Schizophrenia_dr Mushtaq

Question 1

What are the core characteristic disturbances in schizophrenia?

Answer 1

B) Distortions of thinking, perception, and blunted or inappropriate affect

Schizophrenia involves fundamental distortions in thought, perception, and affect, while consciousness and intelligence are usually preserved.

Question 2

Who coined the term “schizophrenia”?

Answer 2

C) Eugen Bleuler

Eugen Bleuler introduced the term “schizophrenia” in 1911 to describe a split between thought, emotion, and behavior.

Question 3

What is the significance of Emil Kraepelin in the history of schizophrenia?

Answer 3

C) Described it as “dementia praecox”

Kraepelin coined the term “dementia praecox” to describe early-onset, deteriorating psychotic illness.

Question 4

Which are Bleuler’s 4 A’s of schizophrenia?

Answer 4

B) Affect, Ambivalence, Autism, Associational disturbances

Bleuler described the core features of schizophrenia as Affect disturbance, Ambivalence, Autism, and Associational disturbances.

Question 5

According to Schneider, what are First-Rank Symptoms (FRS) of schizophrenia considered to be?

Answer 5

B) Pathognomonic features unique to schizophrenia

Schneider considered hallucinations and delusions of control as pathognomonic for schizophrenia.

Question 6

What is the estimated lifetime prevalence of schizophrenia?

Answer 6

B) 1%

Approximately 1% of the global population is affected by schizophrenia.

Question 7

Which finding supports the polygenic inheritance of schizophrenia?

Answer 7

C) Risk decreases as genetic relatedness decreases

Family and twin studies show that risk decreases as genetic relatedness decreases, supporting polygenic inheritance.

Question 8

According to the dopamine hypothesis, which brain pathways are implicated in schizophrenia?

Answer 8

B) Mesocortical and mesolimbic

Hyperactivity in the mesolimbic and hypoactivity in the mesocortical pathway contribute to positive and negative symptoms.

Question 9

Which neurotransmitter’s loss of inhibitory neurons in the hippocampus has been implicated in schizophrenia?

Answer 9

B) GABA

Loss of GABAergic inhibition in the hippocampus may disinhibit dopaminergic neurons, worsening psychotic symptoms.

Question 10

Which substance mimics schizophrenia-like symptoms by antagonizing glutamate receptors?

Answer 10

C) Phencyclidine (PCP)

PCP is an NMDA receptor antagonist and can induce symptoms resembling acute psychosis.

Question 11

Which structural brain finding is common in schizophrenia on imaging?

Answer 11

B) Enlarged ventricles and hypofrontality

CT and MRI often show ventricular enlargement and reduced activity in the frontal cortex.

Question 12

What is the schizophrenia risk in monozygotic twins?

Answer 12

C) 48%

Identical twins show about a 48% concordance rate, reflecting genetic vulnerability.

Question 13

What does the double bind theory suggest?

Answer 13

B) Receiving conflicting emotional messages in early life

The double bind theory posits that repeated conflicting messages in childhood contribute to psychotic withdrawal.

Question 14

Which defense mechanism is most associated with paranoid delusions in schizophrenia?

A) Reaction formation
B) Rationalization
C) Projection
D) Sublimation

Answer 14

C) Projection

Projection involves attributing one’s own unacceptable thoughts to others and underlies paranoid thinking.

Question 15

Which brain structures show degeneration in schizophrenia?

Answer 15

B) Limbic system (amygdala, hippocampus, cingulate cortex)

Neurodegeneration is often seen in limbic structures that regulate emotion and memory.

Question 16

Which imaging finding correlates with negative symptoms in schizophrenia?

Answer 16

B) Cortical atrophy and enlarged ventricles

Enlarged ventricles and cortical thinning are associated with more severe negative symptoms.

Question 17

Which soft neurological signs are common in schizophrenia?

A) Babinski reflex and spasticity
B) Dysdiadochokinesia and grasp reflex
C) Optic disc swelling and tremors
D) Positive Kernig’s sign

Answer 17

B) Dysdiadochokinesia and grasp reflex

Soft signs such as grasp reflex and difficulty with rapid movements are frequently seen.

Question 18

What is the most common eye movement abnormality in schizophrenia?

Answer 18

D) Smooth pursuit dysfunction

Patients often show jerky, saccadic tracking due to impaired smooth pursuit.

Question 19

According to DSM-5, what happened to schizophrenia subtypes?

Answer 19

C) Eliminated due to poor reliability and validity

DSM-5 removed subtypes due to their low diagnostic utility.

Question 20

Which subtype is marked by motor immobility, waxy flexibility, echolalia, or echopraxia?

Answer 20

C) Catatonic type

Catatonic schizophrenia includes motor and speech abnormalities like echolalia and stupor.

Question 21

Which phase of schizophrenia precedes the first psychotic episode?

Answer 21

C) Prodromal phase

The prodromal phase is marked by social withdrawal, irritability, and odd interests before the onset of active psychosis.

Question 22

Which symptoms are predominant in the residual phase of schizophrenia?

Answer 22

B) Flat affect, social withdrawal, odd thinking

Residual phase features negative symptoms such as flat affect and odd behavior with no prominent positive symptoms.

Question 23

Which of the following is NOT a common differential diagnosis of schizophrenia?

A) Schizoaffective disorder
B) Delirium
C) Temporal lobe epilepsy
D) Panic disorder

Answer 23

D) Panic disorder

The major differentials listed in your lecture include:
• Organic syndromes: delirium, dementia, epilepsy
• Psychotic mood disorders
• Schizoaffective disorder
• Personality disorders

Panic disorder typically lacks psychotic features and is not a major differential diagnosis for schizophrenia.

Question 24

What percentage of schizophrenia patients commit suicide?

Answer 24

C) 10–15%

Suicide risk in schizophrenia is approximately 10–15%, especially early in the illness and in those with insight.

Question 25

Which is a poor prognostic feature in schizophrenia? A) Late onset B) Positive symptoms C) Insidious onset D) Married status

Answer 25

C) Insidious onset ## Footnote Insidious onset is associated with a more chronic course and poor response to treatment.

Question 26

Which is a good prognostic indicator in schizophrenia? A) Being male B) Early age of onset C) Presence of mood symptoms D) Long duration of untreated psychosis

Answer 26

C) Presence of mood symptoms ## Footnote Mood symptoms are associated with a better response to antipsychotic treatment and improved prognosis.

Question 27

Which antipsychotic is a partial D2 and 5-HT1A agonist?

Answer 27

C) Aripiprazole ## Footnote Aripiprazole acts as a partial agonist at D2 and 5-HT1A receptors and an antagonist at 5-HT2A.

Question 28

Which atypical antipsychotic is most associated with weight gain and metabolic syndrome?

Answer 28

B) Clozapine ## Footnote Clozapine has the highest risk of weight gain, dyslipidemia, and insulin resistance among antipsychotics.

Question 29

What is tardive dyskinesia?

Answer 29

C) A late-onset involuntary movement disorder ## Footnote Tardive dyskinesia is a late-onset side effect of chronic antipsychotic use, often involving facial movements.

Question 30

What is the preferred antipsychotic for treatment-resistant schizophrenia?

Answer 30

D) Clozapine ## Footnote Clozapine is the gold standard for treatment-resistant schizophrenia, effective even when other antipsychotics fail.

Question 31

Which antipsychotic is most associated with hyperprolactinemia?

Answer 31

B) Risperidone ## Footnote Risperidone strongly blocks D2 receptors in the tuberoinfundibular pathway, elevating prolactin levels.

Question 32

Which second-generation antipsychotic is most sedating? A) Olanzapine B) Clozapine C) Risperidone D) Quetiapine

Answer 32

B) Clozapine ## Footnote Clozapine is highly sedating due to its potent antihistaminic and anticholinergic effects.

Question 33

Which antipsychotic requires ECG monitoring due to QT prolongation? A) Quetiapine B) Clozapine C) Ziprasidone D) Olanzapine

Answer 33

C) Ziprasidone ## Footnote Ziprasidone is associated with QT prolongation and should be used with caution in patients with cardiac risk.

Question 34

Which extrapyramidal symptom is characterized by inner restlessness?

Answer 34

C) Akathisia ## Footnote Akathisia is a subjective feeling of restlessness often seen with antipsychotic treatment, particularly early in therapy.

Question 35

Which lab tests are needed before starting antipsychotics?

Answer 35

C) CBC, electrolytes, LFTs, RFTs, ECG, lipid, thyroid, urine drug screen ## Footnote A full metabolic and cardiac workup is required before initiating antipsychotic treatment.

Question 36

Which antipsychotic requires regular CBC monitoring for agranulocytosis?

Answer 36

B) Clozapine ## Footnote Clozapine carries a risk of agranulocytosis and requires regular monitoring of the absolute neutrophil count (ANC).

Question 37

Which antipsychotic has the least sedating and weight-gaining profile? A) Aripiprazole B) Risperidone C) Clozapine D) Ziprasidone

Answer 37

C) Ziprasidone ## Footnote Ziprasidone has minimal weight gain and sedation but must be monitored for QT prolongation.

Question 38

Which antipsychotic has the highest risk of EPS?

Answer 38

A) Haloperidol ## Footnote Haloperidol is a high-potency typical antipsychotic with a strong risk of extrapyramidal side effects.

Question 39

Which movement disorder develops after long-term antipsychotic use?

Answer 39

B) Tardive dyskinesia ## Footnote Tardive dyskinesia is a delayed, often irreversible side effect involving repetitive facial movements.

Question 40

What is the strongest predictor of long-term functional outcome in schizophrenia? A) Severity of positive symptoms B) Duration of antipsychotic use C) Cognitive function and negative symptoms D) Use of atypical antipsychotics

Answer 40

C) Cognitive function and negative symptoms ## Footnote Cognitive impairment and negative symptoms are the strongest predictors of poor social and occupational functioning.

Question 41

What is required in DSM-5 for schizophrenia diagnosis under Criterion A? A) At least 1 symptom for 1 month B) 3 symptoms for 1 week C) 2 symptoms for 1 month, 1 must be delusions, hallucinations, or disorganized speech D) 4 symptoms for 6 months

Answer 41

C) 2 symptoms for 1 month, 1 must be delusions, hallucinations, or disorganized speech ## Footnote DSM-5 requires two or more symptoms for 1 month, one of which must be delusions, hallucinations, or disorganized speech.

Question 42

What is the minimum duration of illness for a schizophrenia diagnosis (DSM-5)?

Answer 42

C) 6 months ## Footnote The total disturbance (including prodromal and residual phases) must last at least 6 months.

Question 43

Which removed subtype had disorganized speech, behavior, and affect?

Answer 43

C) Disorganized ## Footnote The disorganized type was marked by prominent disorganized speech, behavior, and affect.

Question 44

Which removed subtype fit no specific category but met general schizophrenia criteria? A) Residual B) Undifferentiated C) Catatonic D) Paranoid

Answer 44

B) Undifferentiated ## Footnote The undifferentiated type was a default classification for patients who met general criteria but lacked defining features.

Question 45

Which subtype had persistent negative or attenuated positive symptoms?

Answer 45

B) Residual ## Footnote Residual type included patients with ongoing negative symptoms after positive symptoms had subsided.

Question 46

Which is a known environmental risk factor for schizophrenia?

Answer 46

C) Low SES and urban upbringing Urban birth or upbringing • Low socioeconomic status • Substance abuse (especially cannabis) • Birth complications (e.g., hypoxia) • Winter or early spring birth • Advanced paternal age • Maternal infections or malnutrition during pregnancy

Question 47

Which patient feature predicts poor outcome in schizophrenia?

Answer 47

C) Poor premorbid psychosocial adjustment Other poor prognostic features include: • Male gender • Early age of onset • Negative symptoms • Insidious onset • Social isolation • Poor treatment adherence

Question 48

Which patient group has the highest suicide risk in schizophrenia? A) Elderly female with chronic symptoms B) Adolescent male with early insight into illness C) Male patient with chronic catatonia D) Patient with prominent negative symptoms

Answer 48

B) Young males with early insight . Highest suicide risk is seen in: • Young males • Especially in the early stages of the illness • Who have preserved insight and recognize the impact of their condition

Question 49

What percentage of patients achieve complete recovery from schizophrenia?

Answer 49

B) 20% ## Footnote About 20% achieve full remission with no persistent symptoms.

Question 50

Which symptom domain best predicts long-term disability in schizophrenia?

Answer 50

C) Cognitive function and negative symptoms These are the strongest predictors of long-term functional outcomes in schizophrenia, including: • Social functioning • Occupational performance • Independent living Positive symptoms (e.g., hallucinations, delusions) often respond well to treatment, but cognitive deficits and negative symptoms (e.g., avolition, alogia, affective flattening) are more persistent and disabling.