Schizophrenia 2: Subtypes

Question 1

“-pines” and “-dones” are the suffix for which drug class?

Answer 1

second gen antipsychotics

(ex: clozapine)

Question 2

Clozapine: mechanism of action

Answer 2

• Serotonin 2A and Dopamine 4 receptor antagonism
• Weak Dopamine 2 receptor antagonism

(poorly understood)

Question 3

Why is Clozapine used as a last resort?

Answer 3

May cause a granulocytosis

(must monitor CBC regularly, some pharmacies require it to fill the prescription)

Question 4

The “-Pines” are more potent at the ____receptor than the ____ receptor.

Answer 4

• H1
• D2

(olanzapine, quetiapine, asenapine)

Question 5

_______ (2 second generation antipsychotic drugs) that have anticholinergic properties

Answer 5

Olanzapine and Quiteipine

Question 6

the “-Dones” are potent ______ receptor antagonists. Some activity at ______ (2).

Answer 6

• D2
• Serotonin
• Alpha 1

(Risperidone, paliperidone, ziprasidone, lurasidone, iloperidone)

Question 7

Aripiprazole, brexipiprazole, cariprazine are very potent _____antagonism with partial agonism at_____.

Answer 7

• D2
• D2

Question 8

Patients with a first-episode psychosis may be more responsive and require lower doses of medication than patients with_____.

Answer 8

multiple psychotic episodes

Question 9

For patients with schizophrenia, you should provide the patient and family education on the potential side effects such as: metabolic syndrome, diabetes, weight gain and obesity, _______ (3)

Answer 9

1. dyslipidemia
2. extrapyramidal symptoms (i.e. tardive dyskinesia)
3. neuroleptic malignant syndrome

Question 10

Antipsychotic medicine monitoring includes: _______ (5)

Answer 10

1. Glucose
2. Lipids
3. BMI
4. Weight
5. Abnormal movements

Question 11

If patients have problems reliably taking oral medication, _____may be indicated.

Answer 11

a long-acting depot medication

(depot med: injection formulation of a medication which releases slowly over time )

Question 12

How long should patients who have had two psychotic episodes in five years or multiple psychotic episodes have antipsychotic treatment?

Answer 12

maintenance management

Question 13

CATIE 1 study investigated ____

Answer 13

Clinical antipsychotic effectiveness

Question 14

Resulat of CASTIE 1 study for: olanzapine, perphenazine, risperidone

Answer 14

1. Olanzapine: most efficacious, but had the most AE
2. Perphenazine: comparable efficacy & tolerability
3. Risperidone: hyperprolactinemia

(no single drug is consistently effective or tolerable for all patients, must do a trial and error for each individual patient)

Question 15

Psychosocial interventions of schizophrenia include case management, social skills training and _____ (3)

Answer 15

1. psychosocial rehabilitation
2. cognitive rehabilitation
3. family therapy (they need to be involved in their care and understand and support them)

(case managers make sure they get their meds, make it to appointments)

Question 16

A schizophrenic patient may need to be hospitalized with a new onset to clarify diagnosis and stabilize medication, as well as ____ (5).

Answer 16

1. Disabling side effects (meds)
2. Unable to care for themselves
3. Combativeness
4. Suicidal
5. ECT

Question 17

Define schizophreniform disorder: for at least one month, but less than 6 months, they have:

Answer 17

Core symptoms and at least two of the following:

1. Delusions
2. Hallucinations
3. Disorganized speech
4. Grossly disorganized or catatonic behavior
5. Negative symptoms

(the difference between schizophreniform is at least one month, but less than 6 months; its greater than 6 months for schizophrenia.)

Question 18

Good prognostic factors for schizophreniform disorder include onset within 4 weeks of change in behavior, as well as _____ (2).

Answer 18

1. Confusion or perplexity at the height of the episode
2. Good premorbid functioning (socially & at work)
3. Absence of blunted or flat affect

Question 19

During the period with core symptoms of schizoaffective disorder, one of the following will be present also: (3)

Answer 19

1. Major Depressive Episode
2. Manic Episode
3. Mixed Episode

(with or w/o mood symptoms)

Question 20

Symptoms that meet criteria for a mood episode are present for the majority of the total duration of the _____ periods of the schizoaffective disorder.

Answer 20

active and residual

Question 21

Schizoaffective disorder is bipolar type if the disturbance includes a _____ or _____.

It is a depressive type if the disturbance includes only _____.

Answer 21

• Manic or Mixed Episode
• Major Depressive Episodes

Question 22

What is the difference between bizarre and non-bizarre delusions?

Answer 22

• bizarre: unbelievable
• non-bizarre: understandable that they would believe it even though it is not typically acceptable

Question 23

The long-term outcome for a patient with schizophrenia is better when treatement is ______.

Answer 23

initiated rapidly (acute episode)

Question 24

Prevalence and onset of delusional disorder

Answer 24

• 0.1%
• Middle-aged or later

Question 25

The course of delusional disorder can be remission without relapse or ______ (2).

Answer 25

1. Remission alternating with relapse 2. Chronic waxing and waning

Question 26

Diagnostic criteria for delusional disorder (2).

Answer 26

1. One or more delusions of at least one month 2. Brief mood episodes

Question 27

Delusional disorder does not have at least two of the schizophrenia symptoms and is not \_\_\_\_\_.

Answer 27

Functionally impaired (behavior is not obviously bizarre or impaired either)

Question 28

Persecutory Type: delusions that the person (or someone they are close to) is \_\_\_\_\_.

Answer 28

being malevolently treated in some way

Question 29

Somatic Type: delusions that the person has \_\_\_\_\_\_\_.

Answer 29

some physical defect or general medical condition

Question 30

Mixed type: delusions characteristic of persecutory or somatic type of delusions, but no \_\_\_\_\_\_.

Answer 30

one theme predominates

Question 31

Erotomanic Type: delusions that\_\_\_\_\_.

Answer 31

another person, usually of higher status, is in love with the individual

Question 32

Grandiose Type: delusions of \_\_\_\_.

Answer 32

inflated worth, power, knowledge, identity, or special relationship to a deity or famous person

Question 33

Jealous type: delusions that\_\_\_\_\_\_\_.

Answer 33

the individual’s sexual partner is unfaithful

Question 34

After the patient’s first psychotic episode is successfully treated, how long will they require antipsychotic treatment?

Answer 34

At least a year after full remission of the symptoms of schizophrenia

Question 35

Brief Psychotic Disorder lasts for ***_at least one day, but less than one month,_*** with eventual return to premorbid functioning. It inludes the presence of one (or more) of the following symptoms:

Answer 35

1. Delusions 2. Hallucinations 3. Disorganized speech 4. Grossly disorganized or catatonic behavior (The disturbance is not better accounted by another psychiatric condition, the effects of a substance, or a medical condition)

Question 36

Brief Psychotic Disorder Management (2):

Answer 36

1. Supportive therapy in hospital milieu 2. Antipsychotic if agitation or emotional distress

Question 37

Subtypes of Brief Psychotic Disorder (3):

Answer 37

1. With marked stressors 2. Without marked stressors 3. With postpartum onset

Question 38

Management of delusional disorder includes attempts to build a relationship with the patient and _____ (2).

Answer 38

1. Help them understand how symptoms interfere w/function 2. Medications

Question 39

Which medications are appropriate for delusional disorder (3)?

Answer 39

1. Antipsychotics (mostly ineffective) 2. Pimozide (somatic delusions) 3. SSRIs

Question 40

When attempting to build a relationship with a delusional disorder patient, you must be patient, _____ and do NOT \_\_\_\_\_\_

Answer 40

* Ensure confidentiality * Condemn or collude with delusions (i.e. I believe that you believe this, but I can't see it myself)

Question 41

Onset and course of brief psychotic disorder

Answer 41

1. Onset: late 20’s to early 30’s 2. Course: can resolve within a few days (prevelence unknown)

Question 42

# Define Charles Bonnet syndrome symptoms (patients know that they are not real)

Answer 42

* Complex recurrent visual hallucinations (faces) (Occurs in patients with visual impairment)

Question 43

Capgras syndrome occurs in patients with ______ (3 comorbidities).

Answer 43

1. Schizophrenia 2. Brain injury 3. Dementia

Question 44

Capgras syndrome is a delusion that \_\_\_\_\_.

Answer 44

someone close to the patient has been replaced by an imposter; due to a change in how they feel about the person (i.e. friend, spouse, parent or close family member)

Question 45

Antipsychotics with a D2 occupancy of _____ % correlates with maximal antipsychotic efficacy, anything more than that will lead to extrapyramidal symptoms

Answer 45

65 – 70 (you don't want it to bind too tightly)

Question 46

Antipsychotic drugs also block ______ (3) receptors to different degrees, giving each a unique side effect profile

Answer 46

1. noradrenergic 2. cholinergic 3. histaminic

Question 47

Hyperactivity in the mesolimbic system tract causes ______ symptoms, and hypoactivity in the mesocortical tract causes ______ symptoms.

Answer 47

* positive * negative

Question 48

\_\_\_\_\_\_\_\_\_ now exists as a specifier for neurodevelopmental, psychotic, mood and other mental disorders; as well as for other medical disorders.

Answer 48

Catatonia (catatonia due to another medical condition)

Question 49

Describe the symptoms of catatonia

Answer 49