Deck 19: Schizophrenia: Antipsychotic Drugs

Question 1

Concerning the incidence and severity of schizophrenia,

A) although treatment is available, about 50% of people with the disorder spend a large part of their lives in psychiatric hospitals.
B) approximately 5% of the general population will receive a diagnosis of schizophrenia at some point in their lifetimes.
C) the disorder is considered to be chronic and incurable.
D) the incidence of the disorder is highest among young women in their late teens and early twenties.

Answer 1

C

Question 2

Psychoses are characterized by all of the following except

A) severe distortions of reality.
B) affective disturbances.
C) problems with intellectual functioning.
D) savant-like increases in intelligence.

Answer 2

D

Question 3

Which of the following is/are not a typical symptom of schizophrenia?

A) Auditory hallucinations
B) Delusions of persecution
C) Vague or illogical speech
D) Severe anxiety

Answer 3

D

Question 4

According to the positive/negative symptom classification scheme for schizophrenia,

A) people with positive symptoms have a poor outcome as they do not respond well to medications.
B) positive symptoms are made worse by drugs that increase dopamine.
C) people with negative symptoms tend to develop their problems in adulthood.
D) delusions and hallucinations are examples of negative symptoms.

Question 5

The symptoms of schizophrenia that tend to be more difficult to treat are

A) the positive symptoms.
B) the positive and the negative symptoms.
C) the negative symptoms and the cognitive symptoms.
D) the cognitive symptoms and the positive symptoms.

Question 6

Which statement regarding the diagnosis of schizophrenia is false?

A) Clinicians do not agree on whether it is a single disorder or a group of disorders.
B) The severity of the disorder and its unusual symptoms make diagnosis straightforward.
C) Diagnosis is complicated because symptoms of the disorder change over time.
D) There are several subtypes of schizophrenia recognized by the DSM-5, making the task more complex.

Question 7

A change observed in the brains of people with schizophrenia is

A) enlarged volume of the temporal lobe and limbic structures.
B) shrinkage of the ventricles.
C) increase in definition of selected cortical layers.
D) disorganized arrangement of hippocampal cells.

Question 8

The most consistent functional abnormality in the brains of individuals with schizophrenia is

A) global rather than localized EEG responses to stimuli.
B) eye-movement problems that impair the ability to track objects.
C) hypofrontality.
D) a deficit in stimulus perception and cognitive processing.

Question 9

All of the following evidence supports the idea that there is a strong genetic component to schizophrenia except

A) the monozygotic twin concordance rate is 48% but they share 100% of their genes.
B) first-degree relatives of schizophrenics are 12 times more likely than the general population to develop schizophrenia at some point in their lifetimes.
C) second-degree relatives of schizophrenics are four times more likely than the general population to develop schizophrenia in their lifetimes.
D) even when twins are reared apart, the difference in concordance rates is maintained, with the monozygotic rates always higher than the dizygotic rates.

Question 10

Which statement about molecular genetic research on schizophrenia is true?

A) It has moved forward on the assumption that schizophrenia involves a single gene.
B) It has identified potential "schizophrenia genes" on chromosomes 10 and 14.
C) It involves identifying immune disorders in people with schizophrenia.
D) At present, 145 loci have been identified as likely sites for genes that increase the risk for developing schizophrenia

Question 11

Polymorphisms in the _______ gene, which codes for proteins _______, are associated with a higher probability of schizophrenia.

A) RELN; involved in monoamine synthesis
B) RELN; involved in intracellular transport and axon elongation
C) DISC1; involved in neurogenesis and neuronal migration
D) DISC1; found in dendritic spines

Question 12

Which statement regarding the epigenetic modification of the RELN gene, which codes for the protein reelin, is false?

A) Acetylation causes a more "open" chromatin state and results in enhanced reelin production.
B) Methionine makes schizophrenic symptoms worse for more than 60% of patients tested.
C) Disruption of reelin production could affect fetal neuronal positioning during development.
D) Studies show greater RELN hypermethylation in several corticolimbic brain areas in people with schizophrenia.

Question 13

The most all-encompassing perinatal risk factor for schizophrenia appears to be

A) maternal exposure to second-hand smoke.
B) maternal and/or fetal inflammatory responses.
C) maternal alcohol consumption during pregnancy.
D) age of mother during pregnancy.

Question 14

A patient arrives at a hospital ER with paranoid delusions and auditory hallucinations. If she has no history of schizophrenia, which drug would you expect to find in her blood sample?

A) Heroin
B) LSD
C) THC
D) Cocaine

Question 15

Prenatal inflammation models such as maternal exposure to polyI:C during pregnancy results in _______ in hippocampal neurogenesis.

A) short-term increases
B) long-term increases
C) short-term decreases
D) long-term decreases

Question 16

Which of the following does not support the dopamine hypothesis of schizophrenia?

A) Amphetamine produces a greater release of dopamine in people with schizophrenia than in control subjects.
B) Baseline levels of HVA do not differentiate controls and people with schizophrenia.
C) Increased dopamine receptors are found in post-mortem brains of people with schizophrenia.
D) An exaggerated DA response results in more severe positive symptoms.

Question 17

Which model of schizophrenia integrates the neurochemical data with the neuroanatomical findings concerning the disorder?

A) The dopamine hypothesis
B) The glutamate-dopamine model
C) The DA imbalance hypothesis
D) The neurodevelopmental model

Question 18

Which of the following is associated with the neurodevelopmental model of schizophrenia?

A) Cognitive functions are most affected by the excess activity in the disinhibited mesolimbic pathway.
B) Early damage to the indirect basal ganglia pathway results in the negative symptoms of schizophrenia.
C) High mesolimbic DA activity following mesocortical cell loss may explain the dramatic positive symptoms of schizophrenia.
D) The model attempts to identify the cause of the proposed early mesocortical cell loss.

Question 19

Which of the following is evidence for a possible role for glutamate in symptoms of schizophrenia?

A) Overactivity of glutamatergic NMDA receptors can help explain the negative symptoms.
B) Overactivity of glutamatergic NMDA receptors can help explain the cognitive symptoms.
C) Blocking glutamatergic NMDA receptors with PCP or ketamine produces a psychotic syndrome similar to symptoms of schizophrenia.
D) Increased levels of glutamate are found in post-mortem studies of individuals with schizophrenia.

Question 20

Which findings in rat experiments support glutamate signaling involvement in the positive symptoms of schizophrenia?

A) Chronic AMDA antagonism causes inflammation and activation of microglia and cytokines in specific brain regions.
B) Chronic NMDA agonism causes inflammation and activation of microglia and cytokines in specific brain regions.
C) Blocking NMDA receptors in VTA results in an increase in DA release in the PFC and reduced release of DA in the nucleus accumbens.
D) Blocking NMDA receptors in VTA results in an increase in DA release in the nucleus accumbens and reduced release of DA in the PFC.

Question 21

Which statement about glutamate and DA in regard to symptoms associated with schizophrenia is true?

A) Overabundance of glutamate at the NMDA receptor may be a precursor to DA dysfunction and may explain increases in mesolimbic DA and decreases in PFC function.
B) Insufficient glutamate at the NMDA receptor may be a precursor to DA dysfunction and may explain increases in mesolimbic DA and decreases in PFC function.
C) NMDA receptors have indirect excitatory effects on of midbrain mesolimbic
DA neurons that project to limbic regions.
D) Schizophrenic symptoms are due to increased DA function in mesocortical neurons along with reduced DA function in mesolimbic dopaminergic neurons.

Question 22

Abilify (aripiprazole) can simultaneously decrease DA receptor activation in some brain regions and increase it in others, and this drug is classified as a(n)

A) partial agonist.
B) competitive antagonist.
C) noncompetitive antagonist.
D) inverse agonist.

Question 23

Which evidence supports the idea that traditional antipsychotic medications act on the dopamine system?

A) There is a decrease in dopamine-induced prolactin release from the pituitary gland during treatment with antipsychotic drugs.
B) There is no correlation between the potency of an antipsychotic drug and its ability to displace a labeled ligand from dopamine receptors.
C) antipsychotic drugs cause parkinsonian side effects, which are known to involve dopamine.
D) antipsychotics that have a higher affinity for DA receptors and do not require higher doses to be clinically effective.

Question 24

Parkinsonian symptoms in schizophrenia include

A) anxiety.
B) sedation.
C) flailing movements.
D) loss of facial expressions.

Question 25

One way that parkinsonian side effects from antipsychotic medications can be treated is

A) with anticholinergic drugs, like Cogentin
B) by adding second dopamine blocker from the phenothiazine class (because these effects are due to receptor supersensitivity).
C) with drugs that increase acetylcholine to balance the effects of dopamine blockade.
D) by adding an atypical antipsychotic to the traditional neuroleptic medications.

Question 26

How do the newer drugs valbenazine and deutetrabenazine act to reduce tardive dyskinesia in patients taking neuroleptics?

A) They inhibit the enzyme catechol-O-methyltransferase (COMT), which degrades DA in the synapse, halting its signaling.
B) They enhance glutamate activity at NMDA receptors.
C) As muscarinic ACh receptor antagonists, they reduce excess ACh activity.
D) They reduce the amount of DA that can be released into the synapse by inhibiting vesicular monoamine transporter, subtype 2 (VMAT2).

Question 27

Which of the following is thought to be responsible for tardive dyskinesia in patients taking antipsychotics?

A) Downregulation of D₂ receptors
B) Upregulation of D₂ receptors
C) Downregulation of 5-HT₂ receptors
D) Upregulation of 5-HT₂ receptors

Question 28

Which statement about tardive dyskinesia (TD) is true?

A) It occurs in about 50% to 60% of people treated with neuroleptic medications.
B) Its cause is not well understood, but it may be linked to excess dopamine receptors or a D₁-D₂ receptor imbalance.
C) The incidence of TD tends to decrease with increasing age of patients.
D) It is a motor side effect of neuroleptics that goes away when drug treatment is stopped.

Question 29

The _______ receptor is most involved in the therapeutic effects of the traditional antipsychotics.

A) D₁
B) D₂
C) D₃
D) D_4/5

Question 30

The time course of effectiveness for antipsychotic medications has been explained by all of the following observations except that

A) dopamine receptor blockade is not directly linked to clinical improvement.
B) chronic dopamine autoreceptor blockade may result in receptor supersensitivity, and hence decreased dopamine turnover.
C) a depolarization block can occur in response to increased dopamine turnover, which results from the initial antipsychotic drug blockade of receptors.
D) over time, antipsychotics decrease their binding to DA receptors and begin to act at other receptor populations.

Question 31

Which statement about the effectiveness of the traditional antipsychotic drugs is false?

A) About one-third of patients respond very well to medications and may achieve a relatively normal life.
B) Approximately one-third of patients remain hospitalized due to poor response to medication.
C) The main therapeutic effect of these medications is to reduce cognitive deficits and emotional responsivity.
D) About one-third of patients improve on medications but suffer relapses and need a great deal of support and assistance to deal with daily stresses.

Question 32

Which of the following is a neuroendocrine side effect of the traditional antipsychotic medications?

A) Decreased release of prolactin
B) Excessive sweating
C) Inhibition of growth hormone
D) Increased sex drive

Question 33

Why are selective D₂ receptor antagonists like sulpiride not usually a first choice as antipsychotic agents?

A) Hormonal side effects are common.
B) Their effects on the autonomic nervous system are not tolerated well by patients.
C) They cause too much sedation.
D) They impact the cardiovascular system more than researchers had hoped.

Question 34

One of the newer types of atypical antipsychotic medications are

A) phenothiazines.
B) butyrophenones.
C) dopamine system stabilizers.
D) piperazines.

Question 35

Which statement regarding broad-spectrum antipsychotics is false?

A) They block many receptor types, in addition to the D₂ receptor.
B) They include the best-known atypical neuroleptic, clozapine.
C) They work best with some combination of D₂ and 5-HT₂ receptor blockade.
D) They typically show high affinity for D₁ receptors.

Question 36

Which of the following is an advantage of clozapine in the treatment of schizophrenia?

A) It works more quickly than the other medications.
B) It helps to reduce the occurrence of seizures.
C) It helps about 60% of patients who do not respond to traditional medications.
D) It is more effective than other medications in reducing the positive symptoms of the disorder.

Question 37

Which of the following is not a dopamine pathway affected by antipsychotic medications?

A) Pathway from hypothalamus to pituitary
B) Mesocortical pathway
C) Pathway from the thalamus to the cortex
D) Nigrostriatal pathway

Question 38

Both inhibiting the enzyme catechol-O-methyltransferase (COMT) and the norepinephrine transporter (NET) inhibitor drug atomoxetine are strategies used to treat _______ by _______.

A) cognitive symptoms; enhancing PFC DA function
B) tremors; reducing PFC DA function
C) cognitive symptoms; enhancing PFC glutamate levels
D) tremors; reducing PFC glutamate levels

Question 39

To address the cognitive symptoms of schizophrenia, new pharmacological approaches are being developed that target specific aspects of various neurotransmitter systems, including

A) acetylcholine, dopamine, and glutamate.
B) serotonin and glutamate.
C) GABA and glutamate.
D) glycine, dopamine, and GABA.

Question 40

Which of the following was an important finding of CATIE, a blinded controlled study comparing multiple antipsychotics to replicate "real-world" prescriptions to a representative patient population?

A) Overall rates of drug discontinuation were about 55%.
B) Newer antipsychotic drugs are much more effective than first generation drugs and should be the first choice.
C) Drug effectiveness is very different under conditions similar to routine clinical practice compared with controlled trials.
D) Drug effectiveness is very similar under conditions similar to routine clinical practice compared with controlled trials.

Question 41

Describe schizophrenia in terms of incidence, diagnosis, and symptoms. Distinguish between positive, negative and cognitive symptoms.

Question 42

Describe two structural and two functional abnormalities that have been reported in schizophrenia.

Question 43

The genetic basis of schizophrenia has been explored by family studies, twin studies, linkage studies, searching for candidate genes, and using the microarray technique. Describe evidence from three of these research areas.

Question 44

Explain the current thinking on the biopsychosocial etiology of schizophrenia, including the early, latent, and late stages.

Question 45

Describe the amphetamine-induced stereotypy model of schizophrenia. Include evidence that supports the model's usefulness for understanding schizophrenia.

Question 46

Describe the evidence linking glutamate abnormalities to schizophrenia, including findings from studies with PCP. What do these findings suggest for treatment possibilities?

Question 47

Explain how a dopamine receptor partial agonist can both reduce and increase DA activity and indicate how this could be useful in the treatment of schizophrenia.

Question 48

Describe the characteristics and possible neurochemical basis of one of the following serious side effects of neuroleptic medications: parkinsonian symptoms and tardive dyskinesia.

Question 49

Describe the findings showing that there may be genetic risk factors that make certain people more predisposed to antipsychotic medication side effects.

Question 50

How has schizophrenia been treated in the past? What happened in the 1950s to change this situation? Describe the typical course of schizophrenia, and indicate how patients are treated today.

Question 51

Explain why the atypical neuroleptics are referred to as broad-spectrum antipsychotics. Name most well-known drug in this category and identify its advantages and disadvantages over older medications. Is it a perfect solution for schizophrenia? Why or why not?

Question 52

Describe the research efforts currently underway to address the cognitive symptoms of schizophrenia, including work focused on dopamine, acetylcholine, and glutamate.

Question 53

Cite evidence that shows that the traditional neuroleptics exert their clinical effects on the dopamine system, specifically dopamine receptors. Describe the homeostatic changes at the synapse that most likely account for the therapeutic effectiveness.

Question 54

List the four major dopamine pathways in the brain and identify the antipsychotic drug side effects associated with each. In general, how do doctors manage side effects when prescribing drugs for patients with schizophrenia?