Schizophrenia Flashcards
1
Q
A 37-year-old Caucasian male with a history of chronic paranoid schizophrenia is hospitalized for a relapse of symptoms. He is given parenteral haloperidol because he is very agitated and threatening. The patient continues to be belligerent and has to be put in physical restraints. The next day the patient is less agitated and belligerent, but he reports feeling nauseated and tired and toward evening is found to be disoriented to time and place. His laboratory work-up shows an increase in BUN and creatinine. He is diagnosed with acute renal failure and transferred to the medical floor. What could be the cause of his acute presentation?
A. Intramuscular injection
B. Myoglobinuria due to muscle breakdown secondary to struggling when restrained
C. Dystonia secondary to multiple doses of pareneteral antipsychotic
D. All of the above
A
D. All of the above
Intramuscular injections can lead to muscle injury and an increase in CPK values. When an agitated patient is put in restraints and struggles against the restraints, the patient may develop physical injuries, which can lead to muscle breakdown. Parenteral injections can lead to acute dystonic reactions, which can also lead to muscle breakdown. Muscle breakdown can lead to myoglobinuria, which in turn can lead to acute renal failure.
2
Q
A 32-year-old patient has been under treatment for chronic paranoid schizophrenia. He presents to the ER with a relapse of symptoms and is admitted to the hospital because he is very agitated. He had missed an appointment with his psychiatrist a few days before, although he had his WBC count done the day before that. He is started back on clozapine at the same dosage he was receiving before admission: 450 mg. The next morning he is found unconscious near his bed with a bump on the head. Which of the following could have led to this clinical situation?
A. Starting the patient on clozapine
B. Starting the patient on the same dosage of clozapine as previously
C. Not starting the patient on benztropine
D. None of the above
A
B. Starting the patient on the same dosage of clozapine as previously
A patient who has been off clozapine for more than 36 hours needs to be put back on the starting dosage and the dose slowly increased. Starting at a higher dosage can lead to orthostatic hypotension and other side effects associated with clozapine.
3
Q
A 58-year-old African American male with a long history of NIDDM develops blindness. Approximately 6 months later, he is brought to the ER by his girlfriend. According to the girlfriend, the patient has been reporting seeing burglars breaking into their house. The patient is well oriented to time and place, and he reports that although he realizes what he is seeing is untrue, the experience is very unsettling for him. What is this phenomenon called? A. Doppelganger B. Reflex hallucinations C. Charles Bonnet syndrome D. Functional hallucinations
A
C. Charles Bonnet syndrome
Charles Bonnet syndrome is seen in people with recently developed blindness. The person knows that the visual hallucination is not real. A hallucination of one’s own body, which leads to the belief that one has a double, is called doppelganger.
4
Q
Which of the following is one of the four As identified by Eugene Bleuler as the primary symptoms of schizophrenia? A. Abnormal association B. Autistic behavior C. Ambivalence D. All the above
A
D. All the above
According to Bleuler, the four primary symptoms of schizophrenia are abnormal associations, autistic behavior, abnormal affect, and ambivalence.
5
Q
What is the total direct and indirect cost of schizophrenia to the U.S. economy annually? A. $100 billion B. $50 billion C. $65 billion D. $40 billion
A
C. $65 billion
The direct and indirect costs of schizophrenia are estimated to cost the U.S. economy around $65 billion annually. Direct cost to the United States is approximately $20 billion.
6
Q
What is the concordance rate for schizophrenia in monozygotic twins? A. 90-100% B. 10-20% C. 30-40% D. 40-50%
A
D. 40-50%
Monozygotic twins have a concordance rate of 40-50% for schizophrenia. The lifetime prevalence of schizophrenia for relatives of schizophrenic patients is 4-5% for parents, around 10% for siblings, 13-15% for children with one parent who has schizophrenia, and around 35% for children of parents who are both schizophrenic.
7
Q
Which of the following cognitive impairments is found in persons with schizophrenia? A. Deficits in information processing B. Deficits in executive function C. Deficits in language ability D. None of the above E. All of the above
A
E. All of the above
Patients with schizophrenia show impaired attention and concentration, information processing, executive functions, and memory and language functions.
8
Q
Which season of birth is associated with a higher incidence of schizophrenia? A. Spring B. Summer C. Autumn D. Winter
A
D. Winter
9
Q
Which of the following brain regions has consistently been shown to have abnormal volume measurements? A. Occipital and parietal regions B. Parietal region C. Temporal region D. Frontal and temporal regions
A
D. Frontal and temporal regions
It has consistently been shown persons with schizophrenia have decreased volume of the frontal and temporal regions. Schizophrenia has also been implicated in reduced volume of the superior temporal gyrus, hippocampus, and thalamus.
10
Q
Which of the following antipsychotics has been used in receptor-binding PET studies of schizophrenia? A. Droperidol B. Amisulpride C. Clozapine D. Raclopride
A
D. Raclopride
11
Q
Which of the following psychoanalysts introduced the concept of the schizophrenogenic mother? A. Bateson B. Fromm-Reichmann C. Vaughn and Leff D. Brown
A
B. Fromm-Reichmann
Frieda Fromm-Reichmann propounded the concept of the schizophrenogenic mother, described as being cold, overprotective, moralistic, rejecting, and dominant.
12
Q
A 28-year-old Southeast Asian man presents to the ER accompanied by his parents. According to family members, the patient has been extremely anxious, not sleeping at night and not going to work regularly. During the interview, the patient reports that he is afraid his penis is becoming small and receding into his body. What is the clinical situation described by this man? A. Dhat B. Piblokto C. Latah D. Koro
A
D. Koro
Koro is a culture-bound syndrome seen in Southeast Asia that involves the fear that the penis is shrinking and receding into the abdomen. Dhat is found among Indian men and involves fears about discharge of semen in urine. Piblokto is seen among Eskimo women and involves the person tearing off her clothing, screaming, and crying and running about wildly in the snow. Latah, which is found in women on the Malay Peninsula, is characterized by echolalia, echopraxia, and other extremely compliant behavior.
13
Q
Which French psychiatrist introduced the concept of “folie circulaire” (circular insanity)? A. Jean-Pierre Falret B. Jules Baillarger C. Benjamin Rush D. Gabriel Langfeldt
A
A. Jean-Pierre Falret
Jules Baillarger described “folie à double forme.” Gabriel Langfeldt described schizophreniform psychosis. Benjamin Rush, a signer of the American Declaration of Independence, is considered the father of psychiatry in the United States.
14
Q
A patient with chronic schizophrenia walks the floors of the state hospital where he is an inmate swearing aloud at other inmates. The resident in charge of this patient tells him that he has to earn the right to watch TV from now on. According to the treatment plan submitted to the patient, for every half hour that he is able to prevent himself from using obscenities, he can earn a ticket for a half hour of TV time. What is this treatment plan an example of? A. Extinction B. Token economy C. Counterconditioning D. None of the above
A
B. Token economy
Token economy involves using contingency management for a group of patients living together in a ward or halfway house. Token economy uses positive reinforcement to encourage desirable behaviors.
15
Q
What is the peak onset of schizophrenia in men? A. 22-27 years B. 24-31 years C. 17-25 years D. 26-45 years
A
C. 17-25 years
The peak onset of schizophrenia in males is between the ages of 17 and 25 years. Peak onset in females is later, 24 to 35 years.
16
Q
Which of the following did Bleuler consider a primary symptom of schizophrenia? A. Abnormal associations B. Autistic behavior C. Abnormal affect D. Ambivalence E. All of the above
A
E. All of the above
Eugene Bleuler divided the symptoms of schizophrenia into primary symptoms and secondary symptoms. His four primary symptoms, also known as the four As of schizophrenia, are abnormal associations, abnormal affect, autistic behavior, and ambivalence. Of these four, Bleuler considered the disconnection between thought process and perception and among thought, emotion, and behavior to be the most important.
17
Q
Which of the following is considered a bad consequence of deinstitutionalization of schizophrenic patients?
A. Some of the patients were transferred to alternative forms of unregulated custodial care like nursing homes and poorly managed shelter systems.
B. Some patients were let free into nearby communities, which were unable or unwilling to take care of the released patients.
C. Responsibility for care was transferred to patients’ families, for whom it has become a burden.
D. Some of the released patients ended up in the prison system.
E. All of the above
A
E. All of the above
Deinstitutionalization involved transferring the patients from a hospital setting to a community care setting. This movement gained momentum during the 1960s, but it had severe repercussions for the patients and for society. Some of the patients were transferred from hospitals to nursing homes and poorly managed shelter systems. Others were just released into the community. In some situations the responsibility for care was transferred to the patients’ families, many of which felt burdened and unable to cope with it. Many patients finally wound up in the prison system.
18
Q
For which of the following gene locations is there the strongest research evidence of linkage with schizophrenia in genetic studies of the disorder? A. Chromosome 4 B. Chromosome 8 C. Chromosome 15 D. Chromosome 6
A
D. Chromosome 6
19
Q
Which of the following is considered a possible marker distinguishing schizophrenic probands and their biological relatives from controls? A. Smooth-pursuit eye movements B. Continuous performance tasks C. Sensory gating D. All of the above
A
D. All of the above
Biological markers of schizophrenia are neurophysiological features that reveal underlying pathophysiology and also serve as diagnostic tests. They help in predicting which persons may develop the disease and also help in predicting prognoses. Among the biological tests for schizophrenia are the following: CAT scan, regional cerebral blood flow, structural MRI, functional MRI, magnetic resonance spectroscopy, evoked potentials, smooth-pursuit eye movement test, tests of continuous performance tasks, and tests of sensory gating.
20
Q
Which of the following abnormalities is shown by magnetic resonance imaging (MRI) studies of the brains of schizophrenic patients?
A. Decreased cortical gray matter in the temporal cortex
B. Decreased volume of limbic structures
C. Increased volume of basal ganglia nuclei
D. All of the above
A
D. All of the above
Studies show decreased cortical gray matter in the temporal cortex and limbic structures in persons with schizophrenia. Some studies show that individuals with schizophrenia also have increased numbers of basal ganglia nuclei.
21
Q
Which of the following areas in the brain shows decreased blood flow during the Wisconsin Card Sorting Test in schizophrenic patients? A. Dorsolateral temporal cortex B. Parietal cortex C. Prefrontal cortex D. None of the above
A
C. Prefrontal cortex
Persons with schizophrenia who are doing the Wisconsin Card Sorting Test have been shown to have decreased blood flow in the frontal cortex.
22
Q
A 23-year-old college student is brought to the ER in the early morning by friends who found him behaving strangely. He was very irritable, abusive, and assaultive toward them. He also reported getting special messages from the TV instructing him to perform special missions. What should the psychiatry resident who sees him in the ER do first?
A. Contact the patient’s family to obtain a history regarding mental illness in the family.
B. Give the patient an injection of long-acting risperidone.
C. Do a urine drug screen and other laboratory tests.
D. Place the patient on one-to-one observation.
A
D. Place the patient on one-to-one observation.
The symptoms presented by the patient can be a feature of either acute schizophrenia or substance-induced acute psychosis, so testing the urine for any drugs and getting laboratory tests to rule out other causes of acute psychosis is an absolute necessity. An acutely psychotic patient is very unpredictable and the patient’s actions may lead to harm to the patient or others. The first thing to do in this situation is to maintain one-to-one observation of the patient to prevent any harm.
23
Q
Which of the following neurotransmitters has been implicated in the pathophysiology of schizophrenia? A. Glutamate B. Serotonin C. Dopamine D. All of the above
A
D. All of the above
According to the dopaminergic theory of schizophrenia, the symptoms of schizophrenia are mainly due to an excess of dopamine. This is also shown by the fact that antipsychotics are mostly dopamine antagonists. Phencyclidine, which exerts its effects through its action on the glutamate receptors, can lead to schizophrenia-like symptoms. The atypical antipsychotics exert their therapeutic effect through serotonin-dopamine antagonism.
24
Q
The study of which of the following substances of abuse has substantiated the argument that serotonin plays a role in the development of schizophrenia? A. PCP B. LSD C. Marijuana D. None of the above
A
B. LSD
Lysergic acid diethylamide (LSD) is a hallucinogen that blocks serotonin receptors in the brain. The atypical antipsychotics have been shown to have antagonist properties at both dopamine and serotonin receptors.
25
```
Which of the following anesthetic agents has been shown to have a mechanism of action similar to PCP and can lead to the development of schizophrenia-like symptoms?
A. Midazolam
B. Fentanyl
C. Ketamine
D. None of the above
```
C. Ketamine
PCP (phenycyclidine) acts as an antagonist at the NMDA receptor. It is also known by the street names angel dust, dust, wet, killer weed, and purple rain. It was developed in the 1950s as a general anesthetic. PCP use can lead to severe agitation and hallucinations. The anesthetic ketamine acts as an antagonist at the NMDA receptors and can lead to postanesthetic agitation and hallucinatory behavior.
26
```
Clonidine has been found by some studies to reduce psychotic symptoms in schizophrenic patients. Which of the neurotransmitters do these studies implicate as playing a role in the development of schizophrenia?
A. Serotonin
B. Aspartate
C. Norepinephrine
D. Dopamine
```
C. Norepinephrine
Clonidine, a presynaptic alpha-2 agonist, leads to a decrease in the release of norepinephrine. Clonidine's effect of reducing schizophrenic symptoms in some individuals implicates norepinephrine as playing a role in the development of schizophrenia.
27
```
A 52-year-old woman who is a resident of a state psychiatric hospital is admitted to a private hospital for treatment of her medical problems. When speaking with the resident physician, she claims she is the president of the company that owns the private hospital. However, she willingly takes all the medicines given to her and willingly stays in the room she shares with another patient. What term denotes this phenomenon?
A. Double depression
B. Double bookkeeping
C. Both of the above
D. None of the above
```
B. Double bookkeeping
Some individuals with schizophrenia are totally convinced of the reality of their delusions, but this does not influence their actions and beliefs. This paradox is called double orientation or double bookkeeping.
28
```
A parent of a schizophrenic patient criticizes the patient, saying that he is not showing any affection toward his parents. The same parent shies away when the patient wants to show affection in public. How did Gregory Bateson describe this kind of family interaction?
A. Expressed emotions
B. Double-bind communications
C. Discursive speech
D. None of the above
```
B. Double-bind communications
The double-bind communication pattern was described by Bateson and Jackson. In this type of communication pattern, the family members or caretakers of the patient give mutually incompatible messages like the example shown in the question.
29
```
Emil Kraepelin described persons with dementia praecox as having a prolonged deteriorating course. What percentage of Kraepelin's sample of patients recovered completely?
A. None
B. 10%
C. 22%
D. 4%
```
D. 4%
Kraepelin described dementia praecox as having a chronic deteriorating course, but he also reported that, in his sample of patients, 4% recovered completely and 13% had significant remission.
30
```
Which of the following described the first-rank symptoms of schizophrenia?
A. Manfred Bleuler
B. Kurt Schneider
C. Ernst Kretschmer
D. None of the above
```
B. Kurt Schneider
The symptoms Schneider called first-rank symptoms are characteristic of schizophrenia and rarely found in other illnesses. These include hearing thoughts as if spoken aloud, third-person auditory hallucinations, hallucinations in the form of commentary, somatic hallucinations, thought withdrawal or thought insertion, thought broadcasting, delusional perception, and feelings or actions experienced as made or influenced by external agencies.
31
```
Which of the following is the most common symptom of acute schizophrenia?
A. Auditory hallucinations
B. Delusions of reference
C. Suspiciousness
D. Lack of insight
```
D. Lack of insight
Ninety-seven percent of persons with an acute onset of schizophrenia have lack of insight, 74% have auditory hallucinations, less than 70% have delusions of reference, and around 65% report feeling suspicious.
32
Which of the following statements is true regarding periodic catatonia?
A. It was described by R. Gjessing.
B. The patients have periodic recurrent incidences of both stuporous and excited catatonic states.
C. Each episode is associated with a shift in the patient's metabolic nitrogen balance.
D. All of the above
D. All of the above
Periodic catatonia, first described by Gjessing, is characterized by periodic recurrent incidences of both stuporous and excited catatonic states. Each episode is associated with a shift in the patient's metabolic nitrogen balance.
33
```
Which of the following forms of schizophrenia has the best prognosis?
A. Paranoid schizophrenia
B. Catatonic schizophrenia
C. Disorganized schizophrenia
D. Schizophrenia, undifferentiated type
```
A. Paranoid schizophrenia
Persons who develop paranoid schizophrenia have a later onset (usually in their late 20s or in their 30s). By then they have already established an identity. They have completed their education and started working. Their ego resources have been described as better than those of catatonic and disorganized schizophrenics.
34
```
A 34-year-old woman is referred to a psychiatrist by her primary care physician. According to her husband, the patient has been behaving differently in the last few months. She is paying less attention to her appearance. She has become less industrious in keeping the house clean and taking care of her children and seems isolated from the family. She doesn't get up until late afternoon. Husband reports that these changes appeared gradually over the last two years and that the patient is showing further deterioration. The patient reports fleeting delusional beliefs and hallucinations. Which of the following is the best diagnosis?
A. Paranoid schizophrenia
B. Undifferentiated schizophrenia
C. Stuporous catatonia
D. Simple schizophrenia
```
D. Simple schizophrenia
According to DSM-IV research criteria, persons with simple schizophrenia (simple deteriorative disorder) are characterized by a progressive deterioration over a period of at least 1 year. They show a marked decline in occupational or academic functioning. They show a gradual appearance of and worsening of negative symptoms. They also show a decline in their relationships. Hallucinations and delusions are rare and, even when present, are fleeting.
35
```
A 42-year-old with schizophrenia keeps repeating certain words in the same fashion. What is this phenomenon called?
A. Echolalia
B. Perseveration
C. Echopraxia
D. Verbigeration
```
D. Verbigeration
Verbigeration is characterized by use of words in a stereotypical fashion. Echolalia is the repetition of the examiner's words. Perseveration is the repetition of words even after the significance of the same is past. Verbigeration is found exclusively in chronic and regressed patients with schizophrenia.
36
```
Which of the following stressed the inability of schizophrenics to use their ability of abstraction?
A. Norman Cameron
B. Kurt Goldstein
C. Lidz
D. None of the above
```
B. Kurt Goldstein
Kurt Goldstein described the thinking of persons with schizophrenia as being very concrete and talked about the decrease in their ability to use abstraction. According to Norman Cameron, overinclusive thinking is a significant feature of persons with schizophrenia. Overinclusion refers to the tendency of these persons to include many irrelevant items in their beliefs and behavior. Lidz did psychoanalytic studies in families of schizophrenic patients and reported two types of abnormal family pattern: marital schism and marital skew.
37
```
Which of the following is not a feature of Type I schizophrenia, according to Crow's classification?
A. Acute onset
B. Predominantly positive symptoms
C. Insidious onset
D. Good social functioning
```
C. Insidious onset
Crow et al. described two types of schizophrenia. Type I is characterized by acute onset, mostly positive symptoms, and good social functioning during periods of remission, and it responds well to treatment with antipsychotics. Type II has an insidious onset, poor prognosis, and mostly negative symptoms.
38
```
Which of the following is a good prognostic indicator for schizophrenia?
A. Prominent affective symptoms
B. Insidious onset
C. Ventriculomegaly
D. Negative symptoms
```
A. Prominent affective symptoms
Prominent affective symptoms are a good prognostic indicator. Poor prognostic indicators are insidious onset, male gender, venticulomegaly, social isolation, poor occupational history, earlier onset, negative symptoms, single marital status (widowed, separated, never married, or divorced), and prolonged episode. Good prognostic indicators are acute onset, no prior psychiatric history, paranoid subtype, good social and occupational history, married or in a stable relationship.
39
```
According to Vaughn and Leff, what is the optimal duration of contact between patients and their family members?
A. Less than 48 hours per week
B. Less than 72 hours per week
C. More than 48 hours per week
D. Less than 35 hours per week
```
D. Less than 35 hours per week
Vaughn and Leff described the effect of expressed emotion in relatives and patient's response to medications. Spending less than 35 hours per week with relatives was optimal for patients taking antipsychotic medications. According to Vaughn and Leff spending less than 35 hours leads to a relapse rate of 15%. The more time spent with relatives with high expressed emotion, the higher the relapse rate.
40
```
A patient who presents to a clinic describes seeing green ghosts when he hears classical music. What is the phenomenon described by the patient?
A. Haptic hallucination
B. Autoscopic hallucination
C. Hypnagogic hallucination
D. Reflex hallucination
```
D. Reflex hallucination
In reflex hallucination a stimulus in one modality results in hallucinations in another sensory modality. Hypnagogic hallucinations are described in narcolepsy and in normal persons as hallucinations when a person is drifting off to sleep. Autoscopic hallucination is the experience of seeing one's own body projected into external space. If the person is convinced that that he or she has a double, the hallucination is known as “doppelganger.” Haptic hallucinations are tactile hallucinations.
41
```
A patient reports to his doctor that enemies from Mars have replaced his wife with an impostor that looks and behaves exactly like his real wife. What is the name of this phenomenon?
A. Fregoli syndrome
B. Capgras syndrome
C. Cotard syndrome
D. Othello syndrome
```
B. Capgras syndrome
In Capgras syndrome, the patient insists that a friend or family member has been replaced by a double. In Fregoli syndrome, the patient identifies a familiar person in many different strangers. Extremely nihilistic delusion in depressed individuals is known as Cotard syndrome. Delusions of jealousy on the part of husbands about their wives are known as Othello syndrome.
42
```
A patient with a long history of schizophrenia is brought to the hospital by the local fire department's EMTs after his landlord found him standing in bizarre positions for a prolonged period. On examination he is found to be standing in a very uncomfortable position. The ER staff reports that he has maintained this position for the last 40 minutes and has not responded to any attempt to talk to him. What is the most appropriate management?
A. Haloperidol intramuscularly
B. ECT
C. Risperidone orally dissolving tablet
D. Lorazepam intramuscularly
```
D. Lorazepam intramuscularly
The patient has catatonic schizophrenia. Intramuscular lorazepam is the treatment of choice for catatonic posturing in schizophrenia.
43
```
A 35-year-old woman is referred to a psychiatric outpatient clinic by a plastic surgeon. According to the referral letter, this person has consulted three cosmetic surgeons in the last 6 months about what she perceives to be a deformity in her upper lip. All the physicians have told her that there is no deformity and that there is no need for any surgery. But the woman firmly believes that there is a deformity, and this belief has hampered her socially and occupationally. What is the diagnosis?
A. Hypochondriasis
B. Somatization
C. Body dysmorphic disorder
D. Delusional disorder, somatic type
```
D. Delusional disorder, somatic type
This patient firmly believes that there is a deformity in her upper lip even when presented evidence to the contrary. The belief is delusional. In body dysmorphic disorder the belief does not have the delusional intensity.
44
```
Among the following, which is not a predictor of good response to ECT in patients with schizophrenia?
A. Recent onset
B. Shorter duration of illness
C. Mood incongruent delusions
D. Presence of affective symptoms
```
C. Mood incongruent delusions
Electroconvulsive therapy has been found to be most beneficial in persons with acute onset schizophrenia, persons with shorter episodes, and those with comorbid affective symptoms. Patients should first be treated with antipsychotics. Patients who do not show any response to antipsychotics or who are not able to take antipsychotics would benefit from being treated with ECT.
45
```
Which of the following countries was not part of the International Pilot Study of Schizophrenia conducted by the World Health Organization?
A. Nigeria
B. United Kingdom
C. Taiwan
D. India
E. United States
```
E. United States
The International Pilot Study of Schizophrenia was conducted by the World Health Organization in 1973 to study the diagnosis of schizophrenia in seven countries: Colombia, Czechoslovakia, Denmark, India, Nigeria, Taiwan, and United Kingdom. This study showed that schizophrenic patients in countries like India and Nigeria had better prognoses. This was ascribed to the better family support and less incidence of expressed emotions in these countries.
46
Which of the following abnormalities is not seen in schizophrenic patients?
A. Reduction in the amplitude of P300 wave.
B. Deficits in smooth-pursuit eye movements (SPEM)
C. Reduction in blood flow in the prefrontal cortex while taking Wisconsin Card Sorting Test
D. All of the above
D. All of the above
P300 is an evoked potential developed after a subject hears a stimulus enmeshed in a series of irrelevant stimuli. This measure is indicative of the auditory information processing. In schizophrenic patients the amplitude of P300 wave is reduced. Smooth-pursuit eye movement (SPEM) abnormalities are found in schizophrenia. These deficits often are explained in the context of the attentional and inhibitory deficits central to schizophrenia psychopathology. Patients with schizophrenia have a decrease in the blood flow in the prefrontal cortex while doing the neuropsychological test called the Wisconsin Card Sorting Test.
47
```
Which of the following atypical antipsychotics used in the treatment of schizophrenia is also a norepinephrine reuptake inhibitor?
A. Aripiprazole
B. Ziprasidone
C. Risperidone
D. None of the above
```
B. Ziprasidone
Ziprasidone, besides being a serotonin-dopamine antagonist, also inhibits the reuptake of norepinephrine and serotonin.
48
```
According to Ernst Kretschmer's classification of men into different constitutional groups, which of the following body types has more propensity to develop schizophrenia?
A. Asthenic
B. Pyknic
C. Athletic
D. None of the above
```
A. Asthenic
Kretschmer posited three chief constitutional groups: the tall, thin asthenic type; the more muscular, athletic type; and the rotund, pyknic type. He suggested that the lanky asthenics and to a lesser degree the athletic types, were more prone to schizophrenia, while the pyknic types were more likely to develop manic-depressive disorders. His work was criticized because his thinner, schizophrenic patients were younger than his pyknic, manic-depressive subjects, so the differences in body type could be explained by differences in age.
49
```
Which of the following did Vaughn and Leff consider to be a component of “expressed emotion”?
A. Critical comments
B. Hostility
C. Overinvolvement
D. Lack of warmth
E. All of the above
```
E. All of the above
Expressed emotion is a concept well described by Vaughn and Leff in the 1970s. This concept is characterized by a critical, overinvolved environment experienced by schizophrenic patients either at home or at the caretakers' place, which leads to increased relapse rates. The four components of expressed emotion are the parent's or caretaker's critical comments, hostility, overinvolvement, and lack of warmth.
50
```
Which of the following is NOT a poor prognostic indicator for schizophrenia?
A. Insidious onset
B. Male sex
C. Negative symptoms
D. Short episode
E. Younger age of onset
```
D. Short episode
Longer episode is considered a poor prognostic indicator. Shorter episodes are associated with a better outcome. The following are considered as poor prognostic indicators for schizophrenia: insidious onset, longer episode, presence of negative symptoms, younger age at onset, enlarged lateral ventricles, single status (widowed, divorced, separated, or never married), poor social skills, poor occupational history, and poor psychosexual development.
51
```
The term “dementia praecox” was coined by
A. Emil Kraepelin
B. Eugene Bleuler
C. Karl Jaspers
D. Adolf Meyer
E. Kurt Schneider
```
A. Emil Kraepelin
Emil Kraepelin divided mental disorders into dementia praecox and manic-depressive psychosis. He first described dementia praecox in 1893. He elucidated four subtypes: catatonic, hebephrenic, paranoid, and simple.
52
```
For a diagnosis of schizophrenia according to the DSM-IV, how long should the disturbance be present?
A. 1 month
B. 3 months
C. 6 months
D. 9 months
E. 1 year
```
C. 6 months
For a diagnosis of schizophrenia, the disturbance should be present for at least 6 months. At least two of the following five symptoms must be present for a significant portion of a one-month period: delusions, hallucinations, disorganized speech, disorganized behavior, and negative symptoms (affective flattening, alogia, avolition).
53
For a diagnosis of schizophreniform psychosis according to DSM-IV, how long should the disturbance be present?
A. 6 months
B. At least 1 month but less than 6 months
C. Less than 1 month
D. 3 months
E. None of the above
B. At least 1 month but less than 6 months
For a diagnosis of schizophreniform disorder, the episode should last at least 1 month and less than 6 months. If the symptoms last less than 1 month, the episode is classified as “brief psychotic disorder.”
54
```
The lifetime prevalence of schizophrenia is
A. 0.2-0.6%
B. 1%
C. 0.1-0.5%
D. 1-2%
E. 2-3%
```
B. 1%
55
Which of the following is true regarding schizophrenia?
A. Prevalence is greater in men than women.
B. The age of onset is earlier in women.
C. Women have a poorer prognosis than men.
D. The age of onset is 5 years earlier in men than in woman.
E. Men are more likely to have negative symptoms.
D. The age of onset is 5 years earlier in men than in woman.
Prevalence of schizophrenia is equal in men and women. It has an earlier onset in men. Women have a better prognosis. Men are more likely to have negative symptoms.
56
```
Which of the following is a positive symptom of schizophrenia?
A. Avolition
B. Alogia
C. Auditory hallucinations
D. Affective flattening
```
C. Auditory hallucinations
57
```
Which of the following suggests schizophrenia?
A. Perseveration
B. Autoscopy
C. Olfactory hallucinations
D. Asyndetic thinking
E. Visual hallucinations
```
D. Asyndetic thinking
Asyndesis describes the lack of connection between two consecutive thoughts and is a characteristic of schizophrenia. Schizophrenic patients have an inability to preserve conceptual boundaries.
58
```
The most common feature of chronic schizophrenia is
A. Social withdrawal
B. Underactivity
C. Lack of conversation
D. Few leisure interests
E. Slowness
```
A. Social withdrawal
Social withdrawal is the most common feature of chronic schizophrenia. It is seen in 74% of patients with chronic schizophrenia.
59
```
What percentage of persons with acute schizophrenia experience significant depressive symptoms?
A. 5%
B. 10%
C. 25%
D. 50%
E. 75%
```
D. 50%
Around 50% of patients with acute schizophrenia show significant depressive symptoms. This supports the view that depression is an integral part of schizophrenia. The depressive symptoms remit with the treatment of psychosis.
60
```
In persons with schizophrenia, paranoid symptoms are more common in
A. Children
B. Young adults
C. The middle-aged
D. The elderly
E. Women
```
C. The middle-aged
61
```
The risk of schizophrenia is increased in first-degree relatives of patients with
A. Depressive disorder
B. Bipolar disorder
C. Obsessive-compulsive disorder
D. Panic disorder
E. Schizoaffective disorder
```
E. Schizoaffective disorder
62
Fertility rates among schizophrenic patients are
A. Increased
B. Decreased
C. The same as for the general population
D. Subject to improvement with treatment
B. Decreased
Individuals with schizophrenia, especially men, have a low fertility rate. The low male fertility rate is ascribed to the fact that the disease process has an earlier onset in men.
63
In persons with schizophrenia, brain changes are more evident on
A. The left side of the brain
B. The right side of the brain
C. There is no predisposition to either side of the brain.
D. The cerebellum
A. The left side of the brain
64
```
Psychomotor retardation is associated with increased blood flow in the
A. Left parahippocampal gyrus
B. Caudate nuclei
C. Right anterior cingulate nuclei
D. Right prefrontal cortex
E. Frontal lobes
```
B. Caudate nuclei
The presence of psychomotor retardation in schizophrenic patients is associated with increased blood flow in the caudate nuclei.
65
```
The risk of children developing schizophrenia if both parents have schizophrenia is
A. 5%
B. 17%
C. 46%
D. 72%
E. 100%
```
C. 46%
66
Enlarged lateral ventricles in schizophrenia are associated with
A. Being female
B. Being male
C. Later age of onset of illness
D. Lack of impairment on neuropsychological testing
E. Good response to treatment
B. Being male
Enlargement of the lateral ventricles is present in 75% of schizophrenic patients. It is more prevalent in males and is associated with earlier onset of illness and impairment shown by neuropsychological testing.
67
```
The rates of all of these disorders are increased in relatives of persons with schizophrenia EXCEPT:
A. Bipolar disorder
B. Schizophrenia
C. Schizoaffective disorder
D. Schizotypal disorder
```
A. Bipolar disorder
The risk of schizophrenia, schizoaffective disorder, and schizotypal personality disorder is increased in the first-degree relatives of patients with schizophrenia. The risk of schizophrenia and mood disorder is increased in relatives of patients with schizoaffective disorder.
68
```
Factors associated with the development of psychosis in persons with complex partial seizures include
A. Lateral temporal focus
B. Late onset of seizures
C. Left-sided seizure focus
D. Right-sided seizure focus
```
C. Left-sided seizure focus
Left-sided seizure focus is associated with the development of psychosis in patients with complex partial seizures.
69
All of the following suggest a viral hypothesis for the etiology of schizophrenia EXCEPT:
A. Increased prevalence in children born during winter
B. Increased rate of complications during pregnancy
C. Nonlocalized pathology
D. Increased prevalence in males
D. Increased prevalence in males
According to the viral hypothesis of the origin of schizophrenia, the disease process has its origin in viral infection of the child in utero. The following factors have been postulated to support this hypothesis: increased prevalence in children born during winter, increased rate of birth complications in children who later develop schizophrenia, and the potential of the viral hypothesis to explain the symptoms of schizophrenia without overt encephalitis.
70
All of the following are true regarding chronic institutionalized schizophrenic patients except
A. Patients underestimate their age.
B. Patients score poorly on IQ tests.
C. Patients are similar in cognitive deficits to the mentally retarded.
D. Patients are more likely to be male than female.
C. Patients are similar in cognitive deficits to the mentally retarded.
Institutionalized patients with chronic schizophrenia are characterized by thought disorder and negative symptoms. They show decreased activity, apathy, anhedonia, poor self-hygiene, and social withdrawal. Because onset is earlier in males, and men have a poorer prognosis, the number of chronic institutionalized male schizophrenic patients is higher than the number of females.
71
Which of the following is true regarding depression seen in persons with schizophrenia?
A. Depression might be an integral part of schizophrenia.
B. Depressive symptoms may be a response to recovery of insight.
C. Depression may be a side effect of antipsychotic medications.
D. Fifty percent of patients with acute schizophrenia have depressive symptoms.
E. All of the above
E. All of the above
Depressive symptoms are common in both acute and chronic stages of schizophrenia. Depression may be an integral part of schizophrenia and is present in 50% of patients with acute schizophrenia. Depressive symptoms might also develop as a side effect of the antipsychotic medications. Recovery of insight can also lead to development of depression.
72
Which of the following findings is not associated with schizophrenic patients?
A. High activation levels on the EEG, as judged by reactivity upon opening the eyes
B. Lower alpha power of the EEG
C. Increased variability of frequency
D. Higher wave symmetry than EEGs of control subjects
E. All of the above
E. All of the above
The EEGs of schizophrenic patients differ from those of normal controls. According to Nuechterlein KH and Dawson ME, in Pharmacology: The Fourth Generation of Progress, ACNP, 2000, one difference is “high activation levels, as judged by reactivity of the EEG upon opening the eyes, among schizophrenic patients in an unmedicated state.” Also, schizophrenic patients' EEGs have “lower alpha power, increased variability of frequency, and higher wave symmetry” than those of normal controls.
73
Which of the following is true regarding structural changes in the brain in schizophrenic patients?
A. Reduction in size of hippocampus
B. Reduction in size of amygdala
C. Absence of gliosis
D. Decrease in volume of the hippocampus is restricted to the white matter.
E. All of the above
E. All of the above
Many structural abnormalities are seen in the brains of patients with schizophrenia. Enlargement of lateral ventricles is the most consistent finding. The other findings seen are smaller size of the hippocampus, thalamus, and amygdala. Neuronal cell architecture abnormalities have been seen in the entorhinal cortex, hippocampus, prefrontal cortex, orbitofrontal cortex, and cingulate cortex.
74
Which of the following is true regarding the prevalence of schizophrenia in new immigrants to the United States compared to the population in the immigrants' home country?
A. Prevalence is decreased in migrants from Norway.
B. Prevalence is increased in migrants from Norway.
C. Prevalence is increased in migrants from Mexico.
D. Prevalence is increased in all recent migrant subpopulations.
E. None of the above
B. Prevalence is increased in migrants from Norway.
A study by Odegaard showed that there is a greater prevalence of schizophrenia among Norwegian immigrants to the United States than among Norwegians in Norway. An Epidemiological Catchment Area (ECA) study showed that Mexican immigrants in Los Angeles had a lower prevalence than Mexicans in Mexico.
75
Which of the following is not true regarding the prevalence of schizophrenia in different social classes?
A. In most countries there is a higher prevalence in lower socioeconomic classes.
B. Social causation theory states that lower socioeconomic living condition leads to development of schizophrenia.
C. Social drift theory proposes that lower socioeconomic status is a consequence of the disease.
D. There is a higher prevalence in the upper castes of social hierarchy in India.
E. All of the above
E. All of the above
Schizophrenia has a higher prevalence in the lower socioeconomic classes of most countries. One exception is India, where there is a higher prevalence in the upper castes of the social hierarchy. Social causation theory states that the lower socioeconomic living condition leads to development of schizophrenia. Social drift theory proposes that lower socioeconomic status is a consequence of the disease.
76
Which of the following is associated with increased suicide rates in persons with schizophrenia?
A. Being young
B. Being male
C. Awareness of the deteriorative effects of the illness
D. Chronic illness with frequent exacerbations
E. All of the above
E. All of the above
Risk factors for suicide in schizophrenic patients include male sex, age under 30 years, being unemployed, history of depression, history of substance abuse, recent discharge from a hospital, awareness of the deteriorative effects of illness, and frequent exacerbations.
77
All of the following statements are true regarding the prevalence of schizophrenia in the two sexes EXCEPT:
A. Peak onset in men is at ages 17-25.
B. Peak onset in women is at ages 24-35.
C. Male-to-female ratio of incidence is close to 1.
D. Female schizophrenics are associated with more premorbid asocial characteristics.
E. Male schizophrenics are associated with more birth complications and cerebral structural changes.
D. Female schizophrenics are associated with more premorbid asocial characteristics.
D. Peak onset in men is at ages 17-25; peak onset in women is at age 24-35. The male-to-female ratio of incidence of schizophrenia is close to 1. Male schizophrenics are associated with more premorbid asocial characteristics.
78
```
Which of the following substances demonstrate effects that support the dopamine hypothesis of schizophrenia?
A. Cocaine
B. d-amphetamine
C. Levodopa
D. Methylphenidate
E. All of the above
```
E. All of the above
Cocaine, d-amphetamine, levodopa, and methylphenidate are all drugs that increase dopaminergic activity in the brain. All four of these drugs can lead to paranoid symptoms similar to those seen in schizophrenia.
79
A 19-year-old man was recently discharged from the hospital after treatment for acute schizophrenia. On his follow-up visit 2 weeks later, he reports having stopped taking the prescribed medication. What should be the next step in his treatment?
A. Start the patient on risperidal consta.
B. Hospitalize the patient.
C. Report him to the department of health services.
D. Inquire about side effects from neuroleptics.
E. None of the above
D. Inquire about side effects from neuroleptics.
One of the main reasons for noncompliance with antipsychotic medications is the side effects. Therefore, patients who have stopped taking their prescribed medications should be asked whether they experienced side effects with the medications.
80
```
A 72-year-old patient with over 50 years of being diagnosed with schizophrenia is observed to repeat the same words and phrases over and over again for days. What is this phenomenon called?
A. Echolalia
B. Echopraxia
C. Stilted language
D. Verbigeration
E. None of the above
```
D. Verbigeration
Verbigeration involves the senseless repetition of the same words or phrases again and again for long periods of time, sometimes even days. Echolalia involves the repetition of the examiner's words and sentences by the patient.
81
```
A 42-year-old female patient with schizophrenia stops in the middle of a sentence while being interviewed. She is not able to explain why she stopped. What is this phenomenon called?
A. Thought withdrawal
B. Thought blocking
C. Thought broadcasting
D. None of the above
```
B. Thought blocking
Thought blocking involves a sudden arrest in the train of thought. This leaves a blank and the person is not able to explain how it happened. In thought withdrawal, the person believes that someone or something took away the thought from his mind.
82
Which of the following abnormalities, if present alone without any other symptom, is sufficient for a diagnosis of schizophrenia according to DSM-IV?
A. Bizarre delusions
B. Hallucination giving a running commentary about the person's thoughts and actions
C. Auditory hallucination of two or more voices conversing with each other
D. All of the above
D. All of the above
A diagnosis of schizophrenia can be made even if only one of the following symptoms is present: bizarre delusions, auditory hallucinations giving a running commentary of the person's thoughts and actions, and two or more voices conversing with each other.
83
All of the following statements are true regarding tardive dyskinesia EXCEPT:
A. It decreases during sleep.
B. Oral-facial abnormalities are present in 75% of patients with tardive dyskinesia.
C. It is reduced by voluntary movement.
D. 20-30% of patients who have had chronic treatment with antipsychotic medications develop tardive dyskinesia.
E. It is decreased with emotional arousal.
E. It is decreased with emotional arousal.
Tardive dyskinesia (TD) involves abnormal involuntary movements of mouth, tongue, trunk, and extremities. TD develops in 20% to 30% of patients treated chronically with antipsychotic medications. TD is reduced during voluntary movement and sleep. Emotional arousal increases the movements of TD.
84
```
Plasma levels of clozapine should be above what level for an adequate response?
A. 100 ng/mL
B. 250 ng/mL
C. 450 ng/mL
D. 350 ng/mL
E. None of the above
```
D. 350 ng/mL
Patients show better response to clozapine if the plasma concentration is above 350 ng/mL.
85
Which of the following is associated with increased incidence of tardive dyskinesia?
A. Being elderly
B. Presence of affective symptoms
C. Presence of cognitive disorders
D. Sensitivity to acute extrapyramidal effects
E. All of the above
E. All of the above
Presence of affective symptoms and cognitive disorders increase the risk of developing TD. Being elderly and being sensitive to acute extrapyramidal side effects also are heightened risk factors for the development of TD.
86
```
Which of the following is the least common of the tardive syndromes associated with antipsychotic medications?
A. Tardive tics
B. Tardive myoclonus
C. Tardive akathisia
D. Tardive dyskinesia
E. Tardive dystonia
```
B. Tardive myoclonus
Tardive myoclonus is the least common and tardive dyskinesia is the most common.
87
```
Which of the following pharmacological agents is not available as a longacting intramuscular preparation for treatment of chronic schizophrenia?
A. Fluphenazine
B. Haloperidol
C. Risperidone
D. Flupenthixol
E. None of the above
```
D. Flupenthixol
Risperidone, haloperidol, and fluphenazine (Prolixin) are available as long-acting intramuscular preparations. Flupenthixol longacting preparations are not available in the United States.
88
```
Which of the following is not a good prognostic factor for delusional disorder?
A. Acute onset
B. Early age of onset
C. Absence of precipitating factors
D. Female sex
E. Being married
```
C. Absence of precipitating factors
Presence of precipitating factors is considered a good prognostic factor in addition to acute and earlier onset, being female, and being married.
89
```
Which of the following types of delusions has the best prognosis?
A. Persecutory
B. Erotomanic
C. Jealous
D. Somatic
E. Grandiose
```
A. Persecutory
90
```
Which of the following has no role in the treatment of delusional disorder?
A. Risperidone
B. Pimozide
C. Fluoxetine
D. Clozapine
E. Electroconvulsive therapy (ECT)
```
E. Electroconvulsive therapy (ECT)
Antipsychotic medications remain the preferred treatment method for delusional disorder though the response rates are low. ECT gives no benefit unless there is comorbid depression. SSRIs have been shown to reduce delusional beliefs.
91
```
Which of the following is the most common symptom in persons with delusional disorder?
A. Delusions of reference
B. Delusions of persecution
C. Somatic delusions
D. Jealous delusions
E. Delusions of grandeur
```
B. Delusions of persecution
Delusions of persecution are present in about 83% of patients with delusional order and are the most common.
92
```
For a diagnosis of delusional disorder according to DSM-IV, how long must the delusions be present?
A. 2 weeks
B. 1 week
C. 3 months
D. 1 month
E. 6 months
```
D. 1 month
For a diagnosis of delusional disorder, the delusions should be present at least 1 month. The delusions should be nonbizarre.
93
```
Which subtype of delusional disorder is also known as de Clerambault syndrome?
A. Persecutory
B. Erotomanic
C. Somatic
D. Grandiose
E. Jealous
```
B. Erotomanic
Persons with erotomania have delusions of having secret lovers. The delusion is more prevalent in women and usually involves the belief that a person of higher social standing is in love with the woman. It is also referred to as de Clerambault syndrome.
94
```
Which of the following delusional disorders responds specifically to pimozide?
A. Persecutory
B. Erotomanic
C. Somatic
D. Grandiose
E. Jealous
```
C. Somatic
Monosymptomatic hypochondriacal delusion (delusional disorder, somatic type) was reported to respond specifically to a pimozide dose of 4-8 mg/day.
95
```
Which of the following formal thought disorders is more prevalent in patients with schizophrenia?
A. Tangentiality
B. Derailment
C. Incoherence
D. Illogicality
E. Circumstantiality
```
B. Derailment
Derailment, or loose association, is present in around 45% of patients with schizophrenia and is the most common formal thought disorder in this group of patients.
96
All of the following are true regarding postpartum psychosis except
A. Occurs in approximately in 1 or 2 per 1,000 women after childbirth
B. The onset can be as early as 48 to 72 hours postpartum
C. Usually occurs within 2 to 4 weeks of treatment
D. Has a recurrence rate of less than 50% in future pregnancy
E. Has increased incidence in patients with history of bipolar disorder
D. Has a recurrence rate of less than 50% in future pregnancy
Postpartum psychosis has a recurrence rate of around 70% in future pregnancies, and postpartum depression has a recurrence rate of 50%. It occurs in 1 or 2 per 1,000 women after childbirth. Most of the episodes occur within 2 to 4 weeks after childbirth, although the psychosis can occur as early as 48 to 72 hours postpartum.
97
```
What is the rate of infanticide associated with untreated puerperal psychosis?
A. 10%
B. 2%
C. 1%
D. 4%
E. None of the above
```
D. 4%
Risk of infanticide is estimated to be as high as 4% in untreated puerperal psychosis. The rate of suicide is also very high in this group of patients. Short-term treatment with antipsychotic medication is the most appropriate treatment. ECT is a rapidly effective treatment.
98
```
Which of the following can be considered in the differential diagnosis for schizophrenia?
A. Temporal lobe epilepsy
B. Acute intermittent porphyria
C. Neurosyphilis
D. Systemic lupus erythematosus
E. All of the above
```
E. All of the above
All of the following illnesses can present with features suggestive of schizophrenia: temporal lobe epilepsy, acute intermittent porphyria, neurosyphilis, and systemic lupus erythematosus.
