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

Diagnosis

Course of Illness

Treatment

1 st Generation Antipsychotics

2 nd Generation Antipsychotics

Diagnosis Treatment 2 nd Gen AP’s st Gen AP’s Course of Illness

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

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

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

1,4 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 What are mood disorders?

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

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

1,7 To meet DSM5’s A criteria of Schizophrenia, of the 2 symptoms 1 needs to be a delusion, a hallucination, or this What is disorganized thinking/speech?

1,8 Seen in schizophrenia (& other disorders)-stupor, waxy flexibility, mutism, negativism, stereotypy, & echolalia are motor activities that are part of a clinical picture of this What is catatonia?

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

2,1 These symptoms of schizophrenia present early in the illness, worsen during the active periods, & do not respond well to anti-psychotic medications What are negative symptoms (or cognitive symptoms)?

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

2,3 10%, 30%, 60%: the percentage of patients with schizophrenia who experience a single active episode is this What is 10%? (~30% intermittent course, ~60% chronic course)

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

2,5 For ♂ &♀ with schizophrenia, the peak age of onset (the mode) is the same but the average age of onset is different because of this What is a 2 nd smaller peak age of onset peak for females after age 40?

2,6 Patients with schizophrenia have a life expectancy that is about 25 years less than the general population primarily due to this What is cardiovascular disease?

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

2,8 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 What is live independently?

2,9 The average course of schizophrenia tends to be more severe in males than females because of this What is males generally develop the illness earlier?

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

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

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

3,4 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) What is 2 weeks?

3,5 Lower doses of antipsychotics are used to treat patients with the first active phase of schizophrenia because of this What is greater sensitivity to medication side effects?

3,6 Clozapine (Clozaril) for patients with schizophrenia and lithium for patients with bipolar disorder both have this same unique benefit What is decreases risk of suicide?

3,7 Common indications for a clozapine (clozaril) trial include: persistence of positive symptoms, failure of > 2 antipsychotic trials, co-morbid substance abuse, and this What is recurrent suicidality/violence?

3,8 In treating patients with FGA’s, often titrating the dose up until side effects emerge corresponds to blocking this percentage of dopamine receptors What is 75-80%

3,9 In order to have the desired antipsychotic effect, medications need to block at least 65% of dopamine receptors in this pathway What is mesolimbic tract?

4,1 Low potency antipsychotics have common side effects of dry mouth, constipation, blurred vision, & urinary hesitancy due to this What is anti-cholinergic activity (cholinergic blockade)?

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

4,3 Improve, worsen, or remain unchanged: Once a patient develops tardive dyskinesia, the most common course of the symptoms is this What is remain static/unchanged (ongoing symptoms)?

4,4 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 What is propranolol (indural)

4,5 Antihistaminic Anticholinergic Dopaminergic Diphenhydramine (benadryl) is used to treat EPS because of this What is anticholinergic?

4,6 While there is still a significant risk of EPS, patients are less likely to complain of EPS symptoms from this type of FGA What is low potency FGAs? chlorpromazine (thorazine).

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

4,8 The risk of tardive dyskinesia in patients who take FGA’s for 24 months is 50% in this age group What is older adults/geriatric (>70 y/o)?

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

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

5,2 This SGA has a particularly long half life and a low risk of metabolic syndrome, but is the SGA most likely to cause akathisia What is aripiprazole (abilify)?

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

5,4 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 What is ziprasidone (geodone)?

5,5 This SGA has the highest risk of metabolic syndrome, is very sedating, and the CATIE study showed patients are highly likely to be compliant What are olanzapine (zyprexa)?

5,6 This SGA does not require hepatic metabolism because it is an active metabolite of risperidone (risperdal) What is paliperidone (invega)?

5,7 This SGA has almost zero risk of EPS or agranulocytosis, is often sedating & has a moderate risk of metabolic syndrome What are quetiapine (seroquel)?

5,8 This SGA is unique since it is a partial agonist What is aripiprazole (abilify)?

5,9 This SGA may cause side effects of sialorrhea, weight gain, sedation, anticholinergic effects, myocarditis, and a lower seizure threshold What is clozapine (clozaril)?