Chapter Eight
Summary
Schizophrenia and other psychotic disorders affect more than 1% of the general population. It is key to assess
and treat schizophrenia in its early stages and to prevent relapse. Patients left untreated in the first year of an episode
can be as much as a 15% suicide risk.
Schizophrenia is not caused by poor parenting, trauma, or other “demonic” possession. Schizophrenia is first
and foremost a brain disorder with numerous abnormalities in structure, function and neurochemistry. With regard to
structure, we find an enlargement of the lateral ventricles followed by decreased volume of gray and white matter.
The medial temporal structures such as the hippocampus and amygdala have also been found to be smaller in size to
non-schizophrenic controls.
The most common neurochemical abnormality involves the “hyperdopaminergic” theory in which refers to
the idea that too much dopamine causes psychotic symptoms. Medications used in the treatment of these conditions
block dopamine D2 receptors at the post-synaptic membrane. Newer atypical antipsychotics block D2 and 5HT
receptors as well, but produce less side effects than the older neuroleptics.
Schizophrenia has a strong familial link with high concordance rates among first-degree relatives. We also
find that the disorder is much more prevalent among those in urban areas, those born in colder months in colder
climates, and among those whose mothers may have had a viral infection during their second trimester of pregnancy.
We also need to be aware that many other medical conditions cause or worsen a patient’s psychotic
symptoms. These include brain tumors, infections, dementia, hormonal abnormalities and metabolic changes. Various
medications can also cause severe personality changes and psychoticism. These include drugs of abuse, pain
medications, steroids, antiparkinsonian drugs, and other environmental toxins.
Specific Discussion Questions:
1. Explain the difference between positive and negative symptoms of schizophrenia.
2. Summarize the various causes of schizophrenia and other psychotic disorders.
3. What are some of the advantages of the newer antipsychotic medications over the older neuroleptics?
4. Explain tardive dyskinesia and why it is problematic. What new medications do we have to address this?
Possible True/False Questions:
1. Schizophrenia is typically caused by environmental trauma.
2. Concordance rates for monozygotic twins is about 40-50%.
3. The “social drift” phenomenon refers to where most schizophrenics end up living as a result of
occupational/financial loss.
4. Clozaril is the only atypical antipsychotic medication with no real extra-pyramidal risk.
5. Resperidone requires weekly blood monitoring.
6. Expert consensus suggests that a prescriber wait at least three weeks before switching from one anti-psychotic
medication to another.
7. Symbyax is a medication that consists of both Zyprexa and Prozac.
8. Schizophrenia affects nearly 3% of the general population.
9. Schizophrenia can be detected on brain scans.
10. For patients with multiple-episodes, Risperdol or Invega are the drugs of choice.
11. Seroquel has been studied to determine if it is a popular drug of abuse.
12. Brexpiprasole and cariprasine are most similar to aripiprasole in their action.
13. Invega is similar to Resperdal but is metabolized in the kidney.
14. Both deutetrabenazine and valbenazine are FDA approved for the treatment of TD.
Possible Multiple Choice Questions:
1. All of the following are atypical antipsychotics except:
a. Zyprexa
b. Fanapt
c. Abilify
d. Navane
2. The typical treatment of choice for the first episode psychotic patient is:
a. Risperdal
b. Abilify
c. Haldol
d. None of these
3. The advantages of the newer atypicals include:
a. Minimal EPS
b. Efficacy for reducing the positive symptoms.
c. Improving patient cognition.
d. All of the above
4. The best medication for treatment refractory schizophrenia is:
a. Seroquel
b. Abilify
c. Clozaril
d. Orap
5. Which medication does not belong with the others?
a. Artane
b. Benadryl
c. Cogentin
d. Stelazine
6. Which of the following is most associated with weight gain?
a. Geodon
b. Zyprexa
c. Clozaril
d. Saphris
7. Which of the following typically has the greatest QTc prolongation risk?
a. Invega
b. Geodon
c. Rexulti
d. Latuda
8. Which of the following is most sedating?
a. Rexulti
b. Vraylar
c. Seroquel
d. Abilify
Alternative Class Assignments and Essay Questions:
1. Have the class make a list of all the medications currently available to treat schizophrenia and other psychotic
disorders. Discuss which can be used to address positive symptoms, which can be used to address negative,
and which can be used to address both.
2. Describe tardive dyskinesia. What types of warning signs should one look for?
Case 1 and 2 Vignette Discussion Questions:
1. What is the major pathology or diagnosis presented in each case?
2. Is there another disorder that may apply or should be ruled-out?
3. Do you agree with the medication suggestions made in each case?
Answer Key to Possible True/False and Multiple Choice Questions
Chapter Eight
Multiple Choice Questions: