Schizophrenia

Question 1

Schizophrenia is a type of psychosis. This means the person may not always be able to distinguish their own thoughts and ideas from reality. Symptoms of schizophrenia can include: hallucinations – hearing or seeing things that do not exist outside of the mind. What is the prevalence of schizophrenia?

1 - 4 / 1000
2 - 20 / 1000
3 - 100 / 1000
4 - 1000 / 1000

Answer 1

1 - 4 / 1000

Question 2

What is the lifetime risk of developing schizophrenia?

1 - 1 / 1000
2 - 10 / 1000
3 - 100 / 1000
4 - 1000 / 1000

Answer 2

2 - 10 / 1000

• higher in deprived areas

Question 3

What age does the incidence of Schizophrenia peak at?

1 - 16-25
2 - 30-40
3 - 50-65
4 - >65

Answer 3

2 - 30-40

Question 4

Does Schizophrenia affect men or women more?

Answer 4

• Men

Roughly 1.4:1 ratio

Question 5

What is the estimated genetic contribution to developing Schizophrenia, as shown in twin studies?

1 - 5%
2 - 20%
3 - 30%
4 - 80%

Answer 5

4 - 80%

Question 6

Although there are lots of theories associated with Schizophrenia, which is the main neurotransmitter that has been linked to causing it?

1 - glutamate
2 - dopamine
3 - GABA
4 - serotonin

Answer 6

2 - dopamine

Heavily involved in mesolimbic pathway (MLP)

Hypoactivity in MLP = negative symptoms
Hyperactivity = positive symptoms

Question 7

In Schizophrenia, which 2 of the following have been shown in patients following head MRIs?

1 - reduced grey matter
2 - reduced white matter
3 - reduced ventral size
4 - increased ventral size

Answer 7

1 - reduced grey matter
4 - increased ventral size

Abnormalities in these has been linked with Schizophrenia

Grey mater = neuronal cell bodies
White mater = myelinated axons

Question 8

Patients with psychosis can experience hallucinations. What are hallucinations?

1 - patient is able to sense (hear, smell, taste etc) something that doesn’t exist, but no external stimulus
2 - patient has false and fixed belief that doesn’t keep with non social grounding
3 - loses touch with social surroundings like not there but looking from outside through glass
4 - loses touch with social surrounding and no longer interacts with society

Answer 8

1 - patient is able to sense (hear, smell, taste etc) something that doesn’t exist, but no external stimulus

Question 9

What does it mean when a patient has insight into psychosis?

Answer 9

• they are aware of their condition
• they are aware what is happening (voices etc) are abnormal
• do they think their condition requires treatment

Question 10

What is schizophrenia?

1 - scattered/fragmented thinking
2 - reclusive thinking
3 - hearing voices
4 - manic episodes

Answer 10

1 - scattered/fragmented thinking

• disorganised thinking presents as thought disorder
• located on the spectrum of psychosis
• patient may not always be able to distinguish their own thoughts and ideas from reality

Question 11

In clinical practice symptoms of schizophrenia (and psychosis) are often grouped into 3 categories. Which of the following is NOT one of these categories?

1 - neutral
2 - positive
3 - negative
4 - cognitive

Answer 11

1 - neutral

Question 12

In clinical practice symptoms of schizophrenia (and psychosis) are often grouped into 3 categories: positive, negative symptoms and cognitive symptoms. Which of the following is NOT a positive symptoms?

1 - hallucinations
2 - delusions
3 - disordered thoughts
4 - flat affect

Answer 12

4 - flat affect

Question 13

In clinical practice symptoms of schizophrenia (and psychosis) are often grouped into 3 categories: positive, negative symptoms and cognitive symptoms. Which of the following is NOT a negative symptom?

1 - flat affect
2 - poor motivation
3 - loss of social skills
4 - thought input
5 - poverty of thought

Answer 13

4 - thought input

Question 14

In clinical practice symptoms of schizophrenia (and psychosis) are often grouped into 3 categories: positive, negative symptoms and cognitive symptoms. Which of the following is NOT a cognitive symptom?

1 - poor attention
2 - poor memory
3 - poor planning ability
4 - inability to speak

Answer 14

4 - inability to speak

Question 15

To be diagnosed with schizophrenia, according to the ICD-11 criteria, how long do symptoms need to be present for before a diagnosis can be made?

1 - 1 day
2 - 1 week
3 - 1 month
4 - 1 year

Answer 15

3 - 1 month

Question 16

In a patient with suspected schizophrenia, how many of the following must be present

• hallucinations (perceptions)
• delusions (thoughts)
• disorganised thinking
• experience influence over their own control and influence

1 - all of them
2 - >3
3 - >2
4 - >1

Answer 16

• > 1 must be present
• also need 1 of the following:

e) Negative symptoms
f) Grossly disorganized behaviour
g) Psychomotor disturbances such as

Question 17

What is a delusion?

1 - patient is able to sense (hear, smell, taste etc) something that doesn’t exist, but no external stimulus
2 - patient has false and fixed belief that doesn’t keep with non social grounding
3 - loses touch with social surroundings like not there but looking from outside through glass
4 - loses touch with social surrounding and no longer interacts with society

Answer 17

2 - patient has false and fixed belief that doesn’t keep with non social grounding

Question 18

What is the difference between hallucinations vs delusions?

Answer 18

• BOTH are part of a false reality
• hallucination = sensory perception
• delusion = false belief

Question 19

Schizophrenia is a form of psychosis, where a patient may not always be able to distinguish their own thoughts and ideas from reality. Hallucinations are common, where there is no external stimulus, but the patient experiences the sensory stimulus in their own minds. What is the most common sensory hallucination in schizophrenia?

1 - visual
2 - auditory
3 - smell
4 - touch

Answer 19

2 - auditory hallucinations
- 60-70% of schizophrenia experience them

Question 20

Schizophrenia is a form of psychosis, where a patient may not always be able to distinguish their own thoughts and ideas from reality. Patients commonly experience auditory hallucinations (MOST COMMON), for which there is no external stimulus. In patients with schizophrenia, what % experience auditory hallucinations?

1 - 15-25%
2 - 35-55%
3 - 60-70%
4 >85%

Answer 20

3 - 60-70%

Question 21

What is the difference between affect and mood?

Answer 21

• affect = a visible short term reaction like the daily changes in weather
• mood = is a state of unconscious feeling, long term like the climate

Question 22

Schizophrenia is when a patient has psychotic episodes for >6 months or has re-occurring episodes of psychosis where the patient feels at an interpersonal loss. Is schizophrenia generally diagnosed early or late in age?

1 - early 18-35 years olds
2 - early 15-30 year olds
3 - older 40-60 years old
4 - older >65 years old

Answer 22

1 - early 18-35 years olds

Question 23

What % of patients with schizophrenia commit suicide?

1 - 10%
2 - 30%
3 - 50%
4 - 70%

Answer 23

1 - 10%

Question 24

What % of patients with schizophrenia will have a complete recovery?

1 - 2%
2 - 20%
3 - 50%
4 - all patients

Answer 24

2 - 20%

• 50% will remain with some deficits

Question 25

Dopamine is involved in inhibitory and excitatory pathways in the brain. One of the those pathways is the mesolimbic pathway. The pathway begins at the ventral tegmental area and ends at the nucleus accumbens, striatum. What is the main function of this pathway? 1 - reward and salience 2 - regulates prefrontal cortex 3 - regulates the HPA axis 4 - regulates the basal ganglia

Answer 25

1 - reward and salience - regulates limbic (behaviour and emotion) system - rewards = pleasure - salience = threat evaluation

Question 26

Dopamine is involved in inhibitory and excitatory pathways in the brain. One of the those pathways is the mesolimbic pathway. The pathway begins at the ventral tegmental area and ends at the nucleus accumbens, striatum. The main function of this pathway is the regulation of the limbic (behaviour and emotion) system, specifically rewards = pleasure, and salience = threat evaluation. In psychosis what happens to this pathway? 1 - increases salience 2 - increases reward stimulus 3 - inhibits salience 4 - inhibits reward stimulus

Answer 26

1 - increases salience - patients can believe they are under threat due to hyperactivty

Question 27

Dopamine is involved in inhibitory and excitatory pathways in the brain. One of the those pathways is the mesolimbic pathway. The pathway begins at the ventral tegmental area and ends at the nucleus accumbens, striatum. The main function of this pathway is the regulation of the limbic (behaviour and emotion) system, specifically rewards = pleasure, and salience = threat evaluation. In psychosis the salience (threat evaluation) aspect of this pathway becomes hyperactive. What is the aim of drugs in treating this pathway in psychosis? 1 - increases salience 2 - increases reward stimulus 3 - inhibits salience 4 - inhibits reward stimulus

Answer 27

2 - increases reward stimulus - increases feelings of pleasure

Question 28

All antipsychotic drugs target which neurotransmitter system? 1 - dopamine 2 - glutamate 3 - serotonin 4 - GABA

Answer 28

1 - dopamine - all are post-synaptic antagonists

Question 29

If a patient is becoming aggressive and cannot be calmed, which class of drug can be used at the lowest possible dose? 1 - NSAIDs 2 - anti-convulsant 3 - anti-emetic 4 - benzodiazepine

Answer 29

4 - benzodiazepine

Question 30

Which of the following is NOT a core atypical (2nd generation) l anti-psychotic medication we need to be aware of? 1 - Haloperidol 2 - Clozapine 3 - Risperidone 4 - Lurasidone 5 - Olanzapine 6 - Paliperidone 7 - Quetiapine 8 - Aripiprazole

Answer 30

1 - Haloperidol

Question 31

Which of the following is NOT a core typical (1st generation) anti-psychotic medication we need to be aware of? 1 - Haloperidol 2 - Clozapine 3 - Chlorpromazine 4 - none of the above

Answer 31

2 - Clozapine

Question 32

A patient should be tried on at least 2 different anti-psychotics (at least 6 weeks each) before being categorised a treatment resistant. Which is the only anti-psychotic that has been shown to be affective against treatment resistance? 1 - Haloperidol 2 - Clozapine 3 - Chlorpromazine 4 - Olanzapine

Answer 32

2 - Clozapine - 1 of the 2 anti-psychotics tried, must have been an aytipcal

Question 33

If a patient is reluctant to take their medication, what can be done to make sure their medication is adhered to? 1 - suppository 2 - force feed 3 - depot injection 4 - mixed with food and water

Answer 33

3 - depot injection - same adverse events and can be long acting - improve compliance

Question 34

Atypical drugs, also known as second generation drugs mean are newer drugs that offer the same anti-psychotic effects (both positive and negative symptoms improved), BUT do not have normal neurological side effects, BUT can cause metabolic and CVD side effects. They do not cause the same side effects as typical drugs as they do not bind to the post-synaptic receptors as long. They also have a secondary function that is able to increase dopamine release that typical drugs do not posses. What is this? 1 - bind serotonin receptors on post synapse increasing dopamine release 2 - bind serotonin receptors on pre synapse inhibiting dopamine breakdown

Answer 34

1 - bind serotonin receptors on post synapse increasing dopamine release - binding serotonin receptors increases dopamine release from the pre-synaptic membrane and the neurological side effects

Question 35

Of all the anti-psychotic drugs, which is the most effective? 1 - Aripiprazole 2 - Clozapine 3 - Chlorpromazine 4 - Haloperidol

Answer 35

2 - Clozapine - BUT generally last line drug treatment

Question 36

Of all the anti-psychotic drugs, clozapine is an atypical drug the most effective. Which 2 neurotransmitter receptors does this drug act on? 1 - dopamine and glutamate 2 - dopamine and serotonin 3 - dopamine and GABA 4 - dopamine and acetylcholine

Answer 36

2 - dopamine and serotonin - serotonin (pre synapse) = increase dopamine release - dopamine (post synapse) = decrease dopamine binding

Question 37

If a patient does not want to be admitted to hospital, but needs to be admitted to hospital for psychiatric admission, which part of the mental health act would be suitable? 1 - section 7 2 - section 2 3 - section 28 4 - section 14

Answer 37

2 - Section 2 - patients can be admitted for a period of up to 28 days for a period of assessment and treatment

Question 38

Aripiprazole is a core anti-psychotic drug that is first line treatment for psychosis. What is the mechanism of action of Aripiprazole? 1 - agonist of dopaminergic receptors and antagonist of serotonin receptors 2 - antagonist of dopaminergic receptors and antagonist of serotonin receptors 3 - partial agonist of dopaminergic receptors and agonist of serotonin receptors 4 - partial agonist of dopaminergic receptors and antagonist of serotonin receptors

Answer 38

4 - partial agonist of dopaminergic receptors and antagonist of serotonin receptors - antagonist of serotonin receptors causes increased dopamine release - partial agonist of dopaminergic receptors modulates dopamine binding post-synaptically