Schizophrenia and Psychotic Disorders -Murad

Question 1

What is the DSM IV criteria for Schizophrenia?

Answer 1

2 or more of the following:

• positive symptoms:
• Delusions
• Hallucinations
• Disorganized speech
• Disorganized/catatonic behavior
• Negative symptoms: (flat affect, anergia, withdrawal, anhedonia (no pleasure))
• Social/occupational dysfunction
• duration > 6 months
• other mental d/o excluded

Question 2

What is the difference between a hallucination and an illusion?

Answer 2

• hallucination: sensory perception without an external stimuli
• illusion: actual external stimulus that is misperceived

Question 3

What are examples of psychosis?

Answer 3

• delusions
• hallucinations
• disorganized speech
• disorganized behavior or catatonic behavior

psychosis is NOT a dx but a symptom

Question 4

What negative symptoms can be identified solely on observation?

Answer 4

reduced speech or reduced content of speech (words with little meaning)

poor grooming

limited eye contact

Question 5

The DSM IV-TR criteria for Schizophrenia include all of the following Except? 
A. prominent delusions
B. hallucinations
C. disorganized behavior or speech
D. continues signs of the disturbance

Answer 5

D. Continued signs of disturbance

Question 6

What is schizophreniform disorder?

Answer 6

all criteria for schizophrenia met except ONLY from > 1 month to < 6 months

functioning preserved

absence of blunted/flat affect

good premorbid social and occupational functioning

Question 7

Schizophrenic hallucinations are most commonly:

A	tactile
B	auditory
C	visual
D	olfactory
E	gustatory

Answer 7

B auditory

can occur in any of the senses though

Question 8

Negative symptoms of schizophrenia include all of the following except:

A	flattened affect
B	loose associations
C	avolition
D	anhedonia
E	loss of spontaneity

Answer 8

B loose associations

this is a positive symptom

Question 9

What are the different subtypes of schizophrenia?

Answer 9

• paranoid (does NOT require paranoia)
• undifferentiated
• disorganized
• residual
• catatonic

Question 10

What is the dopamine hypothesis of schizophrenia?

What effects will increased dopamine have on the mesolimbic pathway and what effect will this have on schizophrenic pts?

What effect will an decrease in dopamine have on the mesocortical pathway and what effect will this have in schizophrenic pts?

Answer 10

dopamine levels related to schizophrenia–> increased dopamine found in the amygdala of postmortem schizophrenic pts

increase in dopamine in the mesolimbic pathway can cause the positive symptoms of schizophrenia

decrease in dopamine can lead to the under activity of the mesocortical pathway–> negative, cognitive and affective symptoms of schizophrenia

Question 11

What is the effect of medication in a schizophrenic pt?

What happens with the treatment of the positive symptoms of schizophrenia?

Answer 11

medications generally establish anti-psychotic effects by blocking dopamine

the negative symptoms often become worse due to a decrease in the DA levels in the mesocortical pathway

Question 12

Regarding the Dopamine hypothesis of Schizophrenia all of the following are correct except:

A. is the most most widely accepted hypothesis
B decreased DA activity is the core deficit in Schizophrenia
C is based upon evidence from studies of D-amphetamine
D is substantiated by evidence from anti-psychotic drug studies
E D1 and D5 receptors are present in high concentrations in the cortex and striatum

Answer 12

B. decreased DA activity is the core deficit in schizophrenia

the core deficit in schizophrenia is an increase in DA

Question 13

What is delusional disorder?

Answer 13

Non-bizarre delusions (things that could potentially be real)

Criteria A schizophrenia met (+ and - s/s)

Functioning NOT impaired

Types:
Erotomanic
Grandiose
Jealous
Persecutory
Somatic
mixed

Question 14

What is brief psychotic d/o?

Answer 14

Same as Schizophrenia but < 1 month in duration

Question 15

What is the treatment for schizophrenia?

Answer 15

treat the underlying s/s

• correct dx is imperative for correct tx
• tx: symptom management!!

-normally need medication
can also use CBT for increasing Rx compliance and improving functioning

Question 16

What are some side effects of antipsychotics?

Answer 16

• acute dystonia
• akathisia
• neuroleptic malignany syndrome
• perioral tremor
• tardive dyskinesia

atypical SEs:

• metabolic syndrome (HTN, DM, hyperlipidemia)
• cardio toxicity
• elevated prolactin

Question 17

Clozapine (Clozaril) is an excellent antipsychotic because it:
A	has a low risk of agranulocytosis
B	produces almost no EPS side effects
C	starts working immediately
D	is relatively inexpensive
E	can be used as a first line drug

Answer 17

B produces almost no EPS side effects

Question 18

Schizophrenic patients are at higher risk of mortality due to all of the following except:
A increased cigarette smoking
B increased sensitivity to Rx side effects
C obesity
D diabetes
E hypertriglyceridemia

Answer 18

B increased sensitivity to the Rx side effects

Question 19

Which of the following are effective first line treatments for Schizophrenia? 
A	anti-depressant medication
B	Zydis (Zyprexa, Olanzapine)
C	Clozapine (Clozaril)
D	ECT
E	CBT alone

Answer 19

B Zyprexa, olanzapine

anti-psychotics are the first line meds

Question 20

The difference between Schizophrenia and Schizophreniform d/o is?

A delusions do not have to be present in Schizophreniform d/o
B the total duration for schizophreniform can be no longer than 6 months
C social or occupational dysfunction is only present in Schizophrenia
D major depression must be present in Schizophreniform d/o

Answer 20

B the total duration for schizophreniform can no longer be longer than 6 months