BB3

Question 1

What is the hallmark symptom of SCH? [1]

Answer 1

The hallmark symptom of schizophrenia is psychosis: such as experiencing auditory hallucinations (voices) and delusions (fixed false beliefs)

Question 2

Describe how you diagnose SCH

Answer 2

1) Minimum of one very clear symptom belonging to any one of the groups listed below as (a) to (d)

or

Symptoms from at least two of the groups referred to as (e) to (i):

Question 3

Describe the three types of symptoms of SCH [3]

Answer 3

Positive symptoms include delusions, hallucinations, thought disorder and catatonia (altered movement and muscle tone).

฀ Negative symptoms include apathy, affective blunting, incongruity of emotions (e.g. laughing at a funeral) and a lack of initiative and drive.

฀ Cognitive symptoms - schizophrenic patients suffer from a major information-processing deficit. Their impaired cognitive ability is reflected in poor learning, memory, attention and decision-making.

Question 4

Describe what the patient presents with in this case? [3]

Answer 4

1) auditory hallucinations: 2nd person command auditory hallucinations
2) delusions: paranoid persecutory delusional beliefs
3) isolated/social withdrawal and self-absorbed: a significant change in aspects of her personal
behaviour

Question 5

What is the biggest risk factor for developing a pysciatric disorder? [1]

Answer 5

Having a close relative with psychosis or schizophrenia is the biggest risk factor for developing a psychotic disorder.

Question 6

Name 5 genes linked to developing SCH [5]

Answer 6

COMT, DISC1, RGS4, BDNF, Neuregulin 1

Question 7

Describe environmental factors that influence SCH developement [5]

Answer 7

There is a higher risk for people born in winter months, and also after viral epidemics

excessive cannabis use in adolescence and older paternal age at birth.

stress or tiredness

Question 8

Which regions of the brain and hyperactive and hypoactive in SCH? [2]

Answer 8

It is believed that there is hyperactivity in the mesolimbic dopaminergic system (e.g. possibly due to reduced reuptake), coupled with hypoactivity in the mesocortical dopaminergic projections.

Question 9

Name 4 typical anti-pyschotics [4]

Answer 9

chlorpromazine. Other examples are: haloperidol, trifluoperazine, flupenthixol.

Question 10

State the MoA of
chlorpromazine, haloperidol, trifluoperazine, flupenthixol. [4]

Answer 10

฀ These block dopamine (D2) receptors, as well as acting as antagonists at other receptors, such as the muscarinic cholinergic, histamine H1 and α2-adrenergic receptors.

Question 11

Name two SCH drugs that can be given as slow release preperation? [2]

Answer 11

haloperidol, flupenthixol (IM)

Question 12

Name some of the AEs of first generation anti-pyschotics [4]

Answer 12

Sedation,weightgain,posturalhypotension,blurredvision,drymouthandhypothermia are typical unwanted side effects of drugs such as chlorpromazine.

Question 13

Chronic use of first generation anti-psychotics can lead to? [1]

Answer 13

tardive dyskinesia(involuntary movements of face, tongue and sometimes limbs and trunk), which can be irreversible.

Question 14

Name three atypical antipsychotics [3]

Answer 14

clozapine, olanzapine, risperidone

Question 15

olanzapine and risperidone target which receptors? [2]

Answer 15

5HT2 and D2 antagonists

Question 16

AE associated with olanzapine? [1]

Answer 16

Metabolic dysfunction: weight gain; diabetes

Question 17

What is used to treat treatment resistant SCH? [1]

Answer 17

Clozapine

Question 18

Which symptoms are atypical anti-SCH drugs good for? [2]

Answer 18

Atypical neuroleptics may also improve more her negative symptoms and her cognitive dysfunction.

Question 19

SCH patients have a high risk of..? [1]

Answer 19

Suicide: 10-15% patients die by suicide

Question 20

1. Give an example of a positive symptom and an example of a negative symptom associated with schizophrenia. (2 marks)

Answer 20

Positive symptom: delusions, hallucinations, thought disorder, disorganized behaviour.

Negative symptom: social withdrawal, apathy, emotional blunting, incongruous emotions, neglect of personal hygiene.

Question 21

2. Dysfunction in which brain area is assessed with the Wisconsin Card Sorting Test? (1 mark)

Answer 21

Frontal lobe (prefrontal cortex) (1 mark).

Question 22

3. Name the two dopaminergic systems whose imbalance is thought to occur in schizophrenic patients, and define the dysfunction in each. (1 mark)

Answer 22

The mesolimbic dopaminergic system; hyperactive (½ mark), and the mesocortical dopaminergic system; hypoactive (½ mark).

Question 23

4. Chlorpromazine is a typical neuroleptic drug. Define the class of receptors blocked by this type of drug that is responsible for the patient experiencing dry mouth and constipation. (1 mark)

Answer 23

Muscarinic cholinergic receptors (1 mark).

Question 24

5. Name two atypical antipsychotic drugs used in the treatment of schizophrenia. What 5-HT receptors do atypical neuroleptics bind to? (2 marks)

Answer 24

Olanzapine, risperidone, sulpiride, amisulpride, quetiapine, aripiprazole.
5-HT2 receptor (1 mark).

Question 25

6. What is tardive dyskinesia and how does it present? (2 marks)

Answer 25

Tardive dyskinesia is an irreversible complication of the long-term use of antipsychotic drugs (1 mark). It presents as involuntary purposeless movements of the face, tongue and/or limbs (e.g. grimacing, lip smacking, tongue protrusion or rapid eye blinking) (1 mark).

Question 26

7. What is the major adverse effect associated with the use of clozapine and what is the value of this drug in the management of schizophrenia? (1 mark)

Answer 26

Neutropenia (low white blood cell count) (½ mark).
Antipsychotic drug that is used in treatment-resistant schizophrenia (½ mark).

Question 27

Which anti-psychotics causes reduced seizure threshold? [1]

Answer 27

clozapine

Question 28

Which anti-pyschotic is generally good side-effect profile, particularly for prolactin elevation? [1]

Answer 28

aripiprazole

atypical anti-pyschotic

Question 29

Adverse effects of atypical antipsychotics? [2]
Adverse effects of typical antipsychotics? [2]

Answer 29

typical:
* Extrapyramidal side-effects (EPSEs)
* increased risk of stroke
* increased risk of venous thromboembolism
* impaired glucose tolerance

atypical:
* weight gain
* hyperprolactinaemia

Question 30

Which typical anti-psychotic causes an increased QT interval? [1]

Answer 30

Haloperidol