Deck 18: Schizophrenia: Antipsychotic Drugs

Question 1

Which of the following is not a subtype of schizophrenia, according to Kraepelin?

A) Catatonic
B) Delusional
C) Undifferentiated
D) Paranoid

Answer 1

Delusional

Question 2

Which of the following are not structural changes observed in the brains of people with schizophrenia?

A) Reduced volume of the temporal lobe and limbic structures
B) Shrinkage of the ventricles
C) Atrophy of selected cortical layers
D) Disorganized arrangement of hippocampal cells

Answer 2

Shrinkage of the ventricles

Question 3

Molecular genetic research

A) has moved forward on the assumption that schizophrenia involves multiple genes located at different loci.
B) has identified potential "schizophrenia genes" on chromosomes 6, 8, 13, and 22.
C) uses either linkage studies or considers candidate genes in its search for the genetic basis of schizophrenia.
D) All of the above

Answer 3

All of the above

Question 4

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 neuronal positioning during development.
D) Studies have demonstrated a decrease in reelin in the brains of schizophrenic patients that could be explained by hypermethylation.

Question 5

The DISC1 gene codes for proteins _______ and polymorphisms in this gene are associated with _______.

A) involved in monoamine synthesis; impairments in working memory
B) involved in intracellular transport and axon elongation; motor disturbances
C) involved in neurogenesis and neuronal migration; impairments in performance on the WCST
D) found in dendritic spines; enlarged ventricles

Question 6

Which of the following is not an example of a prenatal or perinatal complication that is associated with schizophrenia?

A) Exposure to viral infection during the second trimester
B) Being delivered by Caesarean section
C) Oxygen deprivation during birth
D) Severe malnutrition

Question 7

Which of the following does not support the idea that CNS stimulants produce a psychosis that strongly resembles schizophrenia?

A) High doses of amphetamine in animals produce a syndrome of stereotyped licking, sniffing, and gnawing.
B) Cocaine and amphetamine addicts often have hallucinations and delusions.
C) Clinicians have difficulty discriminating between paranoid schizophrenia and drug-induced psychosis.
D) Amphetamine given to schizophrenics causes the occurrence of new symptoms.

Question 8

Studies investigating the neonatal ventral hippocampal lesion model show that lesioned rats exhibit _______ earlier and _______ later in development, and that _______ potentiates behavioral and biological outcomes.

A) negative-like symptoms; positive-like symptoms; early stress
B) negative-like symptoms; enhanced stress responses; tetrodotoxin
C) positive-like symptoms; cognitive-like symptoms; antipsychotics
D) enhanced stress responses; impaired cognitive function; antipsychotics

Question 9

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

A) Amphetamine produces a greater release of dopamine in schizophrenics than in control subjects.
B) Baseline levels of HVA do not differentiate controls and schizophrenics.
C) Increased dopamine receptors are found in postmortem schizophrenic brains.
D) Increasing the challenge dose of amphetamine makes schizophrenics' positive symptoms get progressively worse.

Question 10

Which of the following is not a part of 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 mesocortical pathway results in the negative symptoms of schizophrenia.
C) Hypofrontality results in a loss of inhibition of limbic structures, leading to positive symptoms.
D) The developmental event that causes the initial damage could be one of many factors; it is not a specific causal agent.

Question 11

What is evidence for a possible role for glutamate in schizophrenic symptoms?

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) PCP or ketamine can worsen symptoms in individuals with schizophrenia.
D) Increased levels of glutamate are found in postmortem studies of individuals with schizophrenia.

Question 12

All of the following evidence supports the idea that traditional antipsychotic medications act on the dopamine system except

A) there is a decrease in dopamine-induced prolactin release from the pituitary gland during treatment with antipsychotic drugs.
B) there is a positive 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 lower affinity for DA receptors require higher doses to be clinically effective.

Question 13

Parkinsonian symptoms in schizophrenia include all of the following except

A) rigidity.
B) sedation.
C) akathesia.
D) loss of facial expressions.

Question 14

How can Parkinsonian side effects from antipsychotic medications be treated?

A) Use anticholinergic drugs like Cogentin.
B) Because these effects are due to receptor supersensitivity, add another dopamine blocker from the phenothiazine class.
C) Use drugs that increase acetylcholine to balance the effects of dopamine blockade.
D) Add an atypical antipsychotic to the traditional neuroleptic medications.

Question 15

All of the following are true of tardive dyskinesia (TD) except

A) it occurs in about 10-20% of people treated with neuroleptic medications.
B) the cause of TD 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 may be irreversible in some patients.

Question 16

Which of the following is not a neuroendocrine side effect of the traditional antipsychotic medications?

A) Breast enlargement
B) Lack of menstruation
C) Inhibition of growth hormone
D) Increased sex drive

Question 17

Doctors generally take into consideration all of the following side effects when choosing a particular antipsychotic drug for a schizophrenic patient except for

A) sedation.
B) autonomic side effects.
C) hypotension.
D) abuse potential.

Question 18

Which statement about the abuse potential and dangers of antipsychotic medications is false?

A) Antipsychotics are rarely abused because they produce no euphoria.
B) Tolerance to the side effects of neuroleptics has not been observed, which helps to preserve their status as non-abused drugs.
C) Neuroleptic medications have a high therapeutic index and are very unlikely to be involved in overdoses.
D) Physical dependence and a withdrawal syndrome have not been observed with use of antipsychotic medications.

Question 19

Why are selective D₂ receptor antagonists like sulpiride unacceptable as antipsychotic agents?

A) They have common hormonal side effects.
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 20

All of the following are advantages of clozapine treatment of schizophrenia except

A) it works more quickly than the older medications.
B) it has a low incidence of motor side effects.
C) it helps about 60% of patients who do not respond to traditional medications.
D) it reduces negative symptoms of the disorder.

Question 21

Which of the following is not a drawback to using the drug clozapine to treat schizophrenia?

A) It reduces the seizure threshold.
B) It can cause agranulocytosis.
C) It causes the dry mouth syndrome.
D) It can cause cardiovascular problems.

Question 22

Results from CATIE, a blinded controlled study comparing multiple antipsychotics to replicate "real-world" prescriptions to a representative patient population, showed all of the following except that

A) approximately 75% of patients had to switch medications.
B) atypical drugs were no more effective than the classical neuroleptic.
C) the newer drugs did a better job of reducing cognitive symptoms.
D) the incidence of extrapyramidal symptom p s was the same for all drugs.

Question 23

Describe two preclinical models of schizophrenia: amphetamine-induced stereotypy and the neonatal ventral hippocampal lesion (NVHL) model. Include a basic description of each model and evidence that supports their usefulness for understanding schizophrenia.

Question 24

What is the prepulse inhibition of startle model and why is it used as an animal model for schizophrenia?

Question 25

Describe or diagram the neurodevelopmental model of schizophrenia.