Deck 8: Antipsychotic Drugs and Neurochemical Hypotheses of Schizophrenia

Question 1

In response to conventional antipsychotics, improvement in schizophrenic symptoms is most prominent ______________________________ of treatment and levels off soon thereafter.

A)within the first 24 hours
B)over a period of a few days
C)within the first 6-12 weeks
D)between 8 and 12 weeks

Answer 1

B

Question 2

Which form of schizophrenia is LEAST likely going to respond favorably to antipsychotic drugs?

A)schizophrenia with "positive" symptoms
B)chronic schizophrenia
C)acute schizophrenia
D)reactive schizophrenia

Answer 2

B

Question 3

The symptoms of tardive dyskinesia

A)may increase initially upon withdrawal of antipsychotic medication
B)generally decline in young patients after a period of months or years once antipsychotics cease being taken
C)often are not reversible once they develop in elderly patients
D)all of the above

Answer 3

D

Question 4

Clozapine (Clozaril) has been found to differ most clearly from the conventional antipsychotics in that it

A)induces minimal pseudoparkinsonism and tardive dyskinesia
B)has a lower degree of efficacy in the treatment of schizophrenia
C)has a higher degree of efficacy in the treatment of schizophrenia
D)is less likely to induce autonomic nervous system side effects

Question 5

The conventional antipsychotics differ from each other primarily in their _______ (1)_______ , most notably in their ability to __________(2)_____________.

A)(1) therapeutic effects; (2) reduce visual hallucinations
B)(1) nonspecific effects; (2) reduce cognitive disturbances
C)(1) dopaminergic effects; (2) induce tardive dyskinesia
D)(1) side effects; (2) induce sedation and anticholinergic effects

Question 6

The abuse liability of antipsychotic drugs

A)is equal to that of the benzodiazepines.
B)is nonexistent.
C)is increased when used for chronic schizophrenia.
D)has been determined to be problematic in drug-abusers.

Question 7

Which of the following is a common and potentially irreversible complication of chronic exposure to conventional antipsychotic drugs?

A)agranulocytosis
B)pseudoparkinsonism
C)addiction
D)tardive dyskinesia

Question 8

Which of the following are considered "negative symptoms" of schizophrenia?

A)those that develop slowly over time
B)blunted affect, lack of energy, inability to experience pleasure, and poverty of speech
C)hallucinations and delusions
D)those that occur suddenly after stress

Question 9

The atypical antipsychotic clozapine (Clozaril)

A)is less effective in reducing schizophrenia symptoms than conventional antipsychotic drugs
B)is a more specific dopamine receptor antagonist than conventional antipsychotics
C)exerts minimal or no motor side effects
D)all of the above

Question 10

Evaluate the efficacy of conventional (typical) antipsychotics in the treatment of schizophrenia in terms of time course
e.g., hallucinations, delusions, belligerence, disturbed thought processes.Efficacy in reducing negative symptoms is modest at best, and there is little improvement in general cognitive functioning.

Question 11

Besides the dopamine hypothesis, what are the other hypotheses of schizophrenia?

Question 12

What are three basic differences between the anxiolytic benzodiazepines (minor tranquilizers) and the conventional antipsychotics (major tranquilizers), in terms of their effects?

Question 13

The core symptoms of schizophrenia are clustered into

A)neutral and negative symptoms.
B)positive and negative symptoms.
C)positive and cognitive symptoms.
D)cognitive and negative symptoms.

Question 14

Which of the following has accompanied the use of antipsychotic drugs in the treatment of schizophrenia over the past 50 years?

A)decrease in the percentage of schizophrenics that are in institutions
B)decrease in the number of diagnosed schizophrenics
C)decrease in psychiatric admissions based on a diagnosis of schizophrenia
D)all of the above

Question 15

Which type of receptors have been most strongly implicated as a factor in schizophrenia?

A)dopamine
B)serotonin
C)norepinephrine
D)acetylcholine

Question 16

Provide three pieces of evidence to support the dopamine hypothesis of schizophrenia.
e.g., cocaine, amphetamine, PCP, MAOIs can induce schizophrenia-like symptoms or exacerbate those with schizophrenia, whereas drugs that deplete DA levels or competitively block DA receptors or reduce DA release generally reduce the symptoms in schizophrenics.Some schizophrenics have higher density of DA receptors than normal individuals in some areas of the brain.

Question 17

A group of symptoms which may occur in patients treated with conventional antipsychotic drugs in which the limbs stiffen, the hands and head exhibit tremors, and there is a slowness of movement is called

A)akathisia
B)parkinsonism
C)dyskinesia
D)tardive dyskinesia

Question 18

Which of the following is a characteristic of the "neuroleptic malignant syndrome"?

A)potentially lethal
B)severe catatonia
C)instability of the autonomic nervous system
D)all of these

Question 19

Compare the conventional (typical) antipsychotics, such as chlorpromazine (Thorazine) and haloperidol (Haldol), with the atypical antipsychotics, such as clozapine Clozaril and risperidone (Risperdal), in terms of their efficacy in the treatment of schizophrenia and most common and important side-effects.

Question 20

Although the atypical antipsychotic clozapine (Clozaril) has several advantages over other antipsychotics, a side-effect of clozapine that may make it an unacceptable drug in the treatment of many schizophrenic patients is

A)excessive weight gain
B)agranulocytosis
C)EEG abnormalities and grand mal seizures
D)all of these

Question 21

At the present time, the most effective drugs capable of reducing the symptoms of schizophrenia act as antagonists or inverse agonists at which types of receptors?

A)D2 and 5HT 2A
B)D1 and alpha 1 -adrenergic
C)beta 2 -adrenergic and M 1
D)GABA A and H 1

Question 22

A study has demonstrated that _____________ is significantly better than olanzapine in preventing suicidal behaviors.

A)risperidone
B)ziprasidone
C)clozapine
D)aripriprazole

Question 23

When side effects appear when antipsychotic drugs are given in the treatment of schizophrenia, it would be most appropriate to

A)stop administering the antipsychotic immediately
B)reduce the dosage of the antipsychotic
C)switch to another type of antipsychotic
D)either b or c would be appropriate

Question 24

Drugs used to reduce parkinsonism symptoms induced by antipsychotic drugs generally possess

A)anticholinergic properties
B)antiadrenergic properties
C)antiserotonergic properties
D)antidopaminergic properties

Question 25

Of the newer atypical antipsychotics, risperidone (Risperdal) appears to have an advantage over clozapine (Clozaril) in that risperidone is

A)much less likely to induce agranulocytosis
B)more effective in reducing the positive symptoms of schizophrenia
C)more effective in reducing the negative symptoms of schizophrenia
D)less likely to induce early onset extrapyramidal motor disturbances

Question 26

Risperidone (Risperdal), at low, clinically effective doses differs from conventional antipsychotics primarily in terms of their

A)degree of extrapyramidal motor disturbances induced
B)efficacy in reducing the negative symptoms of schizophrenia
C)efficacy in reducing the positive symptoms of schizophrenia
D)only a and b above

Question 27

When antipsychotics are taken chronically, tolerance develops

A)to virtually all their effects
B)most obviously with respect to their therapeutic effects
C)most obviously with respect to sedative effects, hypotension, and anticholinergic effects
D)with respect to tardive dyskinesia

Question 28

Anxiolytics (minor tranquilizers) and antipsychotics (major tranquilizers) are likely to differ a great deal in terms of their

A)efficacy in reducing the symptoms of schizophrenia
B)ability to induce seizure activity
C)ability to decrease muscle tone and tension
D)all of these

Question 29

If a drug blocks dopamine receptors and those receptors are located on both postsynaptic and presynaptic neurons, what would be the initial effect of the drug on levels of dopamine in the synaptic cleft?

A)no change from baseline levels
B)a decrease from baseline levels
C)an increase from baseline levels
D)a decrease and then increase from baseline levels

Question 30

With respect to the hypothesis that schizophrenia is due to structural damage to the brain, it has been observed that

A)some schizophrenics have structural abnormalities in their brains
B)some persons displaying the symptoms of schizophrenia do not evidence structural abnormalities in their brains (using present-day techniques)
C)some persons with structural abnormalities in their brains that resemble those found in some schizophrenics do not evidence the symptoms of schizophrenia
D)all of the above

Question 31

When using the atypical antipsychotic clozapine (Clozaril), it is important to monitor the

A)patients' white blood cell count for evidence of agranulocytosis
B)patients for evidence of tardive dyskinesia
C)patients for evidence of pseudoparkinsonism symptoms
D)patients' weight

Question 32

Clozapine (Clozaril) is most likely going to be used

A)in treatment refractory schizophrenics
B)in younger schizophrenics
C)in older schizophrenics
D)as a first line antipsychotic in acute onset schizophrenics

Question 33

Once their symptoms are in remission with antipsychotic drug treatment, if some schizophrenic patients are maintained on their medication and others have their medication discontinued, it is likely that the percentage of patients in the two groups that show symptom relapse will be approximately the same after

A)10 months
B)one year
C)two years
D)none of these

Question 34

Ceasing antipsychotic drug treatment would be least advisable in

A)schizophrenics with highly critical and nonsupportive relatives
B)chronic hospitalized schizophrenics who show minimal response to antipsychotics
C)patients who developed schizophrenic symptoms rapidly in response to stress
D)either b or c

Question 35

Because their pharmacological profiles are so similar, for research purposes, the dosages of conventional antipsychotics used in different patients are sometimes converted into what are called

A)butyrophenone equivalents
B)chlorpromazine equivalents
C)phenothiazine equivalents
D)antipsychotic equivalents

Question 36

Conventional antipsychotic drugs

A)block dopamine postsynaptic receptors
B)block dopamine autoreceptors
C)initially increase dopamine cell activity
D)all of these

Question 37

Compared to the conventional antipsychotics, the atypical antipsychotic clozapine (Clozaril) is

A)less effective in suppressing schizophrenia symptoms
B)less likely to induce orthostatic hypotension and sedation
C)much less likely to result in tardive dyskinesia with chronic exposure
D)all of the above

Question 38

Of the atypicals, the most extensive research has been with ________________.

A)risperidone
B)olanzapine
C)ziprasidone
D)quetiapine

Question 39

Conventional antipsychotics are most effective in reducing the ______________of schizophrenia.

A)positive symptoms
B)negative symptoms
C)depressed mood
D)anxiety-related symptoms

Question 40

Which two antipsychotics produce the most weight gain?

A)olanzapine and risperidone
B)risperidone and ziprasidone
C)clozapine and olanzapine
D)clozapine and risperidone

Question 41

Conventional antipsychotic drugs

A)reduce dopamine access to postsynaptic receptors
B)reduce dopamine access to autoreceptors
C)initially increase dopamine cell activity
D)all of these

Question 42

The atypical antipsychotics risperidone (Risperdal) and olanzapine (Zyprexa), at low, clinically effective doses differ from conventional antipsychotics primarily in terms of their

A)degree of extrapyramidal motor disturbances induced
B)efficacy in reducing the negative symptoms of schizophrenia
C)efficacy in reducing the positive symptoms of schizophrenia
D)only a and b above

Question 43

The atypical antipsychotics are equally effective in reducing the ______________of schizophrenia.

A)positive symptoms
B)negative symptoms
C)depressed mood
D)anxiety-related symptoms

Question 44

The atypical antipsychotic clozapine (Clozaril) differs from typical antipsychotics in terms of its

A)greater efficacy in reducing the negative symptoms of schizophrenia
B)lower incidence of tardive dyskinesia
C)lower incidence of parkinsonian-like motor disturbances
D)all of these Chapter 8.Answers to multiple choice questions and

Question 45

One problematic characteristic of several of the more commonly used atypical psychotics is

A)their abuse potential
B)their tendency to promote considerable weight gain
C)their tendency to worsen the negative symptoms of schizophrenia

Question 46

Aripiprazole (Abilify) has been called a third-generation antipsychotic.What is a major difference in its pharmacological profile from that of 1^st and 2^nd generation antipsychotic drugs?

A)Abilify blocks 5-HT2A receptors, whereas 1st and 2^nd generation antipsychotic drugs act as agonists at 5-HT2A receptors
B)Abilify blocks dopamine D2 receptors, whereas 1^st and 2^nd generation antipsychotic drugs act as agonists at dopamine D2 receptors
C)Abilify is a partial agonist at dopamine D2 receptors, whereas 1^st and 2^nd generation antipsychotic drugs act as antagonists or inverse agonists at dopamine D2 receptors

Question 47

Present speculations regarding key pharmacodynamic properties distinguishing atypical antipsychotics from conventional antipsychotics have proposed differences in

A)the degree to which these drugs block 5HT2 receptors relative to their ability to block D2-like receptors
B)the rate at which they dissociate from D2-like receptors
C)both a and b
D)none of these

Question 48

Most present-day antipsychotic medications are believed to exert their favorable effects in reducing symptoms of schizophrenia by acting as dopamine

A)agonists at D1-like dopamine receptors
B)agonists at D2-like dopamine receptors
C)antagonists at D1-like dopamine receptors
D)antagonists or inverse agonists at D2-like dopamine receptors

Question 49

Which of the following drugs has been shown to exert the greatest efficacy in the treatment of general cognitive deficits in individuals diagnosed with schizophrenia?

A)monoamine oxidase inhibitors
B)conventional antipsychotics
C)atypical antipsychotics

Question 50

Of the newer atypical antipsychotics, risperidone (Risperdal) and olanzapine (Zyprexa) appear to have an advantage over clozapine (Clozaril) in that these newer drugs are

A)much less likely to induce agranulocytosis
B)more effective in reducing the positive symptoms of schizophrenia
C)more effective in reducing the negative symptoms of schizophrenia
D)less likely to induce early onset extrapyramidal motor disturbances
E)all of the above