for the Psychiatry Clerkship

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Psychiatry Clerkship

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The categories for today’s Jeopardy on Schizophrenia will be:

Diagnosis

Course of Illness

Treatment

FGA’s

SGA’s

100 100

Diagnosis Treatment SGA’s

900 900 900 900

FGA’s

Course of Illness

Row 1, Col 1

Males are more likely than females to have these A Criteria symptoms of

schizophrenia

What are negative symptoms? (alogia, affective flattening, avolution, anhedonia)

Positive symptoms of schizophrenia are delusions, disorganized

thinking, and this

What are hallucinations?

If the A criteria for Schizophrenia have been met for between 1 & 6 months,

the diagnosis is this

What is schizophreniform disorder?

Other psychotic disorders, childhood developmental disorders,

medical or neurological illness, substance abuse or medication induced,

personality disorders, & this must be ruled out before diagnosing

schizophrenia

What are mood disorders?

Regarding the cognitive symptoms of schizophrenia, the mnemonic

SMART refers to speed, memory, attention, reasoning, and this

What is tact (social cognition)?

This A criteria negative symptom of schizophrenia is also a symptom of

major depression

What is anhedonia?

In DSM4, this type of delusion will, by itself, meet the A criteria of

Schizophrenia

What is a bizarre delusion?(In DSM5, for A criteria need 2 of 5 signs/symptoms.

Bizarre vs non-bizarre delusions not a consideration.

Delusions are more likely to be experienced by females than males and hallucinations are more likely

to be experienced by this sex.

What is females?M-negative symptoms; F-positive symptoms

Voices that are only heard when a patient is just waking up from

sleeping are called this

What are hypnopompic hallucinations?

These symptoms of schizophrenia present early in the illness, worsen during the active

periods, & do not respond well to anti-psychotic medications

What are negative symptoms (or cognitive symptoms)?

It is “proposed” that because most patients with schizophrenia have

limited social contacts, only 30-40% do this

What is get married?

10%, 30%, 60%: the percentage of patients with schizophrenia who experience a

single active episode is this

What is 10%?(~30% intermittent course, ~60% chronic course)

Seen in ~85% of patients, this negative prognostic sign lasts

several months to years

What is a prodrome?

For ♂ &♀ with schizophrenia, the peak age of onset (the mode) is the

same but the average age of onset is different because

of this

What is a 2nd smaller peak age of onset peak for females after age 40?

Patients with schizophrenia have a life expectancy that is about 25

years less than the general population primarily

due to this

What is cardiovascular disease?

The functional decline for a patient with schizophrenia begins

during this phase of the illness

What is the prodrome?

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

What is live independently?

The average course of schizophrenia tends to be more severe in males

than females because of this

What is males generally develop the illness earlier?

For patients with schizophrenia, the main goal of continuous treatment

with antipsychotics is this

What is prevent relapse into the active phase?

Decreasing the antipsychotic medication in an attempt to use

the “lowest effective dose” is associated with this

What is increased risk of relapse?

The most common reason patients with schizophrenia are

psychiatrically hospitalized is this

What is psychosis/active phase of illness?

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)

What is 2 weeks?

Lower doses of antipsychotics are used to treat the first active phase of schizophrenia because of this

What is greater sensitivity to medication side effects?

Treating schizophrenic patients with clozapine (clozaril) and treating

bipolar patients with lithium both have this same unique benefit

What is decreases risk of suicide?

Common indications for a clozapine (clozaril) trial include:

persistence of positive symptoms, failure of > 2 antipsychotic trials,

co-morbid substance abuse, and this

What is recurrent suicidality/violence?

In treating patients with FGA’s, often titrating the dose up until side effects

emerge corresponds to blocking this percentage of

dopamine receptors

What is 75-80%

In order to have the desired antipsychotic effect, medications

need to block at least 65% of dopamine receptors in

this pathway

What is mesolimbic tract?

Low potency antipsychotics have common side effects of dry mouth,

constipation, blurred vision, & urinary hesitancy

due to this

What is anti-cholinergic activity (cholinergic blockade)?

Young males may be at higher risk than the rest of the population

for this EPS side effect of muscle spasms

What is dystonia?

Improve, worsen, or remain unchanged:

Once a patient develops tardive dyskinesia, the most common course of the symptoms is this

What is remain static/unchanged (ongoing symptoms)?

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

What is propranolol (indural)

Adjunctive medications that are anticholinergic, dopaminergic,

and/or this are commonly used to treat EPS side effects

What is antihistiminic?

While there is still a significant risk of EPS, patients are less likely to

complain of EPS symptoms from this type of FGA

What is low potency FGAs? chlorpromazine (thorazine) .

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

this medication

What is clozapine (clozaril)?

The risk of tardive dyskinesia in patients who take FGA’s for

24 months is 50% in this age group

What is older adults/geriatric (>70 y/o)?

An EPS side effect often described as a subjective

sense of restlessness (the person can’t sit still)

is this

What is akathisia?

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

What is clozapine (clozaril) and quetiapine (seroquel)?

This SGA has a particularly long half life and a low risk of metabolic syndrome, but is the SGA most

likely to cause akathisia

What is aripiprazole (abilify)?

These 2 SGA’s are available in depot form but can cause dose

dependent EPS &prolactin elevation

What are risperidone (risperdal) & palliperidone (invega)?

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

What is ziprasidone (geodone)?

This SGA has the highest risk of metabolic syndrome, is very sedating, and the CATIE study

showed patients are highly likely to be compliant

What are olanzapine (zyprexa)?

This SGA does not require hepatic metabolism because it is an active

metabolite of risperidone (risperdal)

What is paliperidone (invega)?

This SGA has almost zero risk of EPS or agranulocytosis, is

often sedating & has a moderate risk of

metabolic syndrome

What are quetiapine (seroquel)?

This SGA is unique since it is a partial agonist

What is aripiprazole (abilify)?

This SGA may cause side effects of sialorrhea, weight gain, sedation,

anticholinergic effects, myocarditis, and a lower seizure threshold

What is clozapine (clozaril)?

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