Psychology: Schizophrenia Clinical Presentation

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Questions and Answers

What is a common feature of acute psychotic episode?

Good self-care skills and logical conversation

Positive symptoms and normal sleep pattern

Labile affect and autistic thinking (correct)

Impaired judgment and lack of motivation

What is the minimum duration of symptoms required for the diagnosis of schizophrenia?

6 months (correct)

2 years

3 months

1 year

Which of the following is a Criterion A symptom for schizophrenia?

Good judgment

Lack of motivation

Disorganized speech (correct)

Impaired self-care skills

What is a common residual feature of schizophrenia?

Anxiety Signup and view all the answers

Which of the following is NOT a diagnostic criterion for schizophrenia?

Presence of comorbid disorders Signup and view all the answers

What is a negative symptom of schizophrenia?

Affective flattening Signup and view all the answers

Why is medication nonadherence common in schizophrenia?

Due to side effects of medication Signup and view all the answers

What is a potential comorbid disorder in schizophrenia?

All of the above Signup and view all the answers

What is the primary goal of schizophrenia treatment?

To alleviate target symptoms and achieve compliance with the prescribed regimen Signup and view all the answers

What is the mainstay of nondrug treatment for schizophrenia?

Psychosocial rehabilitation programs Signup and view all the answers

What type of antipsychotics exhibit low D2 antagonism and high 5-HT2A antagonism?

Second-generation antipsychotics (SGAs) Signup and view all the answers

What is the purpose of involving the patient in treatment planning?

To frame clinical decision making in a mutual process Signup and view all the answers

What is the benefit of programs that involve the family aimed at supportive employment and housing?

They decrease rehospitalization Signup and view all the answers

What is the mechanism of action of antipsychotics?

Unknown Signup and view all the answers

What type of antipsychotics exhibit high D2 antagonism and low 5-HT2A antagonism?

First-generation antipsychotics (FGAs) Signup and view all the answers

What is the purpose of conducting a laboratory workup?

To evaluate the patient's physical health Signup and view all the answers

Which of the following antipsychotics is most likely to cause impaired memory?

Clozapine Signup and view all the answers

What is the benefit of taking the entire antipsychotic daily dose at bedtime?

Reduced sedation Signup and view all the answers

Which of the following enzymes is NOT involved in the metabolism of antipsychotics?

Protease Signup and view all the answers

What is the effect of smoking on antipsychotic clearance?

Increases clearance by 50% Signup and view all the answers

Which of the following medications is an inhibitor of CYP2D6?

Asenapine Signup and view all the answers

What are the three factors to consider when selecting an antipsychotic?

Need to avoid certain side effects, concurrent medical or psychiatric disorders, and patient or family history of response Signup and view all the answers

What is the recommended dose for first episode psychosis compared to chronically ill patients?

Half of the dose for chronically ill patients Signup and view all the answers

What is the superior efficacy of clozapine for?

Suicidal behavior Signup and view all the answers

What is the goal of antipsychotic treatment during the first 7 days?

Decreased agitation, hostility, anxiety, and aggression and normalization of sleep and eating Signup and view all the answers

Which of the following is a consequence of rapid titration of antipsychotic dose?

Increased risk of adverse effects Signup and view all the answers

What is the recommended approach for antipsychotic dosing in first-episode schizophrenia?

Initiate dosing at the lower end of the dosing range Signup and view all the answers

Which of the following is a predictor of antipsychotic response?

Prior response to the drug selected Signup and view all the answers

What is the recommended treatment option for Stage 3?

Clozapine monotherapy Signup and view all the answers

What is the significance of an initial dysphoric response to antipsychotic therapy?

Portends a poor drug response, adverse effects, and non-adherence Signup and view all the answers

Which of the following is NOT a recommended first-line antipsychotic in first-episode schizophrenia?

Haloperidol Signup and view all the answers

What is the significance of using a long-acting antipsychotic in schizophrenia treatment?

It is recommended during stages 1A, 1B, and 2 Signup and view all the answers

What is the recommended treatment for dystonias?

IM or IV anticholinergics or benzodiazepines Signup and view all the answers

What is a risk factor for dystonias?

Younger patients and use of FGA, high-potency agents Signup and view all the answers

What is the recommended dose of benztropine for treating dystonias?

2 mg IM or IV Signup and view all the answers

What is the percentage of patients treated with high-potency FGA who experience akathisia?

20%–40% Signup and view all the answers

What is the best intervention for akathisia?

Reducing the antipsychotic dose Signup and view all the answers

Which of the following SGAs appears to have a low risk of akathisia?

Aripiprazole Signup and view all the answers

Why should benzodiazepines be avoided in patients with a history of substance abuse?

Because they can exacerbate substance abuse Signup and view all the answers

What is the recommended dose of propranolol for treating akathisia?

Up to 160 mg/day Signup and view all the answers

Study Notes

Clinical Presentation of Schizophrenia

Symptoms of acute episode: out of touch with reality, hallucinations, delusions, ideas of influence, disconnected thought processes, illogical conversation, ambivalence, flat or inappropriate affect, autistic thinking, uncooperativeness, hostility, and verbal or physical aggression, impaired self-care skills, and disturbed sleep and appetite
Residual features after acute episode: anxiety, suspiciousness, lack of motivation, poor insight, impaired judgment, social withdrawal, difficulty learning from experience, and poor self-care skills
Comorbid psychiatric and medical disorders: depression, anxiety disorders, substance abuse, respiratory disorders, cardiovascular disorders, metabolic disturbances, and medication nonadherence

Diagnosis of Schizophrenia

Diagnostic criteria: • Criterion A: continuous symptoms for at least 6 months with at least 1 month of active phase symptoms, including at least two of delusions, hallucinations, disorganized speech, grossly disorganized or catatonic behavior, and negative symptoms • Criterion B: significantly impaired functioning
Diagnostic process: mental status examination, physical examination, complete family and social history, psychiatric diagnostic interview, and laboratory workup (CBC, electrolytes, hepatic function, renal function, ECG, fasting serum glucose, serum lipids, thyroid function, and urine drug screen)

Treatment of Schizophrenia

Goals of treatment: alleviate target symptoms, avoid side effects, improve psychosocial functioning and productivity, achieve compliance with prescribed regimen, integrate patient back into community, prevent relapse, and involve patient in treatment planning
Nonpharmacologic therapy: psychosocial rehabilitation programs to improve adaptive functioning, involving family in supportive employment and housing
Pharmacologic therapy: • First-generation antipsychotics (FGAs) and second-generation antipsychotics (SGAs) • FGAs have high D2 antagonism and low serotonin-2 receptor antagonism • SGAs exhibit moderate-to-high D2 antagonism and high 5-HT2A antagonism • Clozapine has superior efficacy for suicidal behavior • Consideration of comorbid medical or psychiatric disorders, patient or family history of response, and need to avoid certain side effects in selecting antipsychotic medication

Antipsychotic Medications

Antipsychotic selection: consider need to avoid certain side effects, concurrent medical or psychiatric disorders, and patient or family history of response
Side effects: • Anticholinergic side effects: impaired memory, dry mouth, constipation, tachycardia, blurred vision, inhibition of ejaculation, and urinary retention • Sedation:reduce sedation by taking most or entire antipsychotic daily dose at bedtime
Pharmacogenetics: impact on pharmacokinetics of antipsychotics
Pharmacokinetics: antipsychotics are highly lipophilic, bind highly to membranes and plasma proteins, and are largely metabolized by cytochrome P450 (CYP) pathways

Extrapyramidal Side Effects

Dystonias: prolonged tonic muscle contractions occurring within 24-96 hours of dosage initiation or increase; risk factors include younger male patients and use of FGA, high-potency agents, and high dose
Treatment of dystonias: IM or IV anticholinergics or benzodiazepines
Akathisia: subjective complaints of restlessness and/or objective symptoms of pacing, shifting, shuffling, or tapping feet; reduction in antipsychotic dose, switching to an SGA, and propranolol may be effective

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Description

This quiz covers the symptoms of an acute episode of schizophrenia, including hallucinations, delusions, and disorganized thinking and behavior.