NRNP 6635 UPDATED EXAM SCRIPT QUESTIONS AND
ANSWERS RATED A+
✔✔Other theories:
Hypofunction of the N-methyl-D-aspartate (NMDA) glutamate receptor. Dysfunctional
gamma-amino-butyric acid (GABA) interneurons.
Dysfunctional nicotinic acetylcholine receptors. - ✔✔Pathophysiology of schizophrenia
part 2
✔✔Patients with schizophrenia also have physical abnormalities of the brain tissue,
which can be seen in neuroimaging studies.
Loss of cortical tissue volume, including the limbic system, prefrontal cortex, thalamus,
hippocampus, and amygdala.
Ventricular enlargement (third and lateral).
Decreased symmetry.
Hypoactivity of the frontal lobes and hyperactivity of the basal ganglia. - ✔✔Physical
abnormalities of the brain in schizophrenia
✔✔Impairment of thoughts and affect, characterized by a distorted perception of reality.
The impairments are severe enough to affect the patient's ability to participate in social
events or to form relationships.
Patients with schizophrenia often lack awareness about their illness (insight).
Co-existing substance use disorder and dependence is common ("dual diagnosis").
Symptoms can be classified into premorbid, positive, negative, and cognitive. -
✔✔Clinical Presentation of schizophrenia
✔✔Easy to recognize.
Delusions:
1. False, fixed beliefs maintained by the patient despite being contradicted by reality or
logical arguments.
2. Can include grandiosity, ideas of reference, paranoia, persecutory, erotomania,
jealousy, and somatic delusions.
Hallucinations:
1. Perceptual abnormalities in which sensory experiences occur in the absence of
external stimuli.
2. Can be auditory (most common), visual, somatic, gustatory, and olfactory.
Illusions:
1. distinguished from hallucinations by the presence of real external stimuli that is
simply misinterpreted by the patient.
Disorganized speech and/or behavior:
1. can include neologisms, echolalia, flight of ideas, pressured speech, and loose
associations, among others. - ✔✔Positive (psychotic phase)
, ✔✔- Potentially difficult to recognize because of similarities to depression.
- Flat affect (diminished emotional expression).
- Avolition (lack of initiative).
- Alogia (poverty of speech).
- Poor attention.
- Anhedonia. - ✔✔Negative (residual phase)
✔✔- Usually nonspecific; related to the impact on the patient's quality of life.
- Poor executive functioning, represented by disorganized speech and/or thought that
results in impaired communication.
- Inattention
- Impaired memory - ✔✔Cognitive
✔✔Diagnosis is made by clinical observations based on the type of symptoms
presented, their severity and duration, and how the patient's life is affected by their
presence.
A total duration of symptoms of at least 6 months, including a period of positive
symptoms lasting at least 1 month.
The presence of a mix of positive and/or negative symptoms, especially delusions,
hallucinations, disorganized speech, or grossly disorganized or catatonic behavior.
The presence of these symptoms must disturb the patient's daily functioning, including
the social, personal, and professional areas of life. - ✔✔Diagnosis of Schizophrenia
✔✔Other conditions must be ruled out to make a definitive diagnosis:
- Schizoaffective, brief psychotic, and schizoaffective disorders.
- Mood disorders (e.g., major depressive disorder, bipolar disorder).
- Substance use disorder (requiring urine and blood toxicology tests). - ✔✔Other
conditions to rule out when diagnosing schizophrenia
✔✔Antipsychotic medications form the centerpiece of treatment for schizophrenia,
especially the positive symptoms.
Only caroprazine has been shown to have significant effects on negative symptoms.
The choice of a specific agent is mostly based on the adverse effect profile, the required
route of administration, and the patient's previous response to the drug.
Patients who respond usually show the most rapid improvement in the 1st 2 weeks and
will often continue to improve during the following weeks.
While there is a wide variety of mechanisms of action, most antipsychotics block
postsynaptic dopamine receptors. - ✔✔Pharmacological treatment for schizophrenia
✔✔older medications before 1989.
dopamine receptor antagonist
ANSWERS RATED A+
✔✔Other theories:
Hypofunction of the N-methyl-D-aspartate (NMDA) glutamate receptor. Dysfunctional
gamma-amino-butyric acid (GABA) interneurons.
Dysfunctional nicotinic acetylcholine receptors. - ✔✔Pathophysiology of schizophrenia
part 2
✔✔Patients with schizophrenia also have physical abnormalities of the brain tissue,
which can be seen in neuroimaging studies.
Loss of cortical tissue volume, including the limbic system, prefrontal cortex, thalamus,
hippocampus, and amygdala.
Ventricular enlargement (third and lateral).
Decreased symmetry.
Hypoactivity of the frontal lobes and hyperactivity of the basal ganglia. - ✔✔Physical
abnormalities of the brain in schizophrenia
✔✔Impairment of thoughts and affect, characterized by a distorted perception of reality.
The impairments are severe enough to affect the patient's ability to participate in social
events or to form relationships.
Patients with schizophrenia often lack awareness about their illness (insight).
Co-existing substance use disorder and dependence is common ("dual diagnosis").
Symptoms can be classified into premorbid, positive, negative, and cognitive. -
✔✔Clinical Presentation of schizophrenia
✔✔Easy to recognize.
Delusions:
1. False, fixed beliefs maintained by the patient despite being contradicted by reality or
logical arguments.
2. Can include grandiosity, ideas of reference, paranoia, persecutory, erotomania,
jealousy, and somatic delusions.
Hallucinations:
1. Perceptual abnormalities in which sensory experiences occur in the absence of
external stimuli.
2. Can be auditory (most common), visual, somatic, gustatory, and olfactory.
Illusions:
1. distinguished from hallucinations by the presence of real external stimuli that is
simply misinterpreted by the patient.
Disorganized speech and/or behavior:
1. can include neologisms, echolalia, flight of ideas, pressured speech, and loose
associations, among others. - ✔✔Positive (psychotic phase)
, ✔✔- Potentially difficult to recognize because of similarities to depression.
- Flat affect (diminished emotional expression).
- Avolition (lack of initiative).
- Alogia (poverty of speech).
- Poor attention.
- Anhedonia. - ✔✔Negative (residual phase)
✔✔- Usually nonspecific; related to the impact on the patient's quality of life.
- Poor executive functioning, represented by disorganized speech and/or thought that
results in impaired communication.
- Inattention
- Impaired memory - ✔✔Cognitive
✔✔Diagnosis is made by clinical observations based on the type of symptoms
presented, their severity and duration, and how the patient's life is affected by their
presence.
A total duration of symptoms of at least 6 months, including a period of positive
symptoms lasting at least 1 month.
The presence of a mix of positive and/or negative symptoms, especially delusions,
hallucinations, disorganized speech, or grossly disorganized or catatonic behavior.
The presence of these symptoms must disturb the patient's daily functioning, including
the social, personal, and professional areas of life. - ✔✔Diagnosis of Schizophrenia
✔✔Other conditions must be ruled out to make a definitive diagnosis:
- Schizoaffective, brief psychotic, and schizoaffective disorders.
- Mood disorders (e.g., major depressive disorder, bipolar disorder).
- Substance use disorder (requiring urine and blood toxicology tests). - ✔✔Other
conditions to rule out when diagnosing schizophrenia
✔✔Antipsychotic medications form the centerpiece of treatment for schizophrenia,
especially the positive symptoms.
Only caroprazine has been shown to have significant effects on negative symptoms.
The choice of a specific agent is mostly based on the adverse effect profile, the required
route of administration, and the patient's previous response to the drug.
Patients who respond usually show the most rapid improvement in the 1st 2 weeks and
will often continue to improve during the following weeks.
While there is a wide variety of mechanisms of action, most antipsychotics block
postsynaptic dopamine receptors. - ✔✔Pharmacological treatment for schizophrenia
✔✔older medications before 1989.
dopamine receptor antagonist
