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PSY7 Schizophrenia

Deleted user 23 questions Updated 14 Oct 2019

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Questions in this quiz (23)

1Which of these is not a disorder in which psychosis is defined?
1. APsychotic disorder due to a general medical condition
2. BSubstance-induced psychotic disorder
3. CSchizophrenia
4. DSchizoaffective disorder
5. EDelusional disorder
6. FBipolar
2Schizophrenia:
~ [blank_start]1[blank_end] % of population, psychotic illness, mostly [blank_start]young[blank_end] people, [blank_start]chronic[blank_end] (regular/irregular psychotic episodes), lifelong and highly disabling.

Positive and negative symptoms:
- A positive symptom is one that [blank_start]adds[blank_end] a behavior, thought or feeling. Positive symptoms associated with schizophrenia also occur in other disorders such as [blank_start]bipolar[blank_end], psychotic depression, and [blank_start]Alzheimer[blank_end]'s. Positive symptoms are – [blank_start]delusions[blank_end] (paranoid), hallucinations, thought [blank_start]disordered[blank_end], other abnormal behaviors e.g. aggression.
- Negative symptoms [blank_start]take away[blank_end] a behavior, thought or feeling. Negative symptoms – flattened [blank_start]emotional[blank_end] response, social [blank_start]withdrawal[blank_end], apathy, anhedonia.

Cognitive symptoms:
- [blank_start]Executive dysfunction[blank_end] - poor methodical planning in brain makes basic tasks difficult
- Difficulty representing and maintaining [blank_start]goals[blank_end], allocating [blank_start]attention[blank_end], evaluating/monitoring performance
- Impaired [blank_start]verbal[blank_end] fluency
These are the best predictor of outcome.
1. A1
2. Byoung
3. Cchronic
4. Dadds
5. Ebipolar
6. FAlzheimer
7. Gdelusions
8. Hdisordered
9. Itake away
10. Jemotional
11. Kwithdrawal
12. LExecutive dysfunction
13. Mgoals
14. Nattention
15. Overbal
3Burden of illness
• 25-50% attempt suicide and [blank_start]10[blank_end]% eventually succeed
• Mortality rate 8 times higher than general population due to high rate of [blank_start]CV disease, suicide[blank_end] etc,
• Life expectancy [blank_start]25-30[blank_end] years shorter than the general population
• Patients - early onset, intellectual [blank_start]development[blank_end], relationships, risk of suicide, stigma, self treatment: [blank_start]drugs, alcohol and smoking[blank_end]
• Family/Care Giver - stressors, financial [blank_start]cost[blank_end], pressure on [blank_start]relationships[blank_end]
• Community – healthcare, economic, stigma
• Duration of [blank_start]untreated psychosis[blank_end] (DUP) has major impact on outcomes
1. A10
2. BCV disease, suicide
3. C25-30
4. Ddevelopment
5. Edrugs, alcohol and smoking
6. Fcost
7. Grelationships
8. Huntreated psychosis
4Early symptoms indicating the onset of schizophrenia:
• Worrisome drop in [blank_start]grades or job performance[blank_end]
• New trouble [blank_start]thinking clearly or concentrating[blank_end]
• Suspiciousness, [blank_start]paranoid[blank_end] ideas or uneasiness with others
• Withdrawing socially, spending a lot more time [blank_start]alone[blank_end] than usual
• Unusual, overly intense new [blank_start]ideas[blank_end], strange feelings or having [blank_start]no[blank_end] feelings at all
• Decline in [blank_start]self-care or personal hygiene[blank_end]
• Difficulty telling reality from fantasy
• Confused [blank_start]speech[blank_end] or trouble communicating
1. Agrades or job performance
2. Bthinking clearly or concentrating
3. Cparanoid
4. Dalone
5. Eno
6. Fideas
7. Gself-care or personal hygiene
8. Hspeech
5Match the symptoms to the region:
Positive symptoms - [blank_start]mesolimbic pathway[blank_end]
Affective symptoms (anxiety, suicidality) - [blank_start]ventromedial prefrontal cortex[blank_end]
Aggressive symptoms - [blank_start]orbitofrontal cortex, amygdala[blank_end]
Cognitive symptoms - [blank_start]dorsolateral prefrontal cortex[blank_end]
Negative symptoms - [blank_start]mesocortical pathway, prefrontal cortex[blank_end]
1. Amesolimbic pathway
2. Bventromedial prefrontal cortex
3. Corbitofrontal cortex, amygdala
4. Ddorsolateral prefrontal cortex
5. Emesocortical pathway, prefrontal cortex
6Diagnosis
• Based on patient and often family [blank_start]interviews[blank_end] following presentation of first psychotic episode
• Clinical status/rating determined using psychiatric examination with [blank_start]Positive and Negative Symptom Score[blank_end] (PANSS) and Clinical Global Impression scales (CGI) - commonly use Diagnostics and Statistics Manual (DSM-V) or ICD-11
• Also use At Risk Mental State (ARMS) Brief Psychiatric Scale (BPS)
• [blank_start]Psychosis[blank_end] not otherwise specified often in patient notes due to [blank_start]stigma[blank_end] associated with the term schizophrenia
1. Ainterviews
2. BPositive and Negative Symptom Score
3. CPsychosis
4. Dstigma
7Five dopaminergic pathways:
a) [blank_start]Nigrostriatal[blank_end] – controls motor function/movement
b) [blank_start]Mesolimbic[blank_end] - pleasurable sensations, euphoria & delusions/hallucinations (positive sypmtoms)
c) [blank_start]Mesocortical[blank_end] - mediates cognition and affect (and negative symptoms)
d) [blank_start]Tuberoinfundibular[blank_end] - prolactin secretion
e) there's another one he didn't tell us it's name i don't think it's important??
1. ANigrostriatal
2. BMesolimbic
3. CMesocortical
4. DTuberoinfundibular
8Schizophrenia - the [blank_start]Integrated[blank_end] Dopamine Hypothesis.
Majority of symptoms explained by dysregulation of dopaminergic pathways:
- [blank_start]High[blank_end] activity of mesolimbic pathway explains pos symptoms
- [blank_start]Low[blank_end] activity of mesocortical pathways explains cog, aff, neg symptoms
- [blank_start]Normal[blank_end] activity of nigrostriatal and tuberoinfundibular
1. AIntegrated
2. BHigh
3. CLow
4. DNormal
9Order these drugs from lowest affinity for D2 Rs (low potency, to highest affinity for D2 Rs (high potency); low being 1 and high being 4.
1. [blank_start]Haloperidol[blank_end]
2. [blank_start]Prochlorperazine[blank_end]
3. [blank_start]Clozapine[blank_end]
4. [blank_start]Chlorpromazine[blank_end]
1. AHaloperidol
2. BProchlorperazine
3. CClozapine
4. DChlorpromazine
10NMDA receptor hypofunction hypothesis:

There are NMDA receptors in the brain. NMDA receptors in the [blank_start]cortical brainstem[blank_end] have glutamate projections. A glutamate projection is a [blank_start]descending[blank_end] pathway that uses glutamate, an [blank_start]excitatory[blank_end] neurotransmitter. Schizophrenia may be caused by [blank_start]low[blank_end] activity in these glutamate projections.
When the glutamate projections are [blank_start]hypo[blank_end]-active, downstream [blank_start]inhibition[blank_end] of the mesolimbic DA pathway does [blank_start]not[blank_end] occur, meaning the [blank_start]mesolimbic[blank_end] DA pathway is [blank_start]hyperactive[blank_end]. This causes positive symptoms.
Also low [blank_start]activity[blank_end] of the excitatory NT glutamate means [blank_start]tonic excitation is lost[blank_end], and [blank_start]mesocortical[blank_end] DA pathways become [blank_start]hypoactive[blank_end]. This may cause the cognitive, negative, and affective symptoms.

TLDR; Low activity of [blank_start]NMDR receptors[blank_end] in the [blank_start]brainstem[blank_end] causes low activity of [blank_start]glutamate[blank_end] in connected pathways, causing high activity in the [blank_start]mesolimbic pathway[blank_end] and low activity in the [blank_start]mesocortical pathways[blank_end].
1. Acortical brainstem
2. Bdescending
3. Cexcitatory
4. Dlow
5. Ehypo
6. Finhibition
7. Gnot
8. Hmesolimbic
9. Ihyperactive
10. Jactivity
11. Ktonic excitation is lost
12. Lmesocortical
13. Mhypoactive
14. NNMDR receptors
15. Obrainstem
16. Pglutamate
17. Qmesolimbic pathway
18. Rmesocortical pathways

11Therapy - Antipsychotics
• Note that DA [blank_start]agonists[blank_end] (e.g. methamphetamine) can produce behavioural phenomenon indistinguishable from acute schizophrenia, so this supports the dopamine [blank_start]overactivity[blank_end] hypothesis
• Nearly all antipsychotics are [blank_start]D2 antagonists[blank_end] but some also block [blank_start]5-HT2A[blank_end] to varying degrees
• Potency correlates with [blank_start]activity[blank_end] at D2 receptors - not but dose [blank_start]not[blank_end] correlate effectiveness.
• “Typicals” are [blank_start]less[blank_end] effective at treating [blank_start]negative[blank_end] symptoms vs “atypicals”
• Days/weeks/months to work suggests [blank_start]secondary[blank_end] effects e.g. [blank_start]↑ D2 receptors in limbic structures[blank_end]
1. Aagonists
2. Boveractivity
3. CD2 antagonists
4. D5-HT2A
5. Eactivity
6. Fnot
7. Gnegative
8. Hsecondary
9. I↑ D2 receptors in limbic structures
10. Jless
12“Typical” antipsychotics – D2 antagonists - and how they affect the dopaminergic pathways:
1. Mesolimbic - reduces to [blank_start]normal[blank_end] activity, stopping positive symptoms and the [blank_start]pleasure/reward[blank_end] response.
2. Mesocortical - still low activity
3. Nigrostriatal - reduced to [blank_start]low[blank_end] activity, explains [blank_start]parkinsonian[blank_end] side effects
4. Tuberoinfundibular - [blank_start]reduced[blank_end] to low activity, explains elevated [blank_start]prolactin[blank_end]
1. Anormal
2. Bpleasure/reward
3. Clow
4. Dparkinsonian
5. Ereduced
6. Fprolactin
13‘Typicals’ aka ‘First generation antipsychotic’ side effects:
- Extrapyramidal side effects – direct block of nigrostriatal DA receptors
• [blank_start]Dystonia[blank_end] - Muscle spasm within hours, can be fatal
• [blank_start]Akathisia[blank_end] - subjective tension & need to move, objective restlessness, distress
• Pseudo-Parkinsonism - [blank_start]rigidity, tremor, bradykinesia,[blank_end] gait disturbance
• Tardive Dyskinesia - [blank_start]abnormal involuntary[blank_end] movements, reversible?
- Dry [blank_start]mouth[blank_end], blurred [blank_start]vision[blank_end], constipation, weight [blank_start]gain[blank_end], sedative, [blank_start]QT[blank_end]-prolongation, dyscrasia’s, postural [blank_start]hypotension[blank_end], elevated prolactin
- Sexual [blank_start]dysfunction[blank_end] common with both typical and ‘atypicals’

Role in current treatment - history of [blank_start]good[blank_end] response, [blank_start]range[blank_end] of depots, good for [blank_start]acute[blank_end] management e.g. chlorpromazine, haloperidol, zuclopenthixol, fluphenazine.
1. ADystonia
2. BAkathisia
3. Crigidity, tremor, bradykinesia,
4. Dabnormal involuntary
5. Emouth
6. Fvision
7. Ggain
8. HQT
9. Ihypotension
10. Jdysfunction
11. Krange
12. Lgood
13. Macute
14“Atypical” antipsychotics
• D2 antagonists AND [blank_start]5-HT2A antagonism[blank_end] - defining property of ‘atypicals’
• Critically, [blank_start]less[blank_end] likely to induce dystonia/akathisia/[blank_start]Parkinsonism[blank_end] in the antipsychotic naïve
• Reduced [blank_start]negative[blank_end] symptoms in contrast to the ‘typicals’- debatable?
• Perceived side effects [blank_start]less common[blank_end] with atypicals? e.g. olanzapine, risperidone etc.
• Metabolic syndrome - weight [blank_start]gain[blank_end], elevated [blank_start]lipids[blank_end], insulin [blank_start]resistance[blank_end], diabetes
• Less effect on prolactin - except [blank_start]risperidone[blank_end]
• ~ 30-50% of all patients are treatment-resistant to varying degrees and need [blank_start]clozapine[blank_end]
1. A5-HT2A antagonism
2. Bless
3. CParkinsonism
4. Dnegative
5. Eless common
6. Fgain
7. Glipids
8. Hresistance
9. Irisperidone
10. Jclozapine
15Antipsychotic antagonism of WHICH RECEPTORS is associated with weight gain?
1. A5-HT2c & H1
2. B5-HT2c & H2
3. C5-HT1a & H1
4. D5-HT1a & H2
16Antipsychotic M3 antagonism impairs:
1. Ainsulin regulation
2. Bprolactin regulation
17Which of these drugs is MOST likely to cause hypotension?
1. AChlorpromazine
2. BHaloperidol
3. CQuetiapine
18Which 2 drugs are the most sedating?
1. AChlorpromazine, Clozapine
2. BClozapine, Olanzapine
3. COlanzapine, Zuclopenthixol
19Which 3 drugs are most likely to cause extra-pyrimidal SEs?
1. AZuclopenthixol, Haloperidol, Chlorpromazine
2. BChlorpromazine, Risperidone, Aripiprazole
3. CAripiprazole, Zuclopenthixol, Haloperidol
20Treatment resistant schizophrenia
• Defined by - treatment with a minimum of [blank_start]2[blank_end] antipsychotics for at least [blank_start]6[blank_end] weeks at maximum [blank_start]tolerated[blank_end] dose
• Occurs in ~[blank_start]30[blank_end]% of patients with schizophrenia
• Clozapine induces remission in ~[blank_start]30-50[blank_end]% of patients with TRS, and is the only antipsychotic shown to decrease [blank_start]suicide & re-hospitalization[blank_end] rates, and increase rate of [blank_start]independent[blank_end] living
• Takes about 9 [blank_start]years[blank_end] on average post-first-psychotic-episode before used in NZ due to significant side effects - during this time patients typically have very poor quality of life
1. A2
2. B6
3. Ctolerated
4. D30
5. E30-50
6. Fsuicide & re-hospitalization
7. Gindependent
8. Hyears
21Which of these is NOT a side effect of clozapine?
1. ATachycardia
2. BHypotension
3. CSeizures
4. DConstipation
5. EWeight gain
6. FHypersalivation
7. GNausea and vomiting
8. HSedation
9. IDiarrhoea
22Clozapine monitoring:
- Verbal for [blank_start]constipation[blank_end] - toxic megacolon risk
- Blood monitoring for [blank_start]agranulocytosis[blank_end] (0.8% of patients, during the first year peaks at 8-10 weeks of Tx) and [blank_start]neutropenia[blank_end] (3-4%)
• Monitor [blank_start]weekly[blank_end] for the first 18 weeks, then every 2 weeks for the remainder of the year, then [blank_start]monthly[blank_end]
• 2.4 fold higher incidence in [blank_start]Asians[blank_end] versus caucasians with a 5% increase in risk/decade
• [blank_start]38[blank_end]% experience a further issue following re-challenge after neutropenia...
• NO re-challenge following [blank_start]agranulocytosis or myocarditis[blank_end]
1. Aconstipation
2. Bagranulocytosis
3. Cneutropenia
4. Dweekly
5. Emonthly
6. FAsians
7. G38
8. Hagranulocytosis or myocarditis
23Clozapine Interactions
• Metabolised by CYP450 1A2 and less so by 2D6)
– levels decreased by high levels of [blank_start]caffeine, valproate, carbamazepine[blank_end], cigarette smoking
- levels increased by [blank_start]clarithromycin, rifampicin, erythromycin[blank_end], [blank_start]fluoxetine, paroxetine[blank_end]
• [blank_start]Benzodiazepines[blank_end] may increase sedation and respiratory depression
• [blank_start]Anticholinergics[blank_end] may increase constipation risk, pyrexia
• Evening [blank_start]primrose[blank_end] oil and [blank_start]tramadol[blank_end] may increase seizures
• [blank_start]Lithium[blank_end] may exacerbate ADRs
1. Acaffeine, valproate, carbamazepine
2. Bclarithromycin, rifampicin, erythromycin
3. Cfluoxetine, paroxetine
4. DBenzodiazepines
5. EAnticholinergics
6. Fprimrose
7. Gtramadol
8. HLithium

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Description: User has deleted their subject information Quiz on PSY7 Schizophrenia, created by Deleted user on 14/10/2019.
Author: Deleted user
Language: English
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History: Created on 14 Oct 2019 · updated on 14 Oct 2019
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PSY7 Schizophrenia

Questions in this quiz (23)

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