Schizophrenia Quiz- Check Your Basics

**Admin** Sun Jan 08, 2012 6:56 pm

Q1: In a patient with schizophrenia, therapy with an atypical antipsychotic may be more effective than a typical agent in:
A. Reducing positive symptoms
B. Reducing negative symptoms
C. Avoiding prolactin elevation
D. Avoiding weight gain

Q2: 40 YO female is newly diagnosed with schizophrenia & is planned to be started on atypical antipsychotic. Which of the following clinical indicator goes abnormal first, signifying the onset of metabolic syndrome:
A. Waist Circumference
B. Body weight
C. Triglyceride
D. HDL
E. Blood Pressure
F. Fasting Glucose

Q3: Based on CATIE trial, most likely reason for discontinuation of treatment was:
A. Lack of efficacy
B. Weight gain
C. Patient's decision
D. EPS
E. Sedation.

drkamalika Sun Jan 15, 2012 12:50 pm

Let me try answering.

Q1. B I read risperidone has significant prolactin effect, whereas other atypicals dont have much D2 effect, they have more afinity towards 5HT2A. so prolactin may not be the answer. Typical and atypical both have same weight gain effect in reality I guess.

Q2. Waist circumference

Q3. Patient decision?

Please post the answers, thanks for the good questions, keep them coming.

**Admin** Sun Jan 15, 2012 1:27 pm

Here are the answers with explanations

Ans 1: B. Reducing negative symptoms. Please check drkamalika's answer above for explanation. Also check the diagram below for Dopamine pathways explanation.

Schizophrenia Quiz- Check Your Basics Dopami10

Schizophrenia Quiz- Check Your Basics Dopami10

There are four major dopaminergic pathways: mesolimbic, mesocortical, nigrostriatal, tuberoinfundibular. D2 receptors are present in all 4 pathways.
Typical antipsychotics block D2 receptors in all pathways= Mesolimbic system (decreases positive psychotic symptoms), nigrostriatal system (result in EPS), tuberoinfundibular system (causes hyperprolactinaemia)

Atypical Antipsychotics: have more effect on Seretonin (5HT2A) >>Dopamine. They block D2 receptor in mesolimbic pathway only- so no other side effects (EPS & Hyperprolactinaemia). In addition Seretonin blockage (5HT2A) increases Dopamine release in other pathways -->resulting in improvement in negative symtpoms.
Exception= Risperidone (for more details read= http://www.medsafe.govt.nz/profs/puarticles/hyperpro.htm#Atypical)

Also check this link for "Basics of Nor-Epinephrine, Dopamine & Serotonin Neurons": http://bit.ly/uoDyEz

Schizophrenia Quiz- Check Your Basics Img_0111

Schizophrenia Quiz- Check Your Basics Img_0111

Schizophrenia Quiz- Check Your Basics Img_0112

Ans2: C. Triglyceride
Hypertriglyceridemia is the first abnormal test signifying the onset of Metabolic Syndrome.
Important for both Psychiatrist and primary care physicians.

Ans 3: C. Patient's decision

Schizophrenia Quiz- Check Your Basics Catie_10