SCHIZOPHRENIA – TREATMENT & PROGNOSIS

SCHIZOPHRENIA – TREATMENT & PROGNOSIS

Q. 1

Most common type of schizophrenia is:

 A Simple

 B Paranoid

 C

Catatonic

 D

Undifferentiated

Q. 1

Most common type of schizophrenia is:

 A

Simple

 B

Paranoid

 C

Catatonic

 D

Undifferentiated

Ans. B

Explanation:

Paranoid


Q. 2

A 26-year-old man with schizophrenia and tardive dyskinesia. Which is the most appropriate pharmacotherapeutic agent?

 A

Clozapine

 B

Valproic acid

 C

Haloperidol

 D

Paroxetine

Ans. A

Explanation:

Valproic acid is an anticonvulsant used as a mood stabilizer. It is found useful in the treatment of mania in a bipolar disorder.

It has also been valuable in the treatment of rapid cycling bipolar patients.

Paroxetine is an example of a selective serotonin reuptake inhibitor (SSRI), which is a newer form of antidepressant.

The SSRis are being found to be as effective as the tricyclic antidepressants.

Haloperidol is an example of a neuroleptic or antipsychotic medication useful in the management of acute psychosis, as well as long-term care. Clozapine is a newer atypical antipsychotic medication.

It is not associated with tardive dyskinesia as are the older neuroleptics.

This makes it a drug of choice for individuals who have developed signs of tardive dyskinesia after using other neuroleptics.

Problems with agranulocytosis prevent clozapine from being used as a “first line” neuroleptic.  

Ref: Meltzer H.Y., Bobo W.V., Heckers S.H., Fatemi H.S. (2008). Chapter 16. Schizophrenia. In M.H. Ebert, P.T. Loosen, B. Nurcombe, J.F. Leckman (Eds),CURRENT Diagnosis & Treatment: Psychiatry, 2e. 


Q. 3

An elderly woman suffering from schizophrenia is on antipsychotic medication. She developed purposeless involuntary facial and limb movements, constant chewing and puffing of cheeks. Which of the following drugs is least likely to be involved in this side effect:

 A

Halperidol

 B

Clozapine

 C

Fluphenazine

 D

Loxapine

Ans. B

Explanation:

Ans:B-Clozapine

Common side effects of clozapine include:

  1. Sedation
  2. Hypersalivation
  3. Tachycardia
  4. Hypotension
  5. Hypertension
  6. Weight gain
  7. Constipation 
  8. Hepatic effects
  9. Urinary incontinence
  10. Fever

Serious side effects include:

  1. Agranulocytosis
  2. Cardiovascular/respiratory arrest
  3. Seizures

Q. 4

Drugs abuse with symptoms similar like paranoid schizophrenia are seen in

 A LSD

 B

Cannabis

 C

Heroin/Cocaine

 D

Amphetamine

Ans. B

Explanation:

Ans:B-Cannabis

  • A number of drugs used illicitly for recreational purposes do cause symptoms similar to those experienced in psychosis.
  • For instance cocaine and methamphetamine can both cause paranoia and amphetamine and LSD can cause visual hallucinations.
  • Cannabis can cause both auditory hallucinations (hearing voices) and paranoia. It is thought that this is caused by the primary active constituent of cannabis; a chemical called delta-9-tetrahydrocannabinol.
  • It has been suggested that cannabis use in early life (young teen age) increases the likelihood of the person going on to develop schizophrenia later.
  • It has also been suggested that with the newer forms of stronger cannabis that have become available in recent years this risk has increased.

Q. 5 Drugs used in schizophrenia include:

 A

Chlorpromazine

 B

Haloperidol

 C

Olanzapine

 D

All

Ans. D

Explanation:

Ans:D-All-A -Chlorpromazine; B – Haloperidol; C -Olanzepine

Medications are the cornerstone of schizophrenia treatment, and antipsychotic medications are the most commonly prescribed drugs. They’re thought to control symptoms by affecting the brain neurotransmitter dopamine

Antipsychotics include:

  • Chlorpromazine
  • Fluphenazine
  • Haloperidol
  • Perphenazine

Second generation antipsychotics and long injectable antipsychotics are also used


Q. 6

Drug of therapeutic benefit in Schizophrenia is

 A

Lithium

 B

Doxepin

 C

Imipramine

 D

Fluphenazine

Ans. D

Explanation:

Ans:D-Fluphenazine 

Medications are the cornerstone of schizophrenia treatment, and antipsychotic medications are the most commonly prescribed drugs. They’re thought to control symptoms by affecting the brain neurotransmitter dopamine.

 Antipsychotics include:

  • Chlorpromazine
  • Fluphenazine
  • Haloperidol
  • Perphenazine

Second generation antipsychotics and long-acting injectable antipsychotics are also used in the treatment.


Q. 7

Schizophrenia can be treated with all of the following except-

 A

Pemoline

 B

Olanzapine

 C

Sulpiride

 D

Chlorpromazine

Ans. A

Explanation:

Ans. is ‘a’ i.e., Pemoline

Antipsychotics (Neuroleptics)

o Antipsychotics are a group of psychoactive drugs commonly used to treat psychosis, e.g. Schizophrenia.

o Antipsychotic drugs are divided into:

A) Typical antipsychotics (first generation antipsychotics)

  1. Phenothkanes – Chlorpromazine, Thioridazine, Trifluperazine, Fluphenazine.
  2. Thioxanthenes – Thiothixene, Flupenthixol.
  3. Butyrophenones – Haloperidol, Trifluperidol, Penfluridol.
  4. Other heterocyclics – Pimozide, Loxapine, Sulpiride

B) Atypical antipsychotics (second generation antipsychotics)

  1. Clozopine                  3. Olanzopine                       5. Aripiprazole
  2. Risperidon                 4. Quetiapine                        6. Ziprasidone

Q. 8 Schizophrenia is treated by

 A Anti depressants

 B

Anti psychotics

 C

Anti epileptics

 D

Mood stabilizers

Ans. B

Explanation:

Ans. is ‘b’ i.e., Anti psychotics


Q. 9

Refractory schizophrenia – What is the treatment of choice

 A

Haloperidol

 B

Flupenthixol

 C

Trifluoperazine

 D

Clozapine

Ans. D

Explanation:

Ans. is ‘d’ i.e., Clozapine

o Clozapine (but not the newer atypicals) is more effective than classical agents for resistant schizophrenia.


Q. 10

Most common type of schizophrenia is:

 A

Paranoid

 B

Simple

 C

Catatonic

 D

Undifferentiated

Ans. A

Explanation:

Ans:A-Paranoid

Paranoid schizophrenia used to be the most common form of schizophrenia.

In 2013, the American Psychiatric Association determined that paranoia was a positive symptom of the disorder, so paranoid schizophrenia wasn’t a separate condition. Hence, it was then just changed to schizophrenia.


Q. 11 Type of schizophrenia with mental retardation:

 A Von-Gogh syndrome

 B

Paranoid schizophrenia

 C

Catatonic schizophrenia

 D

pfropfschizophrenia

Ans. D

Explanation:

Ans.D-pfropfschizophrenia

  • The Kraepelinian concept of pfropfschizophrenia refers to the intertwined coexistence of mental retardation and schizophrenia.
  • Patients with this syndrome are relatively treatment resistant and are often harmed by diverging policies and cost cuts within the framework of mental health care services.
  • Thus, a better understanding of this syndrome has important practical implications

Q. 12 All are diagnostic symptoms of schizophrenia except‑

 A

Catatonia

 B

Hallucinations

 C

Disorganized speech

 D

Social withdrawal

Ans. D

Explanation:

Ans. is ‘d’ i.e., Social withdrawal

Diagnostic criteria for schizophrenia

  • Characteristic symptoms:- Two (or more) of the following for a 1 months duration (or less if successfully treated):‑
  1. Delusions
  2. Hallucinations
  3. Disorganized speech
  4. Grossly disorganized or catatonic behavior
  5. Negative symptoms, i.e., affective flattening, alogia.

Note:- Only one of the above is required if delusions are bizarre or there are third-person hallucinations (running commentary or two voices arguing or conversing).

  • Social/occupational dysfunction
  • Duration:- Continuous signs of the disturbance persist for at least 6 months. This 6 months period must include at least 1 month of symptoms that meet criteria A.
  • Exclusion of mood disorder and schizoaffective disorder.
  • Exclusion of substance abuse/general medical condition.

Q. 13 All are true about type 1 schizophrenia except‑

 A

Acute illness

 B

Good prognosis

 C

Negative symptoms

 D

Intellect maintained

Ans. C

Explanation:

Ans:C-Negative symptoms

 

Type I (Reactive or acute schizophrenia)

Type II (Process schizophrenia)

Characteristic symptoms
  • Positive symptoms (Hallucination, Acute Delusion, Thought)
 

  • Negative symptoms (Affect flattening, loss of speech loss of drive)
Type of illness

 

  • Acute

 

  • Chronic

 

Response to neuroleptics

 

  • Reversible

 

  • Poor
  • Long standing
  • Sometimes present

 

Outcome

 

  • Dopamine overactivity

 

 

  • Structural changes in brain (dilated ventricle on CT scan)

 

  Intellectual impairment

 

  • Absent

 

  • Present
Prognosis
  • Good
 

  • Poor

 


Q. 14 A person with violent behaviour and agitation was diagnosed to have Schizophrenia and was receiving haloperidol. Following this, he developed rigidity and inability to move his eyes. Which of the following drugs should be added to his treatment intravenously for this condition?

 A

Diazepam

 B

Risperidone

 C

Promethazine

 D

Haloperidol

Ans. C

Explanation:

Ans: C. Promethazine

  • This case suggestive of acute muscular dystonia in a schizophrenia patient.
  • Due to rigidity & inability to move eyes after haloperidol use.

Treatment:

  • IM anticholinergic (benztropine).
  • IV/IM antihistaminic (diphenhydramine hydrochloride) – Relieves symptoms.
  • Promethazine (25-50 mg IV or IM) – used less frequently but readily available.

Acute Muscular Dystonia:

Features:

  • Bizarre muscle spasms, mostly involving linguo-facial muscles-grimacing, torticollis, locked jaw.
  • Occurs within a few hours of a single dose or at most in the first week of therapy.
  • More common in children below 10 years & in girls, particularly after parenteral administration.

Treatment:

Central anticholinergic, promethazine or hydroxyzine.


Q. 15

Good prognosis in schizophrenia is/are seen in:

 A

Negative symptoms

 B

Early onset

 C

Acute onset

 D

Family history of schizophrenia

Ans. C

Explanation:

Ans. C-Acute onset

Good Prognosis in Schizophrenia:

  • Late onset (Onset >35 yr)
  • Short duration (<6months)
  • Obvious precipitating factors
  • Acute onset/ Abrupt onset
  • Good premorbid social, sexuaI and work histories
  • Mood disorder symptoms
  • (especially depressive disorders)
  • Married
  • Family history of mood disorders
  • Good social support systems

Positive symptoms:

  • Presence of precipitating stressor
  • Catatonic subtype(paranoid- intermediate prognosis)
  • First episode
  • Pyknic (fat) body
  • Female sex
  • Presence of confusion, perplexity or disorientation in the acute phase
  • Normal cranial CT
  • Outpatient treatment – Proper treatment & good response to treatment


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