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The categories for today’s Jeopardy on Schizophrenia will be:
Diagnosis
Course of Illness
Treatment
FGA’s
SGA’s
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Diagnosis Treatment SGA’s
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FGA’s
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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)
1,2
Positive symptoms of schizophrenia are delusions, disorganized
thinking, and this
What are hallucinations?
1,3
If the A criteria for Schizophrenia have been met for between 1 & 6 months,
the diagnosis is this
What is schizophreniform disorder?
1,4
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?
1,5
Regarding the cognitive symptoms of schizophrenia, the mnemonic
SMART refers to speed, memory, attention, reasoning, and this
What is tact (social cognition)?
1,6
This A criteria negative symptom of schizophrenia is also a symptom of
major depression
What is anhedonia?
1,7
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.
1,8
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
1,9
Voices that are only heard when a patient is just waking up from
sleeping are called this
What are hypnopompic hallucinations?
2,1
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)?
2,2
It is “proposed” that because most patients with schizophrenia have
limited social contacts, only 30-40% do this
What is get married?
2,3
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)
2,4
Seen in ~85% of patients, this negative prognostic sign lasts
several months to years
What is a prodrome?
2,5
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?
2,6
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?
2,7
The functional decline for a patient with schizophrenia begins
during this phase of the illness
What is the prodrome?
2,8
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?
2,9
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?
3,1
For patients with schizophrenia, the main goal of continuous treatment
with antipsychotics is this
What is prevent relapse into the active phase?
3,2
Decreasing the antipsychotic medication in an attempt to use
the “lowest effective dose” is associated with this
What is increased risk of relapse?
3,3
The most common reason patients with schizophrenia are
psychiatrically hospitalized is this
What is psychosis/active phase of illness?
3,4
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?
3,5
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?
3,6
Treating schizophrenic patients with clozapine (clozaril) and treating
bipolar patients with lithium both have this same unique benefit
What is decreases risk of suicide?
3,7
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?
3,8
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%
3,9
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?
4,1
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)?
4,2
Young males may be at higher risk than the rest of the population
for this EPS side effect of muscle spasms
What is dystonia?
4,3
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)?
4,4
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)
4,5
Adjunctive medications that are anticholinergic, dopaminergic,
and/or this are commonly used to treat EPS side effects
What is antihistiminic?
4,6
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) .
4,7
About half of the patients with tardive dyskinesia show a 50% symptom reduction from treatment with
this medication
What is clozapine (clozaril)?
4,8
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)?
4,9
An EPS side effect often described as a subjective
sense of restlessness (the person can’t sit still)
is this
What is akathisia?
5,1
These two SGA’s are least likely to have EPS side effects
What is clozapine (clozaril) and quetiapine (seroquel)?
5,2
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)?
5,3
These 2 SGA’s are available in depot form but can cause dose
dependent EPS &prolactin elevation
What are risperidone (risperdal) & palliperidone (invega)?
5,4
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)?
5,5
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)?
5,6
This SGA does not require hepatic metabolism because it is an active
metabolite of risperidone (risperdal)
What is paliperidone (invega)?
5,7
This SGA has almost zero risk of EPS or agranulocytosis, is
often sedating & has a moderate risk of
metabolic syndrome
What are quetiapine (seroquel)?
5,8
This SGA is unique since it is a partial agonist
What is aripiprazole (abilify)?
5,9
This SGA may cause side effects of sialorrhea, weight gain, sedation,
anticholinergic effects, myocarditis, and a lower seizure threshold
What is clozapine (clozaril)?