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110 Cards in this Set

  • Front
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Q: Which of the following has not been identified as an abnormal brain structure in person with schizophrenia?

A. Cortical atrophy
B. Enlarged ventricles
C. Enlarged hippocampus
D. Smaller frontal and temporal lobes
A: Enlarged hippocampus
Which neurotransmission alteration is usually present in schizophrenia?

A. Decreased dopamine in mesolimbic pathway
B. Decreased glutamate
C. Increased dopamine in the mesocortical pathway
D. Decreased GABA and Serotonin
A: Decreased GABA and Serotonin; all others are opposite
Q: True or False: Men tend to have more positive symptoms and better prognosis than women
A: False; men tend to have more negative symptoms than men and a poorer prognosis
Q: True or False: Women tend to have more paranoid delusions and hallucinations than men in schizophrenia
A: True
Q: All of the following are possible risk factors for schizophrenia except:

A. First order relative with schizophrenia
B. CNS infection in adolescence
C. Prenatal exposure to flu or virus
D. Obstetrical complications
A: CNS infection in adolescence; should be childhood
Q: During prodromal period, all of the following are mild manifestations of schizophrenia except:

A. Speech with mild delusional content
B. Odd behavior
C. Feeling unliked or pick on
D. Odd or unusual beliefs
A: Speech with mild delusional content; no delusions with prodromal period
Q: Explain why positive symptoms are called "positive symptoms"
A: Symptoms that respond positively to and that can be controlled by typical antipsychotic medications
Q: Name the neurotransmitter and brain pathway for positive and negative symptoms.
A: Positive: excess dopamine in the mesolimbic pathway

Negative: Decreased dopamine in the mesocortical pathway
Q: Name the seven "a's" of negative symptoms
A: Affective flattening, Alogia, Avolition, Apathy, Abstract-thinking problems, Anhedonia, Attention Deficits
Q: For the diagnosis of schizophrenia, what are the five types of symptoms that could be present?
A: Delusions, Hallucinations, Disorganized Speech, Grossly disorganized behavior, Presence of Negative Symptoms
Q: What is the one caveat were only one criterion meets the diagnosis of schizophrenia rather than two or more for one month period?
A: Only requires one criterion if delusions are bizarre or hallucinations consist of a voice that is running commentary or two or more voices conversing with each other
Q: How long should the duration of symptoms be for a diagnosis of schizophrenia?
A: For at least 6 months
Q: Which symptoms tend to appear first and persist over time, negative or positive?
A: Negative, positive decrease over time
Q: True or False: The longer the premorbid period is untreated in schizophrenia, the worse the prognosis
A: True
Q: What is the most severe subtype of schizophrenia? Least severe type?
A: Most severe; Disorganized

Least severe: Paranoid
Q: Name the five subtypes of schizophrenia
A: Paranoid, Disorganized, Catatonic, Undifferentiated, Residual
Q: Provide some of the characteristics of catatonic schizophrenia.
A: Immobility or excessive, purposeless motor movement influenced by environmental stimuli, extreme negativity, mutism, posturing oddities, echolalia, echopraxia
Q: What is undifferentiated schizophrenia?
A: There is a presence of schizophrenia but not a prominence of symptoms that is consistent with any of the other subtypes
Q: If a person with schizophrenia has the continued presence of negative symptoms but the absence of hallucinations, delusions, disorganized speech, and disorganized or catatonic behavior, which subtype would address this?
A: Residual
Q: Persons with schizophrenia may present with neurological soft signs. What is the difference between asteregnosis and dysdidiochokinesia?
A: Asteregnosis: loss of ability to identify object via touch

Dysdiadochokinesia: Unable to perform rapidly alternating movments
Q: What are two "hard neurological signs" that maybe found on a physical exam for a person with schizophrenia?
A: Weakness and decreased reflexes
Q: Provide two out of four ways speech may present in schizophrenic individuals?
A: Bizarre content, disorganized, tangential, loose associations
Q: In schizophrenia, there is hypovolume in all of the following structures except:

A. Amygdala
B. Hippocampus
C. Medulla
D. Thalamus
A: Medulla
Q: There are many medical problems and diseases that can have psychotic symptoms. Name some.
A: Epilepsy, CNS neoplasm, AIDS, B12 Deficiency, Heavy-metal poisoning, Huntington's Disease, Neurosyphillis, Systemic lupus, Wernike-Korsakoff Syndrome, Wilson's Disease, Acute Intermittent Porphyria
Q: True or False, Affective/Mood Disorders, Substance Disorders, and some Personality Disorders can have schizophrenic symptoms?
A: True, see page 188 in text
Q: Atypical antipsychotics function as what kind of antagonists? Where specifically is this blockade?
A: Serotonin-Dopamine; D2 and 5HT2a blockade
Q: True or false: Atypical generally do not cause tardive dyskinesia?
A: True
Q: True or False: In general, Serotonin inhibits dopamine
A: True
Q: Name the four dopamine pathways involved in schizophrenia and name the effects of each caused by giving antipsychotic medications
A: Mesolimbic pathway: decreased positive symptoms
Mesocortical pathway: decreased negative symptoms
Nigrostriatal pathway: EPS
Tuberoinfundibular pathway: hyperprolactinemia
Q: Name some symptoms of hyperprolactinemia
A: Sexual problems, galactorrhea, amenorrhea, bone demineralization in postmenopausal women not on estrogen
Q: Explain the mechanism for EPS.
A: Dopamine has a reciprocal relationship with acetylcholine. When dopamine is decreased with typical antipsychotics, then acetylcholine increases which causes EPS
Q: True or false: Dopamine increases prolactin
A: False, dopamine inhibits prolactin
Q: What is the only drug used for treatment resistant schizophrenia?
A: Clozapine
Q: Common side effects of clozapine include all of the following except:

A. Sialorrhea
B. Hyperlipidemia
C. Weight Gain
D. Bradycardia
A: Bradycardia
Q: Provide the monitoring schedule for pts. on clozaril in regards to WBC/ANCs.
A: During first 6 months: weekly
During second 6 months: every 2 weeks
Then after 12 months: Montly if WBC/ANC
Q: True or false: Clozaril is known to cause significant prolactin elevation
A: False
Q: There are 3 major life threatening adverse events that can happen with pts. taking clozapine. Name them
A: Agranulocytosis, Myocarditis, NMS
Q: True or False: Clozaril has the highest risk of the atypical antipsychotics for weight gain and diabetes?
A: True
Q: True or False: The higher the clozaril dose, the higher the risk for seizures
A: True
Q: Which of the following atypical antipsychotics would the PMNHP monitor for cataract development?

A. Risperidone
B. Ziprasidone
C. Quetiapine
D. Palliperidone
A: Quetiapine
Q: Name labs/tests that need to be monitored while a person is taking an atypical antipsychotic
A: Lipid panel, Fasting glucose, HA1C, Weight, BP, EKG
Q: Which atypical antipsychotic acts more like a typical antipsychotic at doses > 6mg?
A: Risperdal; >6mg has higher incidence of EPS
Q: Which atypical antipsychotic has the greatest prolactin elevation?
A: Risperidone
Q: With ziprasidone, what is an important teaching point the PMHNP would give the pt. in terms of taking the drug?
A: Taking the drug with food increases absorption twofold
Q: Why does ziprasidone need additional EKG monitoring?
A: Can prolong the QTc interval
Q: A patient who has schizophrenia has hypokalemia and hypomagnesemia. Which antipsychotic would you be more wary of giving and why?
A: Ziprasidone/Geodon because of increase cardiac risk from hypokalemia/hypomagnesemia
Q: A patient with chronic schizophrenia is 5 months post MI. Which of the following atypical antipsychotics would you least likely prescribe?

A. Geodon
B. Seroquel
C. Abilify
D. Invega
A: Geodon, contraindicated in pts. with MI or CHF
Q: How does aripiprazole set itself apart from other atypical antipsychotics? Think mechanism of action.
A: It is a partial agonist of D2 receptors
Q: True or False: Wt. gain, elevated lipid and blood glucose levels are not problematic with Abilify?
A: True
Q: Explain the difference between high and low potency antipsychotics in terms of risk.
A: High potency: Greater risk of EPS, less risk sedation and anticholinergic symptoms (Haldol, Prolixin)

Low potency: Greater risk of sedation and anticholinergic side effects but less risk of EPS (Thorazine)
Q: Provide the types of anti-Parkinsonian drugs used to treat EPS (4 types)
A: Anticholinergics, Antihistamines, Dopamine Agonists, Benzodiazepines
Q: True or false: Tardive dyskinesia can occur within 3 months of starting a typical antipsychotic
A: False, may occur in individuals treated more than a year
Q: What is the most common tardive dyskinesia symptom?
A: Perioral movements
Q: Tardive dyskinesia consists of four distinct abnormal, involuntary movements. What are they?
A: Lip smacking, chewing, tongue protrusion, twisting movements of the trunk or limbs
Q: AIMS test should be done how often on persons taking antipsychotic medications?
A: Every 3-6 months
Q: Which of the following is NOT a risk factor for developing tardive dyskinesia?

A. Older age
B. Presence of mood or cognitive disorder
C. Male gender
D. Long-term treatment with neuroleptics
A: Male gender; females more at risk
Q: What should the PMNHP ensure before starting an AIMS test?
A: That the patient does not have any gum in his or her mouth
Q: If symptoms are evident in an AIMS test, what should the PMHNP ascertain from the client?
A: Awareness of the symptoms, and if symptoms are interfering with daily functioning
Q: All of the following are performed during an AIMS test except:

A. Having the client sit in a chair with hands hanging
B. Having client walk to assess gait
C. Having client touch fingers to palm
D. Having client open their mouth and protrude their tongue
A: Have client touch fingers to palm, should be touch thumb to each finger
Q: Which EPS symptom can be mistaken for laziness or lack of interest?
A: Akinesia
Q: True or False: NMS can occur at anytime during treatment with antipsychotic medication
A: True
Q: All of the following are risk factors for NMS except:

A. Use of low potency typical antipsychotics
B. Use of high-potency typical antipsychotics
C. Rapid dose escalation
D. Parental administration of antipsychotics
A: Use of low potency typical antipsychotics
Q: All of the following labs are performed for suspected NMS except:

A. CPK
B. WBC
C. BUN
D. LFT
A: BUN
Q: All of the following are symptoms known to first occur in NMS except:

A. Hyperthermia
B. Hypertension
C. Hyperreflexia
D. Altered sensorium
A: Hypertension
Q: Assessing for NMS involves checking for symptoms of autonomic instability. Name 3 or 4 physical symptoms of autonomic instability
A: Hypotension, Extreme Muscular Rigidity, Hyperthermia, Tachycardia, Diaphoresis, Tachypnea, Coma, Potential Death
Q: Name 2 primary treatments for NMS.
A: Discontinuing the antipsychotic, administration of dantrolene or bromocriptine
Q: Which EPS symptom is often mistaken for increasing anxiety?
A: Akathisia
Q: A patient receiving Haldol 10mg BID complains of a very painful spasm in his neck. The PMNHP would immediately identify this symptom as what specifically?
A: Dystonia or dystonic reaction
Q: Provide 3-4 symptoms of pseudo-Parkinson's in EPS
A: Shuffling gait, Motor slowing, Mask-like facial expression, pill rolling, tremors, muscle rigidity
Q: Fluphenazine, perphenazine, and haloperidol have high _____________ side effects to low ______________ side effects
A: High: EPS

Low: Anticholinergic, sedation, hypotension
Q: Chlorpromazine has high __________ side effects to moderate __________ side effects
A: High: Sedation, hypotension

Moderate: EPS, anticholinergic
Q: True or False: Anticholinergic medications should be given with low potency typical antipsychotics?
A: False, there is a lower risk of EPS and giving anticholinergic medications would increase risk of anticholinergic toxicity
Q: Which of the following typical antipsychotics has a very high risk of EPS?

A. Mesoridazine
B. Thioridazine
C. Chlorpromazine
D. Fluphenazine
A: Fluphenazine
Q: Name 3 anticholinergic medications used to reduce EPS.
A: Benztropine, Trihexyphenidyl, Diphenhydramine
Q: Which of the following medications is not effective for akathisia?

A. Procyclidine (Kemadrin)
B. Benztropine
C. Diphenhydramine
D. Trihexyphenidyl (Artane)
A: Diphenhydramine
Q: Amantadine is a dopamine agonist that is potentially good for which EPS symptoms?
A: Akinesia and Pseudo-Parkinson's
Q: Which two cardiovascular medications are only used for akathisia?
A: Propanolol (Beta blocker) and Clonidine (Catapres)--Alpha 2 agonist
Q: Benzo's such as clonazepam and lorazepam are used only for 2 symptoms of EPS. What are those 2 symptoms?
A: Akathisia and Dystonia
Q: Antipsychotics have various side effect profiles. Name the common side effects according to alpha adrenergic blockade, muscarinic cholinergic blockade, endocrine side effects, and neurological side effect
A: Alpha adrenergic blockade: Orthostatic hypotension
Muscarinic Cholinergic Blockade: Dry mouth, blurred vision, constipation, urinary retention
Endocrine: Weight gain, increased prolactin levels,
Neurological: lowering of seizure threshold
Q: True or false: Individual therapy for schizophrenia and psychosis is more insight oriented rather than supportive
A: False, more supportive
Q: Which therapy type is used for the management of hallucinations and delusions?
A: CBT
Q: True or False: Children generally have more visual hallucinations than auditory in psychosis
A: True
Q: True or false: Older adults have a better prognosis with late onset schizophrenia because they are more responsive to medications due to dominance of positive symptoms
A: True
Q: In older adults, which kind of delusions are usually predominant in schizophrenia?
A: Persecutory
Q: For older adults on quetiapine, what should the PMNHP or primary care provider perform annually?
A: Annual eye exam checking for cataracts
Q: What is the duration of illness for schizophreniform disorder?
A: At least 1 month but less than 6 months duration
Q: True or False: The majority of those with schizophreniform will usually recover completely within 6 months
A: False, The majority of those with schizophreniform will go on to develop schizophrenia or schizoaffective disorder (66%)
Q: Besides meeting the criteria for schizophrenia, what else must be present for a diagnosis of schizoaffective disorder?
A: One or more mood disorders: Major depressive episode, manic episode, mixed episode
Q: In schizoaffective disorder, what must be present for at least 2 weeks in the absence of prominent mood symptoms?
A: Delusions or hallucinations
Q: Two or more symptoms of schizophrenia must be present for how long for a diagnosis of schizoaffective disorder?
A: At least one month
Q: When predominant mood symptoms are manic or mixed type this would denote which subtype of schizoaffective disorder?
A: Bipolar Type
Q: Is psychosocial functioning and daily behavior impaired for those with delusional disorder?
A: No, except their functioning and behavior are enveloped by the content of the delusion
Q: True or False: Delusions can be bizarre in delusional disorder.
A: False, they are nonbizarre, bizarre are for schizophrenia
Q: Which of the following delusion subtypes in delusional disorder is focused on the false belief that the client's spouse or partner is being unfaithful with someone else?

A. Persecutory
B. Grandiose
C. Erotomanic
D. Jealous
A: Jealous
Q: What does a person focus on in terms of delusional content who has somatic delusions? What are some things they might believe?
A: Focus on bodily functions and sensations

Might believe body part is infected, absent, omits a strange odor or is misshapen or malformed
Q: Which delusion subtype is focused on false belief that another person is in love with the client?
A: Erotomanic
Q: True or False: A person with brief psychotic disorder always returns to premorbid level of functioning.
A: True
Q: What is the duration of illness for brief psychotic disorder?
A: At least one day but less than one month
Q: What is the name of the disorder where two people in a close relationship share the same delusion where one individual has a psychotic disorder
A: Shared psychotic disorder or folie a deux
Q: What provides a good prognosis for the individual sharing a delusion with someone who has a psychotic disorder?
A: Being separated from the individual with the delusion
Q: Brief psychotic disorder has 3 specifiers, what are they?
A: With marked stressor, without marked stressor, with postpartum onset
Q: In which of the following phases would you want to minimize stress, enhance adaptation, and continue to reduce symptoms?

A. Maintenance Phase
B. Acute Phase
C. Relapse Phase
D. Stabilization Phase
A: Stabilization Phase
Q: True or False: In children and adolescents, atypical antipsychotics are faster and more robust than lithium and anticonvulsants for mania
A: True
Q: The full therapeutic effect of dopamine receptor antagonists takes how long?

A. Seven to 10 Days
B, 10 Days to 2 weeks
C. 4-6 weeks
D. 3-6 months
A: 4-6 weeks
Q: What are some motor and behavioral symptoms that might be present in NMS?
A: Muscular rigidity, dystonia, akinesia, mutism, obtundation, agitation
Q: Symptoms for this include agitation, disorientation, hallucinations, seizures, high fever, dilated pupils

What would you order for this?
A: Anticholinergic Toxicity; order physostigmine
Q: At what WBC level and ANC level would you need to suspend clozapine treatment?
A: WBC < 3000 and ANC < 1500, also notify registry
Q: Which antipsychotic has been know to reduce tardive dyskinesia?
A: Clozaril
Q: These two atypical antipsychotics are approved for teens/children with Bipolar I and as an adjunct for MDD?
A: Quetiapine and Aripiprazole
Q: Caffeine and cigarette smoking can do what to antipsychotics?
A: Diminish antipsychotic effects