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Part II ISQ Club - Schizophrenia

39 posts in this topic

30 Part II ISQs on two topics will be posted twice a week. You are encouraged to post a reply in the thread, stating whether you think an ISQ is true or false and why (eg. a short explanation, with reference to the textbook you used). Please only deal with one ISQ in each post and include the question as the first line of your post. All ISQs are taken from previous posts by Forum members.

In a few days this ISQ Club thread will be moved to the Question Bank board. If you submit an answer, your status will be changed to 'Question Bank member' and you will be able to see the Question Bank board. Please allow up to 48 hours for this change to happen.

1. More than 50% of people on antipsychotics long-term will develop tardive dyskinesia

2. 5% of elderly schizophrenics have a family history of schizophrenia in the first degree relatives

3. Studies of expressed emotion have shown that derogatory comments are more important than over-involvement

4. Paraphrenia is characterised by more first rank symptoms than schizophrenia in early life

5. In delusional disorder of old age (paraphrenia), the delusions are usually First Rank

6. Presence of birth injury affects the age of onset of schizophrenia

7. In schizophreniform psychosis associated with temporal lobe epilepsy, it is most common shortly after a seizure

8. Neuroleptic malignant syndrome can be treated with a combination of a Ca-blocker and a dopamine agonist

9. Delusional disorder of old age (paraphrenia) usually progresses to dementia

10. Tardive dyskinesia occurs in > 50% of patients treated with long term neuroleptics

11. Waxy flexibility includes resisting passive movements

12. IQ affects the age of onset of schizophrenia

13. Considering ventricular dilatation on CT scan, there is a qualitative difference between bipolar disorder and schizophrenia

14. Hypometabolism of the prefrontal cortex is associated with schizophrenia

15. The combination of a calcium channel blocker and dopamine agonist is used to treat neuroleptic malignant syndrome

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Waxy flexibility includes resisting passive movements.

False.

From Core Psychiatry.

That is gegenhalten

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2. 5% of elderly schizophrenics have a first degree relative with schizophrenia

TRUE

Gaskell Seminars in Old Age Psychiatry

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14. Hypometabolism of the prefrontal cortex is associated with schizophrenia.

TRUE

Hypofrontality in schizophrenia - Revision Notes (Puri & Hall)

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15. The combination of a calcium channel blocker and dopamine agonist is used to treat neuroleptic malignant syndrome.

FALSE

Main treatments are rehydration, bromocriptine + dantrolene + benzos for sedation if required. Artificial ventilation or ECT may be needed.

Other drugs used include L-Dopa and CBZ 'amongst others'.

Calcium channel blockers not mentioned in:

The Maudsley Prescribing Guidelines 2003 or

Use of Drugs in Psychiatry (Cookson, Taylor, Katona).

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8. NMS can be treated with a combinaion of a Calcium channel blocker and a dopamine agonist.

For same reasons as above,

FALSE.

Saying that, Calcium blockers are probably amongst the 'other drugs'...

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1. More than 50% of people on antipsychotics long-term will develop tardive dyskinesia

FALSE

20-40% (Pg 553, Oxford Txt of Psych, 3rd Ed, Gelder et al)

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5. In delusional disorder of old age (paraphrenia), the delusions are usually First Rank

FALSE

Not usually. 1st rank sympts in about 30%

(Pg 735, Comp to Psych Studies, 6th Ed, Johnstone et al)

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9. Delusional disorder of old age (paraphrenia) usually progresses to dementia

FALSE

“No more than expected develop dementia”

(Pg 735, Comp to Psych Studies, 6th Ed, Johnstone et al)

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10. Tardive dyskinesia occurs in > 50% of patients treated with long term neuroleptics

FALSE

20-40% (Pg 553, Oxford Txt of Psych, 3rd Ed, Gelder et al)

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4. Paraphrenia is characterised by more first rank symptoms than schizophrenia in early life

FALSE  

Not usually. 1st rank sympts in about 30% of paraphrenics, but up to 72% of younger schizophrenics

(Pg 735, Comp to Psych Studies, 6th Ed, Johnstone et al;

Pg 276, Seminars in Gen Adult Psych, Vol 1)

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12. IQ affects the age of onset of schizophrenia

FALSE

Affects clinical features (Pg 252, Oxford Txt of Psych, 3rd Ed, Gelder et al)

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3. Studies of expressed emotion have shown that derogatory comments are more important than over-involvement

TRUE

More impt in depression than schiz (Pg 271, Rev Notes in Psych, Puri & Hall)

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7. In schizophreniform psychosis associated with temporal lobe epilepsy, it is most common shortly after a seizure

FALSE

Schizophreniform psychosis associated with temporal lobe epilepsy is inter-ictal, not post-ictal.

(Pg 341, Oxford Txt of Psych, 3rd Ed, Gelder et al)

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6. Presence of birth injury affects the age of onset of schizophrenia

TRUE

(Pg 276, Oxford Txt of Psych, 3rd Ed, Gelder et al)

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13. Considering ventricular dilatation on CT scan, there is a qualitative difference between bipolar disorder and schizophrenia

FALSE

“When various types of structural abnormalities were first described in schizophrenia, the initial hope was that these differences might turn out to be specific. This was not realized, as similar abnormalities have often been reported in affective disorders… the most consistent findings of structural brain differences relatively specific to affective disorders are abnormalities of subcortical white matter and basal ganglia”.

Brain Imaging in Mood Disorders (Pearlson and Schlaepfer) http://www.acnp.org/g4/GN401000100/CH098.html

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12. IQ affects the age of onset of schizophrenia

False

'Impairment in verbal learning and memory was associated with earlier disease onset. No association was found for working memory or IQ.'

Br J Psychiatry. 2004 Sep;185:215-9.

Age at onset and cognitive functioning in schizophrenia.

Tuulio-Henriksson A, Partonen T, Suvisaari J, Haukka J, Lonnqvist J.

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14. Hypometabolism of the prefrontal cortex is associated with schizophrenia

true

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8 + 15: false

was confused as thought dantrolene was a calcium channel blocker but manchester notes:

'dantrolene... blocks the release of intracellular stored ca ions & prevents the ca-dependent contraction of actin and myosin (thus it is not a ca channel blocker like eg verapamil)

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8 &15 :true nifedipine a calcium channel blocker is use in treatment of nms ref. google.com

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QUES: Tardive Dyskinesia occurs in more than 50% of pts. treated with long term neuroleptics.

ANS : FALSE

The overall prevalance is 20 to 25 percent.The incidence is 4 to 5 percent per anum.In patients first exposed in later life the incidence rates are as high as 30 percent.

COMPANIAN TO PSYCHIATRIC STUDIES. page269

Hasit

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