alogia
2. Affect: Flat or blunted
3. Avolition
4. Anhedonia

Question 18

Alogia:

Answer 18

• Diminished amount of spontaneous speech

Or

• Impoverished in content with adequate amount

Question 19

Affective flattening or blunting:

Answer 19

reduced intensity of emotional expression and response

(unchanging facial expression, decreased spontaneous movements, poverty of expressive gestures, poor eye contact, lack of voice inflections, and slowed speech)

Question 20

Avolition:

Answer 20

unable to initiate goal-directed behavior and complete it

(loss of will or drive)

Question 21

Anhedonia:

Answer 21

inability to experience pleasure

Question 22

Cognitive symptoms of schizophrenia

Answer 22

1. Attention
2. Memory
3. Executive function

(part of how delusions are formed)

Question 23

Schizophrenia: mood symptoms

Answer 23

1. Dysphoria
2. Suicidality (1/3 attemt, 1/10 complete)
3. Hopelessness

Question 24

List the typical stages of schizophrenia

Answer 24

1. Prodromal phase
2. Active phase
3. Residual phase

Question 25

Prodromal phase of schizophrenia: onset & symptoms

Answer 25

* Onset: over months to years * Sx: Subtle behavior changes: social withdrawal, work impairment, blunting of emotions, avolition, odd ideas and behavior

Question 26

In the active phase of schizophrenia, the patient develops ______ symptoms.

Answer 26

psychotic symptoms

Question 27

During the residual phase of schizophrenia, the active symptoms may be abesnt or no longer as prominent, but they do have _______ (3) symptoms.

Answer 27

1. Role impairment 2. Negative symptoms 3. Attenuated positive symptoms

Question 28

Schizophrenia: factors predicting good outcome include normal health otherwise, female gender, late onset (30's), shorter prodrome and _______ (4).

Answer 28

1. Mood symptoms (indicate possibly bipolar, which can be stabilized) 2. No obsessions/compulsion 3. Married 4. High intelligence

Question 29

Guidelines for interviewing schizophrenic patients include being attentive and respectful, structuring the conversation, having brief interactions, and providing educational approach and context the delusions as a reaction to stress. It is best to avoid ________ (2).

Answer 29

1. arguing about delusions (do not agree or encourage them) 2. dangerous interactions (though rare, schizophrenics are more likely than other patients to be violent)

Question 30

First line treatment when initiating therapy for acute psychosis include \_\_\_\_\_. Second-line?

Answer 30

* antipsychotics (first or second gen), +/- benzos * Clozapine (risk of agranulocytosis) (Benzos offset the side effects of antipsychotics)

Question 31

Medications for schizophrenia usually take effect within \_\_\_\_\_

Answer 31

a few days of onset of treatment (effects are cumulative, so an *adequate trial is 4 -6 weeks*)

Question 32

Delusions are disturbances in _____ rather than perception.

Answer 32

thought

Question 33

\_\_\_\_\_\_ theme is the most common delusion.

Answer 33

Persecutory (other themes include: somatic, grandiose, religious, nihilistic or sexual)

Question 34

Delusions are firmly held beliefs that are untrue as well as contrary to \_\_\_\_\_\_\_.

Answer 34

a person's education and cultural background

Question 35

Examples of delusions are "being controlled", "mind reading", or "broadcasting" as well as ______ (4).

Answer 35

1. "reference" 2. "thought broadcasting" 3. "thought insertion" 4. "though withdraawal"

Question 36

Which mental status exam components are seen with dimensions of psychosis (3)?

Answer 36

1. speech 2. thought association 3. abnormal motor behavior 4.

Question 37

Abnormal motor behaviors seen with psychosis include catatonic stupor or excitement as well as _____ (5)?

Answer 37

1. Automatic obedience 2. Echopraxia 3. Negativism (lack of response or opposition to instruction) 4. Odd mannerisms 5. Stereotypy (rythmic, repetitive movements)

Question 38

Which three abnormal thought processes are seen with psychosis?

Answer 38

1. Derailment / loose associations 2. Clanging (i.e. "Slagle", "bagel") 3. Thought blocking

Question 39

Which four abnormal elements of speech are seen with psychosis?

Answer 39

1. Poverty of speech 2. Poverty of content of speech 3. Neologisms (made up words) 4. Echolalia

Question 40

In a catatonic stupor a patient is _______ (3), yet fully conscious

Answer 40

1. immobile 2. mute 3. unresponsive

Question 41

What is the abnormal motor behavior exhibited when a patient has uncontrolled and aimless motor activity? Sometimes bizarre and comfortable postures are maintained for long periods.

Answer 41

Catatonic excitement

Question 42

Define automatic obedience (abnormal motor behavior seen in psychosis)

Answer 42

Carries out simple commands in a robot like fashion

Question 43

Define negativism (an abnormal motor behavior seen in psychosis)

Answer 43

Refuses to cooperate with simple requests for no reason

Question 44

Define echopraxia (an abnormal motor behavior of psychosis)

Answer 44

Initiates movements or gestures of another person

Question 45

\_\_\_\_\_\_\_ & _____ are the rating scales for schizophrenia.

Answer 45

* PANSS * BPRS (18 of the 30 PANSS items)

Question 46

Negative symptoms of schizophrenia are likely related ***_decreased stimulation_*** of the _______ tract in the brain, while positive symptoms of schizophrenia are likely related to the ***_excessive stimulation_*** of the ______ tract in the brain.

Answer 46

* mesocortical dopamine * mesolimbic dopamine