Schizophrenia Jeopardy: Diagnosis, Course, and Treatment

1. Jeopardy for the Psychiatry Clerkship

2. And Now Here Is The Host . . . is proud to present Insert Name Here

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

4. Diagnosis

5. Course of Illness

6. Treatment

7. 1st GenerationAntipsychotics

8. 2nd Generation Antipsychotics

9. Diagnosis 2nd Gen AP’s Course of Illness Treatment 1st Gen AP’s 100 100 100 100 100 200 200 200 200 200 300 300 300 300 300 400 400 400 400 400 500 500 500 500 500 600 600 600 600 600 700 700 700 700 700 800 800 800 800 800 900 900 900 900 900

10. Row 1, Col 1 What are negative symptoms? (alogia, affective flattening, avolution, anhedonia) Males are more likely than females to have these A Criteria symptoms of schizophrenia

11. 1,2 What are hallucinations? Positive symptoms of schizophrenia are delusions, disorganized thinking, and this

12. 1,3 What is schizophreniform disorder? If the A criteria for Schizophrenia have been met for between 1 & 6 months, the diagnosis is this

13. 1,4 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

14. 1,5 What is tact (social cognition)? Regarding the cognitive symptoms of schizophrenia, the mnemonic SMART refers to speed, memory, attention, reasoning, and this

15. 1,6 What is anhedonia? This A criteria negative symptom of schizophrenia is also a symptom of major depression

16. 1,7 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

17. 1,8 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

18. 1,9 What are hypnopompic hallucinations? Voices that are only heard when a patient is just waking up from sleeping are called this

19. 2,1 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

20. 2,2 What is get married? It is “proposed” that because most patients with schizophrenia have limited social contacts, only 30-40% do this

21. 2,3 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

22. 2,4 What is a prodrome? Seen in ~85% of patients prior to the 1st psychotic episode, this negative prognostic sign lasts several months to years

23. 2,5 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

24. 2,6 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

25. 2,7 What is theprodrome? The functional decline for a patient with schizophrenia begins during this phase of the illness

26. 2,8 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

27. 2,9 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

28. 3,1 What is prevent relapse into the active phase? For patients with schizophrenia, the main goal of continuous pharmacologic treatment with antipsychotics is this

29. 3,2 What is increased risk of relapse? Decreasing the antipsychotic medication in an attempt to use the “lowest effective dose” is associated with this

30. 3,3 What is psychosis/active phase of illness? The most common reason patients with schizophrenia are psychiatrically hospitalized is this

31. 3,4 What is 2 weeks? 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)

32. 3,5 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

33. 3,6 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

34. 3,7 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

35. 3,8 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

36. 3,9 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

37. 4,1 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

38. 4,2 What is dystonia? Young males may be at higher risk than the rest of the population for this EPS side effect of muscle spasms

39. 4,3 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

40. 4,4 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

41. 4,5 What is antihistiminic? The most commonly used adjunctive medications to treat EPS side effects are anticholinergic, dopaminergic, and/or this

42. 4,6 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

43. 4,7 What is clozapine (clozaril)? About half of the patients with tardive dyskinesia show a 50% symptom reduction from treatment with this medication

44. 4,8 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

45. 4,9 What is akathisia? An EPS side effect often described as a subjective sense of restlessness (the person can’t sit still) is this

46. 5,1 What is clozapine (clozaril) and quetiapine (seroquel)? These two SGA’s are least likely to have EPS side effects

47. 5,2 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

48. 5,3 What are risperidone (risperdal) & palliperidone (invega)? These 2 SGA’s are available in depot form but can cause dose dependent EPS & prolactin elevation

49. 5,4 What isziprasidone (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

50. 5,5 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