Thread: Schizophrenia Versus Schizoaffective Disorder - Clinical Implications

Schizophrenia Versus Schizoaffective Disorder:

Clinical Implications for Therapeutic Decisions

Test Questions

1. The criteria for schizoaffective disorder (SAD) diagnosis include:

• An uninterrupted period of illness during which, at some time, there is either a major depressive episode, a manic episode, or a mixed episode concurrent with symptoms that meet Criterion A for schizophrenia
• During the same period of illness, there have been delusions or hallucinations for at least 2 weeks in the absence of prominent mood symptoms
• Symptoms that meet criteria for a mood episode are present for a substantial portion of the total duration of the active and residual periods of the illness
• The disturbance is not due to the direct physiological effects of a substance or a general medical condition
• All of the above

Answer / Explanation:

[HIDE]
Answer: All of the above
The criteria for SAD include diagnostic elements of schizophrenia and bipolar disorder. There are controversies in the diagnosis of SAD given the overlap of symptoms.
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Schizophrenia Versus Schizoaffective Disorder:

Clinical Implications for Therapeutic Decisions

Test Questions



2. A poor prognosis in patients with SAD is generally not associated with:

• A predominant psychosis
• Negative symptoms
• A late onset
• An unremitting course
• No precipitating factors

Answer / Explanation:

[HIDE]Answer: A late onset

Onset is most common in late adolescence or early adulthood. An earlier onset has been shown to lead to poorer outcomes in SAD.[/HIDE]

3. Which of the following is not correct regarding issues in treating schizophrenia?

• 10% respond poorly to treatment
• There is a 50% noncompliance rate at 1 year
• There is a 25% relapse rate in treated patients per year
• 50% of patients attempt suicide at least once
• 10-15% of patients commit suicide

Answer / Explanation:

[HIDE]Answer: 10% respond poorly to treatment

30% of patients respond poorly to treatment.[/HIDE]

4. Which of the following neurotransmitter systems have been implicated in schizophrenia?

• Dopamine
• Serotonin
• GABA
• Norepinephrine
• All of the above

Answer / Explanation:

[HIDE]Answer: All of the above

Multiple neurotransmitter systems have been implicated in schizophrenia including dopamine, serotonin, GABA, norepinephrine, glutamate, acetylcholine, and neuropeptides.[/HIDE]

5. Medications suggested in the Expert Concensus Guidelines for use as adjunctive treatment in schizophrenia include all of the following except:

• Anticonvulsants
• Selective serotonin reuptake inhibitors (SSRIs)
• Lithium
• Alpha-adrenergic blockers
• Buspirone

Answer / Explanation:

[HIDE]Answer: Alpha-adrenergic blockers

Anticonvulsants, SSRIs, lithium, buspirone, and beta-adrenergic blockers such as propranolol (Inderal) have been suggested as adjunct therapy in schizophrenia.[/HIDE]

6. Which of the following is a factor affecting patient adherence to medication?

• Substance abuse
• Medication side affects
• Patient's perceived need for treatment
• Cost of treatment
• All of the above

Answer / Explanation:

[HIDE]Answer: All of the above

There are many variables that can negatively impact adherence, including patient symptoms and cognitive function, medication effectiveness and adverse effects, social support, and medication and transportation costs. [/HIDE]

7. Which of the follow is not true regarding the use of anticonvulsants in psychosis?

• They have a growing role in both schizophrenia and schizoaffective disorder
• They provide improvement in positive and negative symptoms
• Carbamazepine (Tegretol) is the most widely studied
• Augmentation with an anticonvulsant has shown to improve CGI, BRPS, and SANS greater than with an antipsychotic alone
• All of the above are true

Answer / Explanation:

[HIDE]Answer: Carbamazepine (Tegretol) is the most widely studied

Divalproex (Depakote) is the most widely studied anticonvulsant for use in psychosis. [/HIDE]

8. Which of the following adverse effect elicits moderate to severe distress among patients who experience it?

• Weight gain
• Akinesia
• Anticholinergic effects
• Sexual problems
• All of the above

Answer / Explanation:

[HIDE]Answer: All of the above

Patients reported moderate to severe distress in the range of 30-40% when experiencing weight gain, akinesia, anticholinergic effects, and sexual problems.[/HIDE]

9. Which is not an advantage of long-acting medication preparations for schizophrenia and schizoaffective disorder?

• Assurance of administration
• More predictable and stable plasma levels
• Loss of control perception from patient
• Reduced drug absorption variability
• Regular contact with health care team

Answer / Explanation:

[HIDE]Answer: Loss of control perception from patient

Long-acting preparations, administered every 2-4 weeks can provide routine contact with the health care team, assurance of administration, and more predictable levels given more consistent drug absorption. [/HIDE]

10. Which is a strategy that has shown to increase patient medication adherence?

• Providing information about the disease state
• Simplifying medication regimens
• Understanding the patient's attitudes about medication
• Providing information on the potential adverse effects of medications
• All of the above

Answer / Explanation:

[HIDE]Answer: All of the above

Providing disease state and medication information has been shown to help increase medication adherence.[/HIDE]