Schizophrenia Jeopardy

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

Positive sx of schizophrenia are delusions, disorganized behavior, disorganized thinking, and this:

Answer 2

Hallucinations

Question 3

If the A criteria for schizophrenia have been met for between 1 and 6 months, the diagnosis is this:

Answer 3

Schizophreniform d/o

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, and this:

Answer 4

Mood disorders

Question 5

Regarding the cognitive symptoms of schizophrenia, the mnemonic SMART refers to:

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 be a delusion, a hallucination, or this

Answer 7

Disorganized speech/behavior

Question 8

Seen in schizophrenia (and other d/o’s)-stupor, waxy flexibility, mutism, negativism, stereotypy, and 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, and 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

the percentage of patients with schizophrenia who experience a single active episode is this:

Answer 12

10%

~30% intermittent course; ~60% 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 M and F with schizophrenia, the peak age of onset (the mode) is the same but the average age of onset is different because of this:

Answer 14

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 this:

Answer 15

CV disease

Question 16

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

Answer 16

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 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: persistence of positive sx, failure of > 2 antipsychotic trials, co-morbid substance abuse, and this:

Answer 25

Recurrent suicidality/violence

Question 26

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

Answer 26

75-80%

Question 27

In order to have the desired antipsychotic effect, meds 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, and urinary hesitancy due to this:

Answer 28

Anti-cholinergic activity (anti-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

Improve, worsen, or remain unchanged: ----------------------------------- Once a patient develops tardive dyskinesia, the most common course of the symptoms is this:

Answer 30

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

Antihistaminic Anticholinergic Dopaminergic ----------------------------------------- Diphenhydramine (Benadryl) is used to treat EPS because of this:

Answer 32

Anticholinergic | can also use benztropine or trihexyphenidyl

Question 33

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

Answer 33

Low potency FGAs: chlorpromazine (Thorazine)

Question 34

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

Answer 34

Clozapine (Clozaril)

Question 35

The risk of tardive dyskinesia in patients who take FGA’s for 24 months is 50% in this age group.

Answer 35

Older adults/geriatric (>70 y/o)

Question 36

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

Answer 36

Akathisia

Question 37

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

Answer 37

- Clozapine (Clozaril) | - Quetiapine (Seroquel)

Question 38

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 38

Aripiprazole (Abilify)

Question 39

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

Answer 39

- Risperidone (Risperdal) | - Palliperidone (Invega)

Question 40

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 40

Ziprasidone (Geodon)

Question 41

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 41

Olanzapine (Zyprexa)

Question 42

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

Answer 42

Paliperidone (Invega)

Question 43

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

Answer 43

Quetiapine (Seroquel)

Question 44

This SGA is unique since it is a partial agonist.

Answer 44

Aripiprazole (Abilify)

Question 45

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

Answer 45

Clozapine (Clozaril)