Schizophrenia and Personality Disorder

Question 1

What is meant by “positive symptoms” associated with schizophrenia?

Answer 1

Presence of symptoms that most people don’t have

ex: hallucinations or delusions; disorganized speech

Question 2

What is meant by “negative symptoms” associated with schizophrenia?

Answer 2

Absence of things present in most people

ex: social withdrawal, affective flattening, lack of motivation

Question 3

Average age of schizophrenia onset in men

Answer 3

early to mid-20s

Question 4

Schizophrenia is a psychiatric disorder involving ______ and _______ psychosis

Answer 4

chronic and recurrent

Question 5

A diagnosis of schizophrenia is based on the presence of such symptoms, coupled with social and occupational dysfunction for ______ in absence of another diagnosis.

And for active psychosis

Answer 5

atleast 6 months

atleast 1 month

Question 6

How many of the following 5 criteria symptoms must be present for a diagnosis of schizophrenia?

Hallucinations
Delusions
Disorganized thinking
Disorganized behavior
Negative symptoms

Answer 6

atleast 2 lasting for atleast 1 month

Question 7

Brief psychotic disorder is diagnosed with psychosis symptoms lasting how long?

Answer 7

Less than 1 month

Question 8

Schizophreniform disorder is diagnosed with psychosis symptoms lasting how long?

Answer 8

1-6 months

Question 9

Schizophrenia is diagnosed with psychosis symptoms lasting how long?

Answer 9

6+ months of persistent disturbance with active psychosis for 1+ months

Question 10

Worldwide prevalence of schizophrenia

Answer 10

0.3%-0.9%

Question 11

What 2 types of hallucinations are most commonly seen with schizophrenia?

Answer 11

Visual & auditory

Question 12

What aspect of schizophrenia is often most responsive to antipsychotic meds?

Answer 12

Auditory hallucinations

Question 13

What is the most common type of hallucination?

Answer 13

Auditory

Question 14

What percent of patients with schizophrenia report auditory hallucinations?

Answer 14

40-80%

Question 15

Auditory hallucinations often involve what phenomena?

Answer 15

Sensations of voices, music, body noises, or machinery

Question 16

Visual hallucinations often involve what phenomena?

Answer 16

Glowing orbs, flashes of color up to people, faces, or body parts

Question 17

What percent of patients with schizophrenia report delusions?

Answer 17

> 80%

Question 18

Delusions that are clearly implausible & impossible are called

Just no way of being true

Answer 18

Bizarre delusions

Question 19

Include feelings of being touched, of sexual intercourse or of pain

Answer 19

somatic hallucinations

Question 20

Strange taste or smell is associated with what type of hallucination

Answer 20

Olfactory and gustatory hallucinations

Question 21

Delusions that are understandable and theoretically possible but are still untrue are called

Answer 21

Non-bizarre delusions

Question 22

Delusions that random or neutral events are in fact targeted and include the patient specifically are called

Answer 22

ideas/delusions of reference

Question 23

Delusions formed around the belief that the person has special significance or power are called

Answer 23

Grandiose delusions

Question 24

What is the most common type of delusion in schizophrenia?

Answer 24

Paranoid delusions

Question 25

Delusions that one is dead or doesn't exist are called

Answer 25

Nihilistic delusions

Question 26

Delusions where the patient thinks (s)he has a special or romantic relationship with someone (often a celebrity) are called

Answer 26

Erotomanic delusions

Question 27

The phenomenon where a schizophrenia patient doesn't talk or move and simply appears entranced is called

Answer 27

Catatonic behavior/catatonic state

Question 28

Does schizophrenia usually start with positive or negative symptoms?

Answer 28

negative

Question 29

Are positive or negative symptoms more responsive to treatment?

Answer 29

positive

Question 30

For what other psychiatric disorder are negative symptoms often mistaken?

Answer 30

depression

Question 31

Negtive symptoms

Answer 31

Flat affect Impairments in cognition Attention deficits Loss of excutive functioning Alogia Avolition Anhedonia Social Withdrawal

Question 32

A negative symptoms appears to cluster into two components

Answer 32

A diminished expression of symptoms cluster An avolition-apapthy cluster

Question 33

The negative symptom cluster of "diminished expression" involves what specific negative symptoms? How may those be manifest?

Answer 33

Affective flattening, manifest by: -Unchanging facies -Little spontaneous movement -Little use of expressive gestures -Poor eye contact -Poor responsiveness -Lack of vocal inflection Alogia, manifest by: -Poverty of speech -Thought blocking -Latency of response

Question 34

The negative symptom cluster of "avolition-apathy" involves what specific negative symptoms? How may those be manifest?

Answer 34

Apathy, manifest by: -Poor grooming & hygiene -Failure of role responsibilities -Anergy Asociality/anhedonia, manifest by: -Failure to engage w/ peers socially -Low interest in stimulating activities -Low interest in sex/intimacy

Question 35

In most patients, the onset of schizophrenia presentation is subtle and evolves in a ________ phase. In adolescents first presentation is with an acute episode of psychosis without ______

Answer 35

prodromal def: the interval between initial symptoms and full symptoms (same answer for both)

Question 36

Specific points to investigate in a patient's Hx related to schizophrenia suspicion include

Answer 36

Drug Hx, including: Hx of substance use Any Rx or OTC drugs Steroids Antihistamines Anticholinergics

Question 37

Schizophrenia is a _____ disorder

Answer 37

thought

Question 38

Schizoprenia risk factors

Answer 38

Genetics! Older paternal age Pregnancy or birth complications Maternal infection, malnutrition, drug use, or DM Late winter-early spring birth month Urban childhood Childhood adversity Hx of head injury Cannabis use in adolescence Immigration Hx

Question 39

Disorganized thought processes in schizophrenia often include and which are the most severe

Answer 39

Derailment (suddenly switching topics) Neologisms (new words) Word salad Tangential speech (getting further off topic) Circumstantial speech (answering a question roundabout) most severe: derailment, neologisms, word salad

Question 40

At what age should a medical explanation for psychosis be most strongly considered?

Answer 40

50 or older

Question 41

Lab testing to rule out medical conditions masquerading as schizophrenia

Answer 41

Serum & urine toxicity CMP Glucose Kidney, liver, thyroid panels Neurosyphilis Pregnancy

Question 42

What percent of schizophrenia patients have a good response to antipsychotic meds?

Answer 42

30-40%

Question 43

How long will it take for the initial response to antipsychotic meds? Significant response? Most expected response?

Answer 43

1-2 weeks 2-4 weeks by 10 weeks

Question 44

Drugs of choice for acute psychosis in ER setting

Answer 44

PO olanzapine or risperidone ± lorazepam OR IM olanzapine or ziprasidone OR Haloperidol + lorazepam

Question 45

Before starting antipsychotic Tx, what all should be assessed?

Answer 45

Baseline movement (rule out preexisting EPS) Baseline labs: -fasting glucose & HbA1C -Lipid panel -Prolactin Baseline ECG to ensure no QT prolongation

Question 46

What antipsychotics are most likely to cause QT prolongation?

Answer 46

Thioridazine Pimozide Ziprasidone

Question 47

What drug is not used for initial therpay ; it is reserevd for treatment resistant symptoms ?

Answer 47

Clozapine

Question 48

What criteria should be met before giving clozapine?

Answer 48

Failure of 2 drugs Those 2 drugs were dosed adequately Each drug was tried for 6 weeks There is evidence of adherence to each drug

Question 49

What is a serious adverse effect with Clozapine ?

Answer 49

agranulocytosis and myocarditis

Question 50

What lab should be measured before giving clozapine?

Answer 50

CBC

Question 51

EPS of Feeling restless like you cant sit still. Urge to tap your fingers, fidget, or kjiggle your legs

Answer 51

Akathisia

Question 52

EPS of Muscle contract involuntarily

Answer 52

Dystonia

Question 53

EPS of symptoms similar to Parkinsons disease. May have tremor difficulty finishing thoughts or speaking and stiff facial muscles

Answer 53

Parkinsonism

Question 54

EPS of facial movements happens involuntairly . May make a sucking or chewing motion with your mouth, stick out tongue, or blink eyes a lot

Answer 54

Tardive Dyskinesia

Question 55

Management of akathisia

Answer 55

Dose reduction followed by change of antipsychotic drug May add propranolol if needed

Question 56

Management of dystonia

Answer 56

Anticholinergic or antihistamine

Question 57

Management of Parkinsonism

Answer 57

Dose reduction/drug change Benzotropine Amantidine preferable in older patients to adverse effects of anticholenergic drugs

Question 58

Management of tardive dyskinesia

Answer 58

Dose reduction/drug change Valbenazine Deutetrabenazine Ginko

Question 59

Medical monitoring with antipsychotics

Answer 59

Monitor and record weight at 4,8,12 weeks and then quaterly Measure wasit circumference annually At 12 weeks then annually : Measure blood pressure Obtain fasting plasma glucose Obtain fasting lipid profile Monitor regularly for tardive dyskinesia EKG CBC with diff

Question 60

Which antipsychotics are least likely to cause QT prolongation?

Answer 60

Aripiprazole Lurasidone

Question 61

What drug may be added to antipsychotic therapy to prevent weight gain?

Answer 61

Metformin

Question 62

Which antipsychotics are most likely to cause prolactin elevation?

Answer 62

FGAs Risperidone

Question 63

High potency FGAs & risperidone are absolutely contraindicated in

Answer 63

Women with breast cancer

Question 64

Which antipsychotic is associated with cataracts?

Answer 64

Quetiapine

Question 65

Which antipsychotics carry the highest risk of seizures?

Answer 65

FGAs Clozapine

Question 66

Neuroleptic malignant syndrome risk factors

Answer 66

High-potency antipsychotics Parenteral administration Rapid dose escalation Use of aripiprazole, lithium, or BZDs

Question 67

Neuroleptic malignant syndrome management

Answer 67

Managment in ICU Stop antipsychotic Rx Cooling measures IV hydration + electrolyte mgmt Muscle relaxant (dantrolene or bromocryptine) BZD

Question 68

"An enduring pattern of inner experience/behavior that deviates markedly from cultural expectations, is inflexible, starts in adolescence/early adulthood, is stable over time, & leads to distress or impairment" is called

Answer 68

Personality disorder

Question 69

Cluster ___? Paranoid, schizoid, schizotypal often appear odd or eccentric

Answer 69

Cluster A personality disorder

Question 70

Cluster___? Antisocial, borderline, histrionic, narcissistic individuals who appear dramatic, emotional, or erratic

Answer 70

Cluster B personality disorder

Question 71

Cluster ___? Avoidant, dependent, obsessive-compulsive individuals who appear anxious or fearful

Answer 71

Cluster C personality disorder

Question 72

A long-standing pattern of distrust & suspiciousness is the hallmark of what personality disorder?

Answer 72

Cluster A Paranoid personality disorder

Question 73

How can paranoid personality disorder be distinguished from schizophrenia?

Answer 73

Paranoid personality disorder lacks long term psychotic symptoms

Question 74

Detachment from social relationships & exhibition of a restricted range of emotions, often appearing cold & indifferent, is the hallmark of what personality disorder?

Answer 74

Cluster A Schizoid personality disorder

Question 75

Which personality disorder displays extreme anhedonia (they are not interested in pleasure)?

Answer 75

Cluster A Schizoid personality disorder

Question 76

"Odd and eccentric" behavior, including magical thinking, odd beliefs, suspicion, paranoia, ideas of reference, or telepathic or clairvoyant experiences is the hallmark of what personality disorder?

Answer 76

Schizotypal (cluster A)

Question 77

What is the main difference between schizoid & schizotypal personality disorders?

Answer 77

Schizoid does not have paranoia or suspicion

Question 78

Disregard for others, behavior that violates others' rights, & deceit for personal gain is the hallmark of what personality disorder?

Answer 78

Antisocial (cluster B)

Question 79

Antisocial personality disorder can only be diagnosed after what age and requires what prior history?

Answer 79

After age 18; requires Hx of conduct disorder

Question 80

Instability in self-image, affect, & relationships, impulsivity, self-destructive behaviors, & intense fear of abandonment is the hallmark of what personality disorder?

Answer 80

Borderline (cluster B)

Question 81

Excessive attention-seeking and emotionalism with dramatic shows of feeling and/or sexual provocativeness is the hallmark of what personality disorder?

Answer 81

Histrionic (cluster B)

Question 82

Grandiosity, a need for admiration, & exaggerated sense of self-importance & social status is the hallmark of what personality disorder?

Answer 82

Narcissistic (cluster B)

Question 83

Excessive anxiety in social situations & intimate relationships and EXTREME hypersensitivity to what others think about them is the hallmark of what personality disorder?

Answer 83

Avoidant (cluster C)

Question 84

Pervasive and excessive need to be taken care of that leads to submissive and clinging behavior and fears of separation is the hallmark of what personality disorder?

Answer 84

Dependent (cluster C)

Question 85

Preoccupation with orderliness, perfectionism, & control and a 24/7 "laser-focus" on details & rules is the hallmark of what personality disorder?

Answer 85

Obsessive-compulsive (cluster C)

Question 86

Management of cluster A personality disorders

Answer 86

Refer; Low-dose antipsychotic may help

Question 87

Management of cluster B personality disorders

Answer 87

Refer/evaluate for prominent mood symptoms

Question 88

Management of cluster C personality disorders

Answer 88

Refer; SSRIs may help b/c anxiety/fear are usually the most dominant symptoms