Transcript Jeopardy

for the
Psychiatry Clerkship
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Is The Host . . .
is proud
to present
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The categories for today’s
Jeopardy on Schizophrenia
will be:
Diagnosis
Course of Illness
Treatment
st
1
Generation
Antipsychotics
nd
2
Generation
Antipsychotics
1st Gen AP’s
2nd Gen AP’s
Diagnosis
Course of
Illness
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Treatment
What are negative symptoms?
(alogia, affective flattening, avolution, anhedonia)
Males are more likely than females to
have these A Criteria symptoms of
schizophrenia
Row 1, Col 1
What are hallucinations?
Positive symptoms of schizophrenia
are delusions, disorganized
thinking, and this
1,2
What is schizophreniform disorder?
If the A criteria for Schizophrenia have
been met for between 1 & 6 months,
the diagnosis is this
1,3
What are mood disorders?
Before diagnosing schizophrenia,
exclusionary diagnoses that must
be ruled out include:
other psychotic disorders,
childhood developmental disorders,
medical or neurological illness,
substance abuse or medication induced,
personality disorders, & this
1,4
What is tact (social cognition)?
Regarding the cognitive symptoms of
schizophrenia, the mnemonic
SMART refers to speed, memory,
attention, reasoning, and this
1,5
What is anhedonia?
This A criteria negative symptom of
schizophrenia is also a symptom of
major depression
1,6
What is disorganized thinking/speech?
To meet DSM5’s A criteria of
Schizophrenia, of the 2 symptoms
1 needs to be a delusion,
a hallucination, or this
1,7
What is catatonia?
Seen in schizophrenia & other
disorders, stupor, waxy flexibility,
mutism, negativism, stereotypy, &
echolalia, are motor activities that
are seen in a patient with this
1,8
What are hypnopompic hallucinations?
Voices that are only heard when a
patient is just waking up from
sleeping are called this
1,9
What are negative symptoms (or cognitive symptoms)?
These symptoms of schizophrenia
present early in the illness,
worsen during the active
periods, & do not respond
well to anti-psychotic medications
2,1
What is get married?
It is “proposed” that because most
patients with schizophrenia have
limited social contacts, only
30-40% do this
2,2
What is 10%?
(~30% intermittent course, ~60% chronic course)
10%, 30%, 60%:
the percentage of patients with
schizophrenia who experience a
single active episode is this
2,3
What is a prodrome?
Seen in ~85% of patients prior to
the 1st psychotic episode, this
negative prognostic sign lasts
several months to years
2,4
What is a 2nd smaller peak age of onset peak for females
after age 40?
For ♂ &♀ with schizophrenia, the
peak age of onset (the mode) is the
same but the average age of
onset is different because
of this
2,5
What is cardiovascular disease?
Patients with schizophrenia have a
life expectancy that is about 25
years less than the general
population primarily
due to this
2,6
What is the prodrome?
The functional decline for a patient
with schizophrenia begins
during this phase of
the illness
2,7
What is live independently?
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
2,8
What is males generally develop the illness earlier?
The average course of schizophrenia
tends to be more severe in males
than females because of this
2,9
What is prevent relapse into the active phase?
For patients with schizophrenia, the
main goal of continuous
pharmacologic treatment with
antipsychotics is this
3,1
What is increased risk of relapse?
Decreasing the antipsychotic
medication in an attempt to use
the “lowest effective dose” is
associated with this
3,2
What is psychosis/active phase of illness?
The most common reason patients
with schizophrenia are
psychiatrically hospitalized
is this
3,3
What is 2 weeks?
Except for clozapine (Clozaril), all antipsychotic medications are unlikely to
work by 4 weeks if a patient does not
show a response within this
number of week(s)
3,4
What is greater sensitivity to medication side effects?
Lower doses of antipsychotics are used
to treat patients with the first active
phase of schizophrenia
because of this
3,5
What is decreases risk of suicide?
Clozapine (Clozaril) for patients with
schizophrenia and lithium for
patients with bipolar disorder both
have this same unique benefit
3,6
What is recurrent suicidality/violence?
Common indications for a clozapine
(clozaril) trial include:
persistence of positive symptoms,
failure of > 2 antipsychotic trials,
co-morbid substance abuse,
and this
3,7
What is 75-80%
In treating patients with FGA’s, often
titrating the dose up until side effects
emerge corresponds to blocking
this percentage of
dopamine receptors
3,8
What is mesolimbic tract?
In order to have the desired
antipsychotic effect, medications
need to block at least 65% of
dopamine receptors in
this pathway
3,9
What is anti-cholinergic activity (cholinergic blockade)?
Low potency antipsychotics have
common side effects of dry mouth,
constipation, blurred vision,
& urinary hesitancy
due to this
4,1
What is dystonia?
Young males may be at higher risk
than the rest of the population
for this EPS side effect of
muscle spasms
4,2
What is remain static/unchanged (ongoing
symptoms)?
Improve, worsen, or remain unchanged:
Once a patient develops tardive
dyskinesia, the most common
course of the symptoms is this
4,3
What is propranolol (indural)
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
4,4
What is antihistiminic?
The most commonly used adjunctive
medications to treat EPS side effects
are anticholinergic, dopaminergic,
and/or this
4,5
What is low potency FGAs?
chlorpromazine (thorazine)
.
While there is still a significant risk
of EPS, patients are less likely to
complain of EPS symptoms
from this type of FGA
4,6
What is clozapine (clozaril)?
About half of the patients with tardive
dyskinesia show a 50% symptom
reduction from treatment with
this medication
4,7
What is older adults/geriatric (>70 y/o)?
The risk of tardive dyskinesia in
patients who take FGA’s for
24 months is 50% in
this age group
4,8
What is akathisia?
An EPS side effect often
described as a subjective
sense of restlessness
(the person can’t sit still)
is this
4,9
What is clozapine (clozaril) and quetiapine
(seroquel)?
These two SGA’s are least likely to
have EPS side effects
5,1
What is aripiprazole (abilify)?
This SGA has a particularly long half
life and a low risk of metabolic
syndrome, but is the SGA most
likely to cause akathisia
5,2
What are risperidone (risperdal) & palliperidone
(invega)?
These 2 SGA’s are available in
depot form but can cause dose
dependent EPS &
prolactin elevation
5,3
What is ziprasidone (geodone)?
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
5,4
What are olanzapine (zyprexa)?
This SGA has the highest risk
of metabolic syndrome, is very
sedating, and the CATIE study
showed patients are highly
likely to be compliant
5,5
What is paliperidone (invega)?
This SGA does not require hepatic
metabolism because it is an active
metabolite of risperidone (risperdal)
5,6
What are quetiapine (seroquel)?
This SGA has almost zero risk of
EPS or agranulocytosis, is
often sedating & has a
moderate risk of
metabolic syndrome
5,7
What is aripiprazole (abilify)?
This SGA is unique since it
is a partial agonist
5,8
What is clozapine (clozaril)?
This SGA may cause side effects of
sialorrhea, weight gain, sedation,
anticholinergic effects, myocarditis,
and a lower seizure threshold
5,9