Schizophrenia Sutherland

Question 1

What precedes the onset of classical psychosis?

Answer 1

Cognitive impairment

Question 2

What are the negative symptoms of shcizophrenia?

Answer 2

apathy, flat affect, withdrawal, social avoidance, poor motivation, self neglect

Question 3

What are positive symptoms of schizophrenia

Answer 3

Hallucinations (auditory >visual> other), Delusions (paranoid, nihilistic), Odd behavior

Question 4

What are top three risk factors for schizophrenia?

Answer 4

Positive family hx, perinatal complications (infxn), late winter/early spring births

Question 5

When is the onset of schizophrenia?

Answer 5

Late teens/20’s (30’s for women

Question 6

What are the most common causes of death for schizophrenia

Answer 6

90-95% of pts die of other causes other than suicide, 4-5% (up to 10) die of suicide

Question 7

What is the pathophys of schizophrenia?

Answer 7

Increased brain dopamine, loss of brain mass, loss of white matter, “neurodevelopmental” disorder

Question 8

T/F: You have an increased risk of having schizophrenia with a 1st degree relative?

Answer 8

True; 10-12x higher risk

Question 9

T/F: increased risk of schizophrenia with perinatal complications?

Answer 9

True; late winter/early spring, maternal infxns, birth complications, Rh incompatibility, nutritional deficiencies, famine

Question 10

What do drugs that increase DA do to psychosis?

Answer 10

Cause psychosis (hallucinations, paranoia, manic symptoms)

Question 11

What do drugs that decrease DA do to psychosis?

Answer 11

Reduce psychotic symptoms

Question 12

What is the mechanisms of PCP (for fun)?

Answer 12

Blocks glutamate, which increases DA and increases psychotic symptoms

Question 13

What is the effect of schizophrenia on Basal ganglia?

Answer 13

Contributes to paranoia and hallucinations. Anti-DA meds also cause motor side effects

Question 14

What is the effect of schizophrenia on frontal lobe?

Answer 14

difficulty planning actions and organizing thoughts

Question 15

What is the effect of schizophrenia on limbic system?

Answer 15

agitation

Question 16

What is the effect of schizophrenia on auditory system

Answer 16

auditory hallucinations

Question 17

What is the effect of schizophrenia on occipital lobe

Answer 17

difficulties interpreting complex images, recognizing motions, reading emotions on faces

Question 18

What is the effect of schizophrenia on hippocampus

Answer 18

difficulty learning and memory formation

Question 19

What are psychotic sx of schizophrenia?

Answer 19

delusions, hallucinations, incoherence, catatonic or hyperactive behavior, flat affect

Question 20

What are key features for schizophrenia Dx?

Answer 20

Chronic illness (>6 mos), Deterioration from previous fxn level, complex psychotic symptoms

Question 21

What should be included in a DDx of schizophrenia?

Answer 21

Other psychotic disorders, substance use disorder, general medical disorder

Question 22

What are other psychotic disorders to include on a DDx of schizophrenia?

Answer 22

Schizophreniform disorder (

Question 23

What are general medical disorders to include in a DDx of schizophrenia?

Answer 23

Metabolic and hepatic diseases, Endocrine (hypo/per thyroid), infection (neurosyphillus), Neurologic (tumor, MS), DA agonists, Heavy metal poisoning

Question 24

What are key recent history findings for schizophrenia

Answer 24

Cognitive problems, behavior problems, Positive Sx, social isolation, unable to manage complex challenges

Question 25

What are labs you can do for schizophrenia?

Answer 25

CT/MRI of head, STD screening, CBC, urine drug screen, plasma drug levels, B12 levels, Thyroids functions

Question 26

What is acute management for schizophrenia?

Answer 26

Psychiatric care, psychotherapy, outreach and case management in community, medication

Question 27

What are the antipsychotic medications for schizophrenia?

Answer 27

D2 blockers (FGA: Chlorpromazine, haloperidol, thioridazine, trifluoperazine) (SGA: Clozapine, Risperidone, Paliperidone)

Question 28

What types of Sx of schizophrenia are D2 blockers effective at treating?

Answer 28

Positive symptoms

Question 29

What are side effects of first gen antipsychotics?

Answer 29

Acute Parkinson-like symptoms, movement disorders (tardive dyskinesia, tardive dystonia), sedation, CV, GI, sexual side effects, urinary retention, weight gain

Question 30

What is the advantage of using second gen antipsychotics?

Answer 30

No Parkinson Sx or TD

Question 31

What can clozapine cause?

Answer 31

agranulocytosis

Question 32

Why are second gen antipsychotics more effective?

Answer 32

D2 blockade plus 5HT2 blockade

Question 33

What are adverse effects of second gen antipsychotics?

Answer 33

weight gain, diabetes, premature death, stroke and pneumonia in elderly

Question 34

T/F: Metabolic syndrome is a major concern with antipsychotic meds?

Answer 34

True; monitor fasting glucose, lipids, BP, waist/BMI

Question 35

When is onset of schizophrenia?

Answer 35

early adulthood after years of vague "prodromal" symptoms

Question 36

what are key Sx of schizophrenia?

Answer 36

Cognitive impairment, affective Sx, perceptual & thought disturbance, social fxn impairment

Question 37

Are more males or females affected by schizophrenai?

Answer 37

Males > females (1.4:1)