Psychosis

QUESTIONS

1. What is the most common form of thought disorder in patients with schizophrenia?

A. Loose associations

B. Circumstantiality

C. Tangentiality

D. Flight of ideas

E. Prolixity

View Answer

1. Answer: A. Loose associations are the most common form of thought disorder seen in patients with schizophrenia. It is present in about 45% of patients with schizophrenia.

2. A 46-year-old male with treatment-resistant schizophrenia is started on clozapine after unsuccessful trials of two other atypical antipsychotics and one typical antipsychotic. He shows signs of response but unfortunately develops seizures when be begins taking a higher dose. What is the incidence of seizures in patients taking clozapine at a dose greater than 600 mg per day?

A. 1%

B. 10%

C. 5%

D. 15%

E. 25%

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2. Answer: C. The incidence of seizures in patients taking more than 600 mg per day of clozapine is around 5%. Therefore, some psychiatrists tend to start seizure prophylaxis in patients who need at least 600 mg or more of clozapine every day.

3. All of the following drugs can cause psychotic symptoms similar to schizophrenia except:

A. ecstasy

B. opiates

C. phencyclidine

D. ketamine

E. lysergic acid diethylamide (LSD)

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3. Answer: B. Ecstasy, phencyclidine, ketamine and LSD can all cause psychotic symptoms similar to schizophrenia. Opiates are rarely associated with any psychotic symptoms.

4. All of the following are considered to be risk factors for neuroleptic-induced tardive dyskinesia except:

A. male gender

B. brain injury

C. mood disorder

D. old age

E. long duration of treatment

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4. Answer: A. Female gender is associated with a higher incidence of neuroleptic-induced tardive dyskinesia, not male gender. All the other risk factors mentioned increase the risk of neuroleptic-induced tardive dyskinesia.

5. All of the following are characteristic features of a delusion except:

A. firmly held belief

B. consistent with an individual’s cultural context

C. no basis in reality

D. believed by the subject despite evidence to the contrary

E. all of the above

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5. Answer: B. Delusion is a fixed, firmly held belief that has no basis in reality and persists despite evidence to the contrary. It is out of character of a person’s social or cultural background.

6. Bleuler’s four A’s of schizophrenia include all of the following except:

A. loosening of associations

B. inappropriate affect

C. altruism

D. autism

E. ambivalence

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6. Answer: C. Bleuler made great contributions to the understanding of schizophrenia. He believed that schizophrenia has four fundamental symptoms including loosening of associations, inappropriate affect, autism, and ambivalence.

7. Which of the following illicit drugs can lead to a full range of symptoms similar to that seen in patients with schizophrenia?

A. Ecstasy

B. Alcohol

C. Marijuana

D. Phencyclidine

E. Opiates

View Answer

7. Answer: D. Although many illicit drugs including ecstasy, LSD, and ketamine can cause symptoms similar to schizophrenia, only phencyclidine is associated with the full range of symptoms as seen in patients with schizophrenia.

8. The first rank-symptoms of schizophrenia were described by:

A. Schneider

B. Bleuler

C. Kraepelin

D. Freud

E. Jung

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8. Answer: A. Schneider described the first-rank symptoms of schizophrenia. The 11 symptoms describing different types of hallucinations (including passivity symptoms) were thought to be important in the diagnosis of schizophrenia. We now know that these symptoms are not always present in schizophrenia, however, and that they can be present in other conditions such as mania.

9. According to the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV), the duration criteria to make a diagnosis of schizophrenia is:

A. 1 month

B. 6 months

C. 2 months

D. 2 weeks

E. 6 weeks

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9. Answer: B. According to the DSM-IV, to diagnose schizophrenia, the total duration of illness (including prodromal or residual phases) should last at least 6 months.

10. The prevalence of schizophrenia is:

A. 10%

B. 1%

C. 5%

D. 0.1%

E. 2%

View Answer

10. Answer: B. The prevalence of schizophrenia worldwide is about 1%.

11. All of the following are true about schizophrenia except:

A. stressful life events appear to trigger schizophrenia at an earlier age in vulnerable individuals

B. equally prevalent in both men and women

C. females have an earlier age of onset compared to males

D. in the northern hemisphere, schizophrenic patients are more likely to have been born between January and April

E. substance abuse is common in patients with schizophrenia

View Answer

11. Answer: C. Males tend to have earlier onset of illness compared to females (18 to 25 years vs 26 to 45 years). Also, males tend to be more symptomatic and have a poorer prognosis compared to females, in general.

12. A 32-year-old male with chronic paranoid schizophrenia, in full remission is married and living a productive life. He and his wife decide to have children, but would like to know the probability of his children developing schizophrenia. Which of the following statements is correct?

A. The risk is similar to that of general population (1%).

B. The risk is about 50%.

C. The risk is much lower than the general population because he will be able to recognize the early signs of schizophrenia and seek prompt treatment for his child.

D. The risk is about 10%.

E. The risk is about 100%.

View Answer

12. Answer: D. The risk of schizophrenia for a child of a schizophrenic patient is 10%. Genetic contribution is considered to play a role based on various genetic studies in schizophrenia. Monozygotic twins have a higher rate of schizophrenia (45% to 50%) compared to dizygotic twins (10% to 15%).

13. All of the following support the theory of dopamine hyperactivity in schizophrenia except:

A. dopamine receptor antagonists are effective antipsychotic agents

B. dopamine-releasing agents such as cocaine produce psychosis

C. atypical antipsychotics such as quetiapine act at serotonin receptors and decrease psychotic symptoms

D. all of the above

E. none of the above

View Answer

13. Answer: C. One of the proposed theories of the etiology of schizophrenia is dopamine hyperactivity. The facts that dopamine antagonists are used to treat psychosis and dopamine agonists are associated with psychosis support this theory. However, the atypical antipsychotics have minimal action at dopamine receptors and mainly act at serotonin receptors. This suggests possible serotonin dysfunction in schizophrenia rather than just dopamine hyperactivity.

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