American Board of Psychiatry and Neurology 1 — Questions and Answers
Question 1: On average, how long does the active phase of schizophrenia last?
- 1 Month (Correct answer)
- 1 Week
- 5 Months
- 8 Months
- 1 Year
Correct answer: 1 Month
The active phase of schizophrenia, characterized by prominent positive symptoms like delusions and hallucinations, must last for at least one month to meet diagnostic criteria according to the DSM-5. While the overall duration of the disorder is longer, the 'active phase' specifically refers to this period of acute symptom presentation. This duration helps differentiate schizophrenia from brief psychotic disorder, which is shorter.
Question 2: Which of the following DOES NOT indicate that a person has positive symptoms of schizophrenia?
- Erratic behaviors
- Avolition (Correct answer)
- Delusions
- Disorganized speech
- Movement disorders
Correct answer: Avolition
Positive symptoms of schizophrenia are those that add to or distort normal functions, such as delusions, hallucinations, and disorganized speech. Avolition, on the other hand, is a negative symptom, characterized by a decrease in motivated self-initiated purposeful activities. Negative symptoms represent a deficit or absence of normal functions, distinguishing them from the 'added' features of positive symptoms.
Question 3: Which receptors are inhibited by antipsychotics of the second generation?
- D1 and Alpha 1
- D2 and Beta 2
- D2 and 5HT2 (Correct answer)
- 5HT2 and Alpha 1
- Alpha 1 and Beta 2
Correct answer: D2 and 5HT2
Second-generation antipsychotics (SGAs), also known as atypical antipsychotics, primarily exert their therapeutic effects by blocking dopamine D2 receptors and serotonin 5-HT2A receptors. The D2 receptor antagonism helps reduce positive symptoms, while the 5-HT2A receptor antagonism is thought to contribute to their efficacy against negative and cognitive symptoms and a lower risk of extrapyramidal side effects compared to first-generation antipsychotics.
Question 4: Which combination of antipsychotics causes the most weight gain?
- Olanzapine and Clozapine (Correct answer)
- Olanzapine and Ziprasidone
- Olanzapine and Risperidone
- Risperidone and Clozapine
- Aripiprazole and Clozapine
Correct answer: Olanzapine and Clozapine
Among the antipsychotic medications, olanzapine and clozapine are consistently associated with the highest risk of significant weight gain and metabolic side effects. This is due to their potent antagonism of various receptors, including histamine H1 and serotonin 5-HT2C receptors, which play roles in appetite regulation and metabolism. Clinicians must carefully monitor patients on these medications for metabolic changes.
Question 5: What condition is not usually associated with Neuroleptic Malignant Syndrome (NMS)?
- Elevated fever
- Dysphagia
- Leukopenia (Correct answer)
- Lead pipe rigidity
- Autonomic instability
Correct answer: Leukopenia
Neuroleptic Malignant Syndrome (NMS) is characterized by elevated fever, severe muscle rigidity, autonomic instability, and altered mental status. While NMS can cause leukocytosis (elevated white blood cell count) due to stress, leukopenia (low white blood cell count) is not typically associated with NMS itself. Leukopenia, specifically agranulocytosis, is a known serious side effect of clozapine, but not a feature of NMS.
Question 6: Which antipsychotic medication is linked to retinal pigmentation?
- Haloperidol
- Fluphenazine
- Trifluoperazine
- Thioridazine (Correct answer)
- Chlorpromazine
Correct answer: Thioridazine
Thioridazine, a first-generation antipsychotic, is specifically linked to the rare but serious side effect of retinal pigmentation (retinitis pigmentosa). This adverse effect can lead to impaired vision and, in severe cases, blindness, especially at higher doses. Due to this and other side effects, its use has become very limited, and it is crucial to monitor for visual changes if prescribed.
Question 7: What is the mortality rate of Neuroleptic Malignant Syndrome if left untreated?
- 20% (Correct answer)
- 50%
- 85%
- 10%
- 25%
Correct answer: 20%
Neuroleptic Malignant Syndrome (NMS) is a medical emergency with a significant mortality rate if not promptly recognized and treated. Historically, the mortality rate for untreated NMS was reported to be as high as 20-30%, though with modern supportive care and early intervention, it has decreased. This high mortality underscores the importance of immediate discontinuation of the offending antipsychotic and aggressive medical management.
Question 8: Which percentage of schizophreniform disorders patients progress to schizoaffective or schizophrenia?
- 88%
- 50%
- 66% (Correct answer)
- 15%
- 25%
Correct answer: 66%
Schizophreniform disorder is diagnosed when symptoms of schizophrenia last for at least one month but less than six months. Approximately two-thirds (66%) of individuals diagnosed with schizophreniform disorder will eventually progress to a full diagnosis of schizophrenia or schizoaffective disorder if their symptoms persist beyond the six-month mark. The remaining one-third may recover completely.
Question 9: How common is schizophrenia in the general population?
- 5 to 15%
- 0.5 to 1.5% (Correct answer)
- 1 to 3%
- 20 to 25%
- 3 to 10%
Correct answer: 0.5 to 1.5%
Schizophrenia is a relatively uncommon but severe mental illness, with its prevalence in the general population consistently estimated to be around 0.5% to 1.5% worldwide. This figure represents the proportion of people who will experience schizophrenia at some point in their lives. This highlights its impact despite its lower prevalence compared to other mental health conditions.
Question 10: Which of these DOES NOT correspond to a schizophrenia subtype?
- Cataleptic Type (Correct answer)
- Disorganized Type
- Residual Type
- Paranoid Type
- Undifferentiated Type
Correct answer: Cataleptic Type
The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), previously recognized several subtypes of schizophrenia, including Paranoid, Disorganized, Catatonic, Undifferentiated, and Residual types. However, the DSM-5 eliminated these subtypes due to their limited diagnostic stability and predictive validity. While 'catatonic' was a subtype, 'cataleptic type' is not a recognized subtype of schizophrenia.
Question 11: In schizophrenia, which of the following is the best prognostic sign?
- High emotive family dynamic
- Highly negative symptoms
- Residing in a developed country
- Female gender
- Initial response to medication (Correct answer)
Correct answer: Initial response to medication
A strong initial response to antipsychotic medication is considered one of the best prognostic indicators for individuals with schizophrenia. Early and significant improvement in symptoms with treatment suggests a better likelihood of long-term symptom control, reduced relapse rates, and improved functional outcomes. This direct measure of treatment effectiveness is a powerful predictor of future success.
American Board of Psychiatry and Neurology 1
On average, how long does the active phase of schizophrenia last?