Schizophrenia

Question 1

Males are more likely than females to have these A Criteria symptoms of schizophrenia

Answer 1

negative symptoms 
(alogia, affective flattening, avolution, anhedonia)

Question 2

What are the positive symptoms of schizophrenia?

Answer 2

delusions, disorganized

thinking, and hallucinations

Question 3

If the A criteria for Schizophrenia have been met for between 1 & 6 months, the diagnosis is this

Answer 3

schizophreniform disorder

Question 4

Before diagnosing schizophrenia, exclusionary diagnoses that must
be ruled out include:
other psychotic disorders,
childhood developmental disorders, medical or neurological illness,
substance abuse or medication induced, personality disorders, & this

Answer 4

Mood disorders

Question 5

Regarding the cognitive symptoms of schizophrenia, the mnemonic SMART refers what?

Answer 5

speed, memory, attention, reasoning, and tact (social cognition)

Question 6

This A criteria negative symptom of schizophrenia is also a symptom of major depression

Answer 6

Anhedonia

Question 7

To meet DSM5’s A criteria of Schizophrenia, of the 2 symptoms 1 needs to one of the following:

Answer 7

a delusion, a hallucination, or disorganized thinking/speech

Question 8

Seen in schizophrenia (& other disorders) - stupor, waxy flexibility, mutism, negativism, stereotypy, & echolalia are motor activities that are part of a clinical picture of this

Answer 8

Catatonia

Question 9

Voices that are only heard when a patient is just waking up from sleeping are called this

Answer 9

hypnopompic hallucinations

Question 10

These symptoms of schizophrenia present early in the illness, worsen during the active periods, & do not respond well to anti-psychotic medications

Answer 10

negative symptoms (or cognitive symptoms)

Question 11

It is “proposed” that because most patients with schizophrenia have limited social contacts, only
30-40% do this

Answer 11

Get married

Question 12

What is the percentage of patients with schizophrenia who experience a single active episode?

Answer 12

10%

~30% have an intermittent course, ~60% have a chronic course

Question 13

Seen in ~85% of patients prior to the 1st psychotic episode, this negative prognostic sign lasts several months to years

Answer 13

Prodrome

Question 14

For ♂ &♀ with schizophrenia, the peak age of onset (the mode) is the same but the average age of onset is different due to what?

Answer 14

There is a 2nd smaller peak age of onset peak for females after age 40

Question 15

Patients with schizophrenia have a life expectancy that is about 25 years less than the general population primarily
due to what?

Answer 15

Cardiovascular disease

Question 16

The functional decline for a patient with schizophrenia begins during this phase of
the illness

Answer 16

The prodrome

Question 17

Due to their many problems as outlined in the B criteria, only 33% of those with schizophrenia are able to do this on July 4th

Answer 17

Live independently

Question 18

The average course of schizophrenia tends to be more severe in males than females because of this.

Answer 18

males generally develop the illness earlier

Question 19

For patients with schizophrenia, the main goal of continuous pharmacologic treatment with antipsychotics is this

Answer 19

prevent relapse into the active phase

Question 20

Decreasing the antipsychotic medication in an attempt to use the “lowest effective dose” is associated with this

Answer 20

increased risk of relapse

Question 21

The most common reason patients with schizophrenia are psychiatrically hospitalized is this

Answer 21

psychosis/active phase of illness

Question 22

Except for clozapine (Clozaril), all anti-psychotic medications are unlikely to work by 4 weeks if a patient does not show a response within this number of week(s).

Answer 22

2 weeks

Question 23

Lower doses of antipsychotics are used to treat patients with the first active phase of schizophrenia because of this

Answer 23

greater sensitivity to medication side effects

Question 24

Clozapine (Clozaril) for patients with schizophrenia and lithium for patients with bipolar disorder both have this same unique benefit

Answer 24

decreases risk of suicide

Question 25

Common indications for a clozapine (clozaril) trial include these 4 reasons:

Answer 25

- persistence of positive symptoms - failure of > 2 antipsychotic trials - co-morbid substance abuse - recurrent suicidality/violence

Question 26

In treating patients with FGA’s, often titrating the dose up until side effects emerge corresponds to blocking this percentage of dopamine receptors

Answer 26

75-80%

Question 27

In order to have the desired antipsychotic effect, medications need to block at least 65% of dopamine receptors in this pathway

Answer 27

Mesolimbic tract

Question 28

Low potency antipsychotics have common side effects of dry mouth, constipation, blurred vision, & urinary hesitancy due to this

Answer 28

anti-cholinergic activity (cholinergic blockade)

Question 29

Young males may be at higher risk than the rest of the population for this EPS side effect of muscle spasms

Answer 29

Dystonia

Question 30

Once a patient develops tardive dyskinesia, the most common course of the symptoms is this

Answer 30

Symptoms remain static/unchanged (ongoing symptoms

Question 31

While amantadine (symmetrel), lorazepam (ativan), clonidine (catapres), even mirtazepine (remeron), can be used for treating akathisia, the first choice of medication for treatment is this

Answer 31

propranolol (indural)

Question 32

Name treatments for akathisia.

Answer 32

propranolol (indural), amantadine (symmetrel), lorazepam (ativan), clonidine (catapres), mirtazepine (remeron)

Question 33

Diphenhydramine (benadryl) is used to treat EPS because of this effect

Answer 33

Benadryl is anticholinergic

Question 34

While there is still a significant risk of EPS, patients are less likely to complain of EPS symptoms from this type of FGA

Answer 34

low potency FGAs, like chlorpromazine (thorazine)

Question 35

About half of the patients with tardive dyskinesia show a 50% symptom reduction from treatment with this medication

Answer 35

clozapine (clozaril)

Question 36

50% of patients in this age are at risk of tardive dyskinesia if they FGA’s for 24 months

Answer 36

older adults/geriatrics (>70 y/o)

Question 37

``` An EPS side effect often described as a subjective sense of restlessness (the person can’t sit still) is this ```

Answer 37

akathisia

Question 38

These two SGA’s are least likely to have EPS side effects

Answer 38

clozapine (clozaril) and quetiapine (seroquel)

Question 39

This SGA has a particularly long half life and a low risk of metabolic syndrome, but is the SGA most likely to cause akathisia

Answer 39

aripiprazole (abilify)

Question 40

``` These 2 SGA’s are available in long acting injectable form but can cause dose dependent EPS & prolactin elevation ```

Answer 40

risperidone (risperdal) & palliperidone (invega)

Question 41

This SGA has a low risk of metabolic syndrome, needs to be taken with food, and is the most likely SGA to cause qTc prolongation

Answer 41

ziprasidone (geodone)

Question 42

This SGA has the highest risk of metabolic syndrome, is very sedating, and the CATIE study showed patients are highly likely to be compliant

Answer 42

olanzapine (zyprexa)

Question 43

This SGA does not require hepatic metabolism because it is an active metabolite of risperidone (risperdal)

Answer 43

paliperidone (invega)

Question 44

This SGA has almost zero risk of EPS or agranulocytosis, is often sedating & has a moderate risk of metabolic syndrome

Answer 44

quetiapine (seroquel)

Question 45

This SGA is unique since it | is a partial agonist

Answer 45

aripiprazole (abilify)

Question 46

This SGA may cause side effects of sialorrhea, weight gain, sedation, anticholinergic effects, myocarditis, and a lower seizure threshold

Answer 46

clozapine (clozaril)