PSY7 Schizophrenia

Beschreibung

PHCY320 (Psychiatry) Quiz am PSY7 Schizophrenia, erstellt von Mer Scott am 13/10/2019.
Mer Scott
Quiz von Mer Scott, aktualisiert more than 1 year ago
Mer Scott
Erstellt von Mer Scott vor etwa 5 Jahre
3
0

Zusammenfassung der Ressource

Frage 1

Frage
Which of these is not a disorder in which psychosis is defined?
Antworten
  • Psychotic disorder due to a general medical condition
  • Substance-induced psychotic disorder
  • Schizophrenia
  • Schizoaffective disorder
  • Delusional disorder
  • Bipolar

Frage 2

Frage
Schizophrenia: ~ [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.
Antworten
  • 1
  • young
  • chronic
  • adds
  • bipolar
  • Alzheimer
  • delusions
  • disordered
  • take away
  • emotional
  • withdrawal
  • Executive dysfunction
  • goals
  • attention
  • verbal

Frage 3

Frage
Burden 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
Antworten
  • 10
  • CV disease, suicide
  • 25-30
  • development
  • drugs, alcohol and smoking
  • cost
  • relationships
  • untreated psychosis

Frage 4

Frage
Early 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
Antworten
  • grades or job performance
  • thinking clearly or concentrating
  • paranoid
  • alone
  • no
  • ideas
  • self-care or personal hygiene
  • speech

Frage 5

Frage
Match 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]
Antworten
  • mesolimbic pathway
  • ventromedial prefrontal cortex
  • orbitofrontal cortex, amygdala
  • dorsolateral prefrontal cortex
  • mesocortical pathway, prefrontal cortex

Frage 6

Frage
Diagnosis • 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
Antworten
  • interviews
  • Positive and Negative Symptom Score
  • Psychosis
  • stigma

Frage 7

Frage
Five 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??
Antworten
  • Nigrostriatal
  • Mesolimbic
  • Mesocortical
  • Tuberoinfundibular

Frage 8

Frage
Schizophrenia - 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
Antworten
  • Integrated
  • High
  • Low
  • Normal

Frage 9

Frage
Order 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]
Antworten
  • Haloperidol
  • Prochlorperazine
  • Clozapine
  • Chlorpromazine

Frage 10

Frage
NMDA 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].
Antworten
  • cortical brainstem
  • descending
  • excitatory
  • low
  • hypo
  • inhibition
  • not
  • mesolimbic
  • hyperactive
  • activity
  • tonic excitation is lost
  • mesocortical
  • hypoactive
  • NMDR receptors
  • brainstem
  • glutamate
  • mesolimbic pathway
  • mesocortical pathways

Frage 11

Frage
Therapy - 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]
Antworten
  • agonists
  • overactivity
  • D2 antagonists
  • 5-HT2A
  • activity
  • not
  • negative
  • secondary
  • ↑ D2 receptors in limbic structures
  • less

Frage 12

Frage
“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]
Antworten
  • normal
  • pleasure/reward
  • low
  • parkinsonian
  • reduced
  • prolactin

Frage 13

Frage
‘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.
Antworten
  • Dystonia
  • Akathisia
  • rigidity, tremor, bradykinesia,
  • abnormal involuntary
  • mouth
  • vision
  • gain
  • QT
  • hypotension
  • dysfunction
  • range
  • good
  • acute

Frage 14

Frage
“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]
Antworten
  • 5-HT2A antagonism
  • less
  • Parkinsonism
  • negative
  • less common
  • gain
  • lipids
  • resistance
  • risperidone
  • clozapine

Frage 15

Frage
Antipsychotic antagonism of WHICH RECEPTORS is associated with weight gain?
Antworten
  • 5-HT2c & H1
  • 5-HT2c & H2
  • 5-HT1a & H1
  • 5-HT1a & H2

Frage 16

Frage
Antipsychotic M3 antagonism impairs:
Antworten
  • insulin regulation
  • prolactin regulation

Frage 17

Frage
Which of these drugs is MOST likely to cause hypotension?
Antworten
  • Chlorpromazine
  • Haloperidol
  • Quetiapine

Frage 18

Frage
Which 2 drugs are the most sedating?
Antworten
  • Chlorpromazine, Clozapine
  • Clozapine, Olanzapine
  • Olanzapine, Zuclopenthixol

Frage 19

Frage
Which 3 drugs are most likely to cause extra-pyrimidal SEs?
Antworten
  • Zuclopenthixol, Haloperidol, Chlorpromazine
  • Chlorpromazine, Risperidone, Aripiprazole
  • Aripiprazole, Zuclopenthixol, Haloperidol

Frage 20

Frage
Treatment 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
Antworten
  • 2
  • 6
  • tolerated
  • 30
  • 30-50
  • suicide & re-hospitalization
  • independent
  • years

Frage 21

Frage
Which of these is NOT a side effect of clozapine?
Antworten
  • Tachycardia
  • Hypotension
  • Seizures
  • Constipation
  • Weight gain
  • Hypersalivation
  • Nausea and vomiting
  • Sedation
  • Diarrhoea

Frage 22

Frage
Clozapine 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]
Antworten
  • constipation
  • agranulocytosis
  • neutropenia
  • weekly
  • monthly
  • Asians
  • 38
  • agranulocytosis or myocarditis

Frage 23

Frage
Clozapine 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
Antworten
  • caffeine, valproate, carbamazepine
  • clarithromycin, rifampicin, erythromycin
  • fluoxetine, paroxetine
  • Benzodiazepines
  • Anticholinergics
  • primrose
  • tramadol
  • Lithium
Zusammenfassung anzeigen Zusammenfassung ausblenden

ähnlicher Inhalt

Mental health chapter 10
nursing fairy
Mental State Exam
Matthew Coulson
Perinatal Psychiatry
Matthew Coulson
Psychiatry Genetics
Matthew Coulson
Eating Disorders
Matthew Coulson
Neurobiology of Addiction
Matthew Coulson
Addictive behaviour
Megan Kerr
Behavioral Neuroscience
Tambriell Caudill
Introduction to Psychology
Skye Chen
Liaison Psychiatry
Vishnu Pradeep
Perinatal Psychiatry
Kit Grissett