Question 1

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

Accepted Answer

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. D

Question 2

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.

Accepted Answer

In the general population, the incidence of schizophrenia is approximately 1%. Both family studies and twin studies show that there is a significant genetic component for inheriting schizophrenia. First-degree relatives have an average lifetime risk 12 times higher (6-17%) than the general population. More distant (second-degree) relatives risk is still higher than the general population (average incidence of approximately 4% higher than the general population). Comparisons of monozygotic twins to dizygotic twins provide further confirmation of the role of genetics. Dizygotic twins (that share the same proportion of genes as siblings but also share the same prenatal and usually postnatal environment) have a concordance rate of 17%. Identical twins (or monozygotic) who share virtually all of their genes have a 48% concordance rate. These studies provide a compelling argument for the role of genes, although there is also a role for environment, otherwise the concordance rate would be markedly higher. Linkage studies look for similarities in the loci in families with affected members and some of these have been identified as possible sites that increase the risk for developing schizophrenia.

Question 3

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.

Accepted Answer

Prior to the introduction of antipsychotics in the 1950s, patients with schizophrenia were typically hospitalized. With the introduction of the first antipsychotics, hyperactivity, manic symptoms, and positive symptoms disappeared for many people who were then released from the hospital. Possible outcome is often discussed in terms of the "law of thirds": one-third of patients treated with antipsychotics show excellent response to the drug and may not ever need hospitalization even if they discontinue their medicine; one-third show improvement in symptoms but may experience relapse that requires hospitalization again from time to time; and one-third shows reduced recovery and may spend a considerable amount of time hospitalized.

Question 4

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.

Accepted Answer

The answer of Cite evidence that shows that the traditional...

Question 5

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)

Accepted Answer

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

Question 6

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

Accepted Answer

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 7

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

Accepted Answer

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 8

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?

Accepted Answer

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 9

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

Accepted Answer

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 10

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

Accepted Answer

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 11

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?

Accepted Answer

The answer of List the four major dopamine pathways in...

Question 12

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

Accepted Answer

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 13

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

Accepted Answer

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

Question 14

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

Accepted Answer

The answer of Describe two structural and two functional abnormalities...

Question 15

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

Accepted Answer

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 16

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

Accepted Answer

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 17

Which statement regarding broad-spectrum antipsychotics is false?

Accepted Answer

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 18

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

Accepted Answer

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 19

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

Accepted Answer

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

Question 20

Which statement regarding the diagnosis of schizophrenia is false?

Accepted Answer

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.

Exam 19: Schizophrenia: Antipsychotic Drugs