SCHI

ZOPHRENI
A

Def
ini
ti
on

•Schi
zophr
eni
a:Apsy
chi
atr
icdi
sor
deri
nvol
vi
ngchr
oni
corr
ecur
rentpsy
chosi
s.I
t
i
sabur
densomecondi
ti
ont
hatl
eadst
osi
gni
fi
cantf
unct
ional
disabi
l
ity
.

•Psy
chi
atr
y:Thebr
anchofmedi
ci
nedeal
i
ngwi
tht
hedi
agnosi
sandt
reat
mentof
ment
aldi
sor
der
srel
atedt
opsy
chosi
sandot
hercondi
ti
ons.

•Psy
chosi
s:Adi
stur
bancei
ntheper
cept
ionofr
eal
i
ty,ev
idencedbysy
mpt
oms
l
i
kehal
l
uci
nat
ions,del
usi
ons,ort
houghtdi
sor
gani
zat
ion.Psy
chot
icst
atesar
e
per
iodsofhi
ghr
iskf
oragi
tat
ion,
aggr
essi
on,
andi
mpul
siv
ity
.

•Ov
eral
lSy
ndr
ome:Schi
zophr
eni
aisahet
erogeneoussy
ndr
omechar
act
eri
zed
bydi
sor
gani
zedandbi
zar
ret
hought
s,del
usi
ons,hal
l
uci
nat
ions,i
nappr
opr
iat
e
af
fect
,andi
mpai
redpsy
chosoci
alf
unct
ioni
ng.

Epi
demi
ology

•Li
fet
imePr
eval
ence:
Rangesf
rom 0.
28%t
o0.
6%gl
obal
l
y.

•Gl
obal
Impact
:Ov
er26mi
l
li
onpeopl
ewor
ldwi
del
i
vewi
thschi
zophr
eni
a.

•Onset
:Usual
l
yoccur
sinl
ateadol
escenceorear
lyadul
thood(
15-
25y
ear
sol
d).
Onseti
srar
ebef
oreadol
escenceoraf
terage40.

•GenderDi
ff
erences:

•Pr
eval
encei
sequal
inmal
esandf
emal
es.

1|
Page
 •Theonsetofi
l
lnesst
endst
obeear
li
eri
nmal
es(
ear
ly20s)compar
edt
o
f
emal
es(
lat
e20s)
.

•Pr
ognosi
sisgener
all
ywor
sei
nmen.

•Soci
alI
mpact
:Schi
zophr
eni
ais a di
sabl
i
ng di
sease,wi
th hi
gh r
ates of
homel
essness(
50%)
,ment
alheal
thadmi
ssi
ons(
50%)
,andunempl
oyment(
80%)
.

Et
iol
ogyandPat
hophy
siol
ogy

Theexactcausei
sunknown,
buti
tisconsi
der
edmul
ti
fact
ori
al.

•Genet
icBase:

•10%r
iskf
orf
ir
st-
degr
eer
elat
ivesofapat
ient
.

•40%r
iski
fbot
hpar
ent
shav
ethedi
agnosi
s.

•~50%concor
dancer
atef
ormonozy
got
ic(
ident
ical
)twi
ns.

•Env
ironment
alFact
ors:Pr
enat
aldi
ff
icul
ti
es (
e.g.
,mal
nut
ri
ti
on i
nthe f
ir
st
t
ri
mest
er)
,per
inat
alcompl
i
cat
ions,subst
anceuse,andi
mmi
grat
ionhav
ebeen
l
i
nked.

•Neur
oanat
omy
:Br
ain abnor
mal
i
ties i
ncl
ude i
ncr
eased v
ent
ri
cul
arsi
ze and
decr
easedgr
aymat
ter
.

Neur
otr
ansmi
tt
erHy
pot
heses:

1.Dopami
ner
gic Hy
pot
hesi
s:The cent
ralt
heor
y,suggest
ing t
hatpsy
chosi
s
r
esul
tsf
rom hy
per
act
ivi
tyorhy
poact
ivi
tyofdopami
ner
gicpr
ocessesi
nspeci
fi
c
br
ainr
egi
ons.

2|
Page
 •Posi
ti
veSy
mpt
oms(
hal
l
uci
nat
ions,del
usi
ons)ar
eli
nkedt
ohy
per
act
ivi
tyof
dopami
nei
nthemesol
i
mbi
cpat
hway
.

•Negat
iveandCogni
ti
veSy
mpt
omsar
eli
nkedt
ohy
poact
ivi
tyofdopami
nei
n
t
hemesocor
ti
cal
pat
hway
.

• Ev
idence: Dr
ugs t
hat i
ncr
ease dopami
ne (
agoni
sts l
i
ke L-
Dopa,
amphet
ami
nes)can i
nduce psy
chosi
s,whi
l
e dr
ugs t
hatdecr
ease dopami
ne
(
ant
agoni
stsl
i
keneur
olept
ics)r
educepsy
chosi
s.

2.Gl
utamat
ergi
cDy
sfunct
ion:Adef
ici
encyi
ngl
utamat
ergi
cact
ivi
ty,par
ti
cul
arl
y
att
heNMDAr
ecept
or,
canpr
oducesy
mpt
omssi
mil
art
odopami
nehy
per
act
ivi
ty.
Dr
ugs t
hatbl
ock NMDA r
ecept
ors(
li
ke PCP and ket
ami
ne)can i
nduce a
schi
zophr
eni
c-l
i
kest
ate.

3.Ser
otoni
n(5-
HT)Abnor
mal
i
ties:Schi
zophr
eni
cpat
ient
smayhav
ehi
gherbl
ood
5-
HT concent
rat
ions,whi
chcor
rel
atewi
thi
ncr
easedv
ent
ri
cul
arsi
ze.5-
HT2A
ant
agoni
stsar
eakeycomponentofat
ypi
cal
ant
ipsy
chot
ics.

Cl
i
nical
Present
ati
on

•Acut
eEpi
sode:
Char
act
eri
zedbybei
ng"
outoft
ouchwi
thr
eal
i
ty.
"

•Sy
mpt
om Cat
egor
ies:

1.Posi
ti
veSy
mpt
oms:
Thepr
esenceofabnor
mal
funct
ions.

•Del
usi
ons:
Fixedf
alsebel
i
efs(
e.g.
,par
anoi
a,gr
andi
osi
ty)
.

•
Hal
l
uci
nat
ions:Sensor
yexper
ienceswi
thoutext
ernalst
imul
i
.Audi
tor
y
hal
l
uci
nat
ions(
hear
ingv
oices)ar
emostcommon(
40-
80%)
.

•Di
sor
gani
zedSpeech:
Looseassoci
ati
ons,
tangent
ial
i
ty.

3|
Page
 •Di
sor
gani
zedorCat
atoni
cBehav
ior
.

2.Negat
iveSy
mpt
oms:
Theabsenceorr
educt
ionofnor
mal
funct
ions.

•Al
ogi
a:Pov
ert
yofspeech.

•Av
oli
ti
on:
Lackofmot
ivat
ion.

•Anhedoni
a:I
nabi
l
ityt
oexper
iencepl
easur
e.

•Fl
atAf
fect
:Di
mini
shedemot
ional
expr
essi
on.

•Asoci
ali
ty:
Soci
alwi
thdr
awal
.

3.Cogni
ti
veSy
mpt
oms:

•I
mpai
redat
tent
ionandwor
kingmemor
y.

•Di
ff
icul
tywi
thexecut
ivef
unct
ion(
planni
ng,
probl
em-
sol
vi
ng)
.

•Resi
dualFeat
ures:Af
teranacut
epsy
chot
icepi
soder
esol
ves,pat
ient
smay
ex
per
ienceanxi
ety
,suspi
ci
ousness,
lackofmot
ivat
ion,
andpoori
nsi
ght
.

Di
agnosi
s(DSM-
5Abbr
evi
atedCr
it
eri
a)

•Cr
it
eri
on A:Atl
eastt
wo oft
he f
oll
owi
ng sy
mpt
oms,each pr
esentf
ora
si
gni
fi
cantpor
ti
onoft
imedur
inga1-
mont
hper
iod(
atl
eastonemustbe1,2,or
3)
:

1.Del
usi
ons

2.Hal
l
uci
nat
ions

3.Di
sor
gani
zedspeech

4.Gr
ossl
ydi
sor
gani
zedorcat
atoni
cbehav
ior

4|
Page
 5.Negat
ivesy
mpt
oms

•Cr
it
eri
onB:Si
gni
fi
canti
mpai
rmenti
nfunct
ioni
ng(
wor
k,soci
alr
elat
ions,sel
f-
car
e).

•Cr
it
eri
onC:Cont
inuoussi
gnsoft
hedi
stur
banceper
sistf
oratl
east6mont
hs,
i
ncl
udi
ngatl
east1mont
hofact
ive-
phasesy
mpt
oms.

Tr
eat
mentPr
inci
plesandPhases

•Desi
red Out
comes:Al
l
evi
atet
argetsy
mpt
oms,pr
eventr
elapse,i
mpr
ove
psy
chosoci
alf
unct
ioni
ng,
andav
oidsi
deef
fect
s.

•PhasesofTr
eat
ment
:

1.Acut
e Phase (
<7 day
s):Goali
sto decr
ease agi
tat
ion,host
il
it
y,and
nor
mal
i
zesl
eep/
eat
ingpat
ter
ns.

2.St
abi
l
izat
ionPhase(
6-8weeks)
:Goali
stoi
mpr
ovesoci
ali
zat
ion,sel
f-
car
e,
andf
ormal
thoughtpr
ocesses.

3.Mai
ntenancePhase:Goali
stoav
oidr
elapses.Ant
ipsy
chot
icsshoul
dbe
cont
inuedf
oratl
east18mont
hs(
2-3y
ear
s)af
terr
emi
ssi
onf
rom af
ir
stepi
sode.
Forpat
ient
swi
thr
ecur
rentepi
sodes,
treat
menti
sof
teni
ndef
ini
te.

Phar
macot
her
apy
:Ant
ipsy
chot
ics

A.Fi
rst
-Gener
ati
on(
Typi
cal
)Ant
ipsy
chot
ics(
FGAs)

•Mechani
sm:
HighD2r
ecept
orant
agoni
sm,
low5-
HT2Aant
agoni
sm.

•Ef
fi
cacy
:Pr
imar
il
yef
fect
ivef
orposi
ti
vesy
mpt
oms.

5|
Page
•Si
de Ef
fect
s:Hi
gh r
isk ofExt
rapy
rami
dalSy
mpt
oms (
EPS)and Tar
div
e
Dy
ski
nesi
a(TD)
.

•Pot
ency
:

•Hi
ghPot
ency(
e.g.
,Hal
oper
idol
,Fl
uphenazi
ne)
:Hi
gherr
iskofEPS.

•Low Pot
ency(
e.g.
,Chl
orpr
omazi
ne,Thi
ori
dazi
ne)
:Hi
gherr
iskofsedat
ion,
ant
ichol
i
ner
gicef
fect
s,andor
thost
ati
chy
pot
ensi
on.

B.Second-
Gener
ati
on(
Aty
pical
)Ant
ipsy
chot
ics(
SGAs)

•Mechani
sm:
Moder
ate-
to-
high5-
HT2Aant
agoni
sm andl
owerD2ant
agoni
sm.

•Ef
fi
cacy
:Ef
fect
ivef
orposi
ti
ve,
negat
ive,
andcogni
ti
vesy
mpt
oms.

•Rol
e:Consi
der
edf
ir
st-
li
net
reat
ment(
exceptcl
ozapi
ne)
.

•Si
deEf
fect
s:Lowerr
iskofEPSandTD,butahi
gherr
iskofmet
abol
i
csi
de
ef
fect
s(wei
ghtgai
n,hy
per
li
pidemi
a,hy
per
gly
cemi
a).

•Exampl
es:Ri
sper
idone,Ol
anzapi
ne,Quet
iapi
ne,Ar
ipi
prazol
e,Zi
prasi
done,
Cl
ozapi
ne.

C.Cl
ozapi
ne:The mostef
fect
ive ant
ipsy
chot
ic,butr
eser
ved f
ort
reat
ment
-
r
esi
stantschi
zophr
eni
a due t
othe r
isk ofsev
ere agr
anul
ocy
tosi
s(r
equi
res
weekl
ybl
oodmoni
tor
ingi
nit
ial
l
y).

D.Long-
Act
ingI
nject
abl
eAnt
ipsy
chot
ics(
LAI
As)/DepotDosi
ng:

•Use:
Consi
der
edf
orpat
ient
swi
thpar
ti
alorpooradher
ence.

•For
mul
ati
on:Anest
erf
orm oft
hedr
ugi
sat
tachedt
oaf
att
yaci
dchai
nand
di
ssol
vedi
nanoi
lvehi
cle,
all
owi
ngf
orsl
ow,
gradual
rel
easeov
ert
ime.

6|
Page
• Exampl
es:Hal
oper
idolDecanoat
e,Fl
uphenazi
ne Decanoat
e,Ri
sper
idone
Mi
crospher
es,
Pal
i
per
idonePal
mit
ate,
Ari
pipr
azol
eMonohy
drat
e.

KeyAdv
erseEf
fect
s

•Ext
rapy
rami
dal
Sympt
oms(
EPS)
:

1.Dy
stoni
a:Sudden,
sust
ainedmuscl
espasms(
e.g.
,tor
ti
col
l
is)
.

2.Akat
hisi
a:Ani
ntensef
eel
i
ngofi
nnerr
est
lessnessandani
nabi
l
ityt
osi
tst
il
l.

3.Pseudo-
Par
kinsoni
sm:
Tremoratr
est
,ri
gidi
ty,
brady
kinesi
a.

•Tar
div
eDy
ski
nesi
a(TD)
:Inv
olunt
ary
,repet
it
ivemov
ement
soft
hef
ace,l
i
mbs,
andt
runk.Of
teni
rr
ever
sibl
e.I
nci
dencei
s~20%.

•Neur
olept
icMal
i
gnantSy
ndr
ome(
NMS)
:Ar
arebutl
i
fe-
thr
eat
eni
ngemer
gency
char
act
eri
zedbyf
ever
,muscl
eri
gidi
ty,aut
onomi
cinst
abi
l
ity
,andal
ter
edment
al
st
atus.

•Met
abol
i
cSi
deEf
fect
s:Wei
ghtgai
n,hy
per
gly
cemi
a,anddy
sli
pidemi
aar
emost
pr
omi
nentwi
thcl
ozapi
neandol
anzapi
ne.

•Endocr
ine:Hy
per
prol
act
inemi
a(i
ncr
easedpr
olact
inl
evel
),l
eadi
ngt
osexual
dy
sfunct
ion,gy
necomast
ia,and gal
act
orr
hea.Hi
ghestr
isk wi
th FGAs and
r
isper
idone.

•Car
diov
ascul
ar:Or
thost
ati
chy
pot
ensi
onandQTCpr
olongat
ion(
especi
all
ywi
th
t
hior
idazi
neandzi
prasi
done)
.

7|
Page
•Ant
ichol
i
ner
gicEf
fect
s:Dr
ymout
h,bl
urr
edv
isi
on,
const
ipat
ion,
uri
nar
yret
ent
ion
(
commonwi
thl
ow-
pot
encyFGAsandcl
ozapi
ne)
.

────────────────────

St
andar
dMul
ti
ple-
Choi
ceQuest
ions(
50)

1.Schi
zophr
eni
aisapsy
chi
atr
icdi
sor
derpr
imar
il
ychar
act
eri
zedbychr
oni
cor
r
ecur
rent
:

a)Anxi
ety

b)Psy
chosi
s

c)Depr
essi
on

d)Mani
a

2. The Dopami
ner
gic Hy
pot
hesi
s suggest
s t
hat posi
ti
ve sy
mpt
oms of
schi
zophr
eni
aar
erel
atedt
o:

a)Hy
per
act
ivi
tyofdopami
nei
nthemesol
i
mbi
cpat
hway

b)Hy
poact
ivi
tyofdopami
nei
nthemesol
i
mbi
cpat
hway

c)Hy
per
act
ivi
tyofdopami
nei
nthemesocor
ti
cal
pat
hway

d)Hy
poact
ivi
tyofdopami
nei
nthemesocor
ti
cal
pat
hway

3.Accor
dingt
otheDSM-
5,adi
agnosi
sofschi
zophr
eni
arequi
rescont
inuous
si
gnsofdi
stur
bancef
oratl
east
:

8|
Page
a)2weeks

b)1mont
h

c)6mont
hs

d)1y
ear

4.Whi
choft
hef
oll
owi
ngi
sconsi
der
edanegat
ivesy
mpt
om ofschi
zophr
eni
a?

a)Hal
l
uci
nat
ions

b)Del
usi
ons

c)Di
sor
gani
zedspeech

d)Av
oli
ti
on(
lackofmot
ivat
ion)

5.The mostcommon t
ype ofhal
l
uci
nat
ion exper
ienced byi
ndi
vi
dual
swi
th
schi
zophr
eni
ais:

a)Vi
sual

b)Ol
fact
ory

c)Tact
il
e

d)Audi
tor
y

6.Fi
rst
-Gener
ati
on(
Typi
cal
)Ant
ipsy
chot
ics(
FGAs)pr
imar
il
ywor
kbybl
ocki
ng
whi
chr
ecept
or?

a)5-
HT2A

b)D2(
Dopami
ne)

c)H1(
Hist
ami
ne)

d)M1(
Muscar
ini
c)

9|
Page
7.Second-
Gener
ati
on(
Aty
pical
)Ant
ipsy
chot
ics(
SGAs)ar
econsi
der
edf
ir
st-
li
ne
t
reat
mentmai
nlybecauset
heyhav
e:

a)Hi
gheref
fi
cacyf
orposi
ti
vesy
mpt
oms

b)Al
owerr
iskofExt
rapy
rami
dal
Sympt
oms(
EPS)

c)Nomet
abol
i
csi
deef
fect
s

d)Af
ast
eronsetofact
ion

8.Whi
choft
hef
oll
owi
ngi
sahi
gh-
pot
encyFGA?

a)Chl
orpr
omazi
ne

b)Thi
ori
dazi
ne

c)Hal
oper
idol

d)Cl
ozapi
ne

9.Whi
chadv
erseef
fecti
schar
act
eri
zedbyani
ntensei
nnerr
est
lessnessandan
i
nabi
l
ityt
osi
tst
il
l?

a)Dy
stoni
a

b)Akat
hisi
a

c)Tar
div
eDy
ski
nesi
a

d)Pseudo-
Par
kinsoni
sm

10.Neur
olept
ic Mal
i
gnantSy
ndr
ome (
NMS)i
sal
i
fe-
thr
eat
eni
ng condi
ti
on
char
act
eri
zedbymuscl
eri
gidi
ty,
aut
onomi
cinst
abi
l
ity
,al
ter
edment
alst
atus,
and:

a)Hy
pot
her
mia

b)Fev
er

10|
Page
c)Br
ady
car
dia

d)Sev
erer
ash

11.Tar
div
e Dy
ski
nesi
a(TD)i
sa l
ong-
ter
m si
de ef
fecti
nvol
vi
ng i
nvol
unt
ary
mov
ement
sthati
sof
ten:

a)Easi
l
ytr
eat
edwi
thant
ichol
i
ner
gics

b)Asi
gnoft
reat
mentsuccess

c)I
rr
ever
sibl
e

d)Anacut
ereact
iont
othef
ir
stdose

12.Cl
ozapi
nei
sreser
vedf
ort
reat
ment
-r
esi
stantschi
zophr
eni
aduet
oit
sri
skof
:

a)Sev
ereEPS

b)Agr
anul
ocy
tosi
s

c)QTCpr
olongat
ion

d)Tar
div
eDy
ski
nesi
a

13.Whi
cht
woSGAsar
emostassoci
atedwi
thahi
ghr
iskofmet
abol
i
csi
de
ef
fect
sli
kewei
ghtgai
nanddi
abet
es?

a)Ar
ipi
prazol
eandLur
asi
done

b)Zi
prasi
doneandI
loper
idone

c)Cl
ozapi
neandOl
anz
api
ne

d)Ri
sper
idoneandPal
i
per
idone

14.Bl
ocki
ngdopami
nei
nwhi
chpat
hwayi
sthoughtt
oleadt
oExt
rapy
rami
dal
Sy
mpt
oms(
EPS)
?

11|
Page
a)Mesol
i
mbi
cpat
hway

b)Mesocor
ti
cal
pat
hway

c)Ni
grost
ri
atal
pat
hway

d)Tuber
oinf
undi
bul
arpat
hway

15.Bl
ocki
ngdopami
nei
nthet
uber
oinf
undi
bul
arpat
hwayl
eadst
owhatadv
erse
ef
fect
?

a)EPS

b)Sedat
ion

c)I
ncr
easedpr
olact
inl
evel
s(Hy
per
prol
act
inemi
a)

d)Wei
ghtgai
n

16.Whati
stheusual
ageofonsetf
orschi
zophr
eni
a?

a)Chi
l
dhood(
5-10y
ear
s)

b)Lat
eadol
escence/
ear
lyadul
thood(
15-
25y
ear
s)

c)Mi
ddl
eage(
40-
50y
ear
s)

d)Lat
eli
fe(
>65y
ear
s)

17.The Gl
utamat
ergi
c Dy
sfunct
ion hy
pot
hesi
s ofschi
zophr
eni
afocuses on
whi
chr
ecept
or?

a)D2

b)5-
HT2A

c)GABA-
A

d)NMDA

12|
Page
18.Theacut
ephaseofschi
zophr
eni
atr
eat
mentt
ypi
cal
l
ylast
s:

a)<7day
s

b)6-
8weeks

c)4-
9mont
hs

d)1-
2year
s

19.Long-
Act
ingI
nject
abl
eAnt
ipsy
chot
ics(
LAI
As)ar
epr
imar
il
yusedt
o:

a)Pr
ovi
deaf
ast
eronsetofact
ion

b)Reducemet
abol
i
csi
deef
fect
s

c)I
mpr
oveadher
encei
npat
ient
swi
thpoorcompl
i
ance

d)Tr
eatnegat
ivesy
mpt
omsonl
y

20.Whi
chFGAi
spar
ti
cul
arl
yknownf
orcausi
ngsi
gni
fi
cantQTcpr
olongat
ion?

a)Hal
oper
idol

b)Fl
uphenazi
ne

c)Thi
ori
dazi
ne

d)Chl
orpr
omazi
ne

21.Asudden,sust
ained,i
nvol
unt
arymuscl
espasm,of
teni
ntheheadandneck
ar
ea,
iscal
l
ed:

a)Akat
hisi
a

b)Dy
stoni
a

13|
Page
c)Tr
emor

d)My
ocl
onus

22.Whati
stheappr
oxi
mat
eri
skofdev
elopi
ngschi
zophr
eni
aifone'
sident
ical
t
winhast
hedi
sor
der
?

a)10%

b)25%

c)50%

d)90%

23.Whi
cht
erm descr
ibesast
ateofdi
mini
shedemot
ional
expr
essi
on?

a)Al
ogi
a

b)Av
oli
ti
on

c)Anhedoni
a

d)Fl
ataf
fect

24.Whi
chSGAl
osesi
ts"
aty
pical
"pr
oper
ti
esandact
smor
eli
keanFGAathi
gher
doses(
>6mg)
?

a)Ol
anzapi
ne

b)Quet
iapi
ne

c)Ri
sper
idone

d)Ar
ipi
prazol
e

25.Accor
dingt
othet
reat
mental
gor
it
hm,i
fat
reat
ment
-naï
vepat
ientf
ail
sthei
r
f
ir
stant
ipsy
chot
ic,
thenextst
epi
sof
tent
o:

14|
Page
a)Addasecondant
ipsy
chot
ic

b)Ref
erf
orECT

c)Swi
tcht
oadi
ff
erentant
ipsy
chot
ic

d)Augmentwi
thanant
idepr
essant

26.Whi
choft
hef
oll
owi
ngi
sacogni
ti
vesy
mpt
om ofschi
zophr
eni
a?

a)Del
usi
ons

b)I
mpai
redwor
kingmemor
y

c)Fl
ataf
fect

d)Audi
tor
yhal
l
uci
nat
ions

27.Thet
erm"
psy
chosi
s"r
efer
sto:

a)Ast
ateofext
remesadness

b)Apat
ter
nofi
mpul
si
vebehav
ior

c)Adi
stur
bancei
ntheper
cept
ionofr
eal
i
ty

d)Achr
oni
clackofmot
ivat
ion

28.Low-
pot
encyFGAsl
i
kechl
orpr
omazi
near
eassoci
atedwi
thahi
gherr
iskof
:

a)EPS

b)Sedat
ionandant
ichol
i
ner
gicef
fect
s

c)Akat
hisi
a

d)Tar
div
eDy
ski
nesi
a

29.Thei
nit
ial
goal
oft
hest
abi
l
izat
ionphaseoft
reat
ment(
6-8weeks)i
s:

15|
Page
a)Compl
eter
emi
ssi
onofal
lsy
mpt
oms

b)I
mpr
ovementi
nsoci
ali
zat
ionandsel
f-
car
ehabi
ts

c)Fi
ndi
ngasui
tabl
elong-
act
ingi
nject
abl
e

d)Pr
event
ingf
utur
erel
apses

30.Themai
ntenancet
reat
mentaf
teraf
ir
stepi
sodeofschi
zophr
eni
ashoul
dbe
cont
inuedf
oratl
east
:

a)6mont
hs

b)1y
ear

c)18mont
hs(
2-3y
ear
s)

d)5y
ear
s

31.Whi
choft
hef
oll
owi
ngi
sNOTasecond-
gener
ati
on(
aty
pical
)ant
ipsy
chot
ic?

a)Ri
sper
idone

b)Ol
anzapi
ne

c)Quet
iapi
ne

d)Fl
uphenazi
ne

32.Whati
sthepr
imar
ymanagementst
rat
egyf
orDy
stoni
a?

a)I
ncr
easi
ngt
heant
ipsy
chot
icdose

b)Admi
nist
eri
nganant
ichol
i
ner
gicagentorabenzodi
azepi
ne

c)Swi
tchi
ngt
oal
ow-
pot
encyFGA

d)Wai
ti
ngf
ori
ttor
esol
veoni
tsown

16|
Page
33.Whi
chSGAi
sknownt
obeapar
ti
alagoni
statt
heD2r
ecept
or?

a)Cl
ozapi
ne

b)Ol
anzapi
ne

c)Ri
sper
idone

d)Ar
ipi
prazol
e

34.Adel
usi
oni
sbestdef
inedas:

a)Asensor
yper
cept
ionwi
thoutanext
ernal
sti
mul
us

b)Adi
mini
shedr
angeofemot
ional
expr
essi
on

c)Af
ixed,
fal
sebel
i
eft
hati
sresi
stantt
oev
idence

d)Asev
eredi
sor
gani
zat
ionofspeech

35.Whi
chsi
deef
fectr
equi
resr
egul
armoni
tor
ingofANC(
Absol
uteNeut
rophi
l
Count
)?

a)Tar
div
eDy
ski
nesi
a

b)Neur
olept
icMal
i
gnantSy
ndr
ome

c)Agr
anul
ocy
tosi
swi
thcl
ozapi
ne

d)Akat
hisi
a

36.I
nthet
reat
mental
gor
it
hm,whati
sther
ecommendedmonot
her
apyf
ora
pat
ientwhohashadani
nadequat
eresponset
otwoappr
opr
iat
eant
ipsy
chot
ic
t
ri
als?

a)Hal
oper
idol

b)Ri
sper
idone

17|
Page
c)Cl
ozapi
ne

d)Ar
ipi
prazol
e

37.Ar
ipi
prazol
elaur
oxi
lisal
ong-
act
ingi
nject
abl
ethatcanbeadmi
nist
eredat
whatf
requency
?

a)Ev
eryday

b)Ev
eryweek

c)Ev
ery6weeksorev
ery2mont
hs

d)Ev
ery6mont
hs

38.Si
alor
rhea(
drool
i
ng)
,especi
all
yatni
ght
,isapr
omi
nentsi
deef
fectofwhi
ch
ant
ipsy
chot
ic?

a)Hal
oper
idol

b)Ar
ipi
prazol
e

c)Cl
ozapi
ne

d)Ri
sper
idone

39.Thet
erm"
alogi
a"r
efer
sto:

a)Lackofpl
easur
e

b)Lackofmot
ivat
ion

c)Pov
ert
yofspeech

d)Soci
alwi
thdr
awal

40.Hi
gh-
pot
encyFGAshav
eahi
gherbi
ndi
ngaf
fi
nit
ytowhi
chr
ecept
or?

a)5-
HT2A

18|
Page
b)D2

c)H1

d)Al
pha-
1

41.Whi
choft
hef
oll
owi
ngi
sapr
edi
ctorofagoodant
ipsy
chot
icr
esponse?

a)I
nsi
diousonset

b)Onseti
nchi
l
dhood

c)Acut
eonsetandshor
tdur
ati
onofi
l
lness

d)Enl
argedv
ent
ri
cles

42.The"
FARM"acr
ony
mforNMSpr
esent
ati
onst
andsf
orFev
er,Aut
onomi
c
i
nst
abi
l
ity
,Ri
gidi
ty,
and:

a)My
ocl
onus

b)Mal
aise

c)Ment
alst
atuschange

d)Muscl
eweakness

43.Whi
chant
ipsy
chot
icr
equi
resamealofatl
east350-
500cal
ori
esf
orpr
oper
absor
pti
on?

a)Ol
anzapi
ne

b)Ri
sper
idone

c)Lur
asi
doneandZi
prasi
done

d)Ar
ipi
prazol
e

44.Depotf
ormul
ati
onsofFGAs,l
i
kehal
oper
idoldecanoat
e,ut
il
izewhatki
ndof

19|
Page
chemi
cal
str
uct
uret
oal
l
owf
orsl
owr
elease?

a)Asal
tcompl
ex

b)Anest
erf
orm at
tachedt
oaf
att
yaci
dchai
n

c)Ami
crospher
eencapsul
ati
on

d)Al
i
posomal
del
i
ver
ysy
stem

45.Whi
choft
hef
oll
owi
ngi
sNOTaposi
ti
vesy
mpt
om ofschi
zophr
eni
a?

a)Del
usi
ons

b)Hal
l
uci
nat
ions

c)Fl
ataf
fect

d)Di
sor
gani
zedspeech

46.Whi
choft
hef
oll
owi
ngi
sakeycomponentofadi
agnost
icwor
kupf
or
schi
zophr
eni
a?

a)At
ri
alofant
ipsy
chot
icmedi
cat
ion

b)At
hor
oughpat
ienthi
stor
yandment
alst
atusexami
nat
ion

c)AnEEGt
oconf
ir
mthedi
agnosi
s

d)Agenet
ict
est

47.Ant
ichol
i
ner
gicsi
deef
fect
sar
ecausedbyt
hebl
ockadeofwhi
chr
ecept
ors?

a)Dopami
ne

b)Ser
otoni
n

c)Hi
stami
ne

20|
Page
d)Muscar
ini
c

48.Apat
ientonanFGAdev
elopsashuf
fl
inggai
t,st
oopedpost
ure,
andat
remor
atr
est
.Thi
sisknownas:

a)Dy
stoni
a

b)Akat
hisi
a

c)Pseudo-
Par
kinsoni
sm

d)Tar
div
eDy
ski
nesi
a

49.Ol
anzapi
nepamoat
e,al
ong-
act
ingi
nject
abl
e,car
ri
esar
iskofwhatr
arebut
ser
iouspost
-i
nject
ionsy
ndr
ome?

a)Ser
otoni
nsy
ndr
ome

b)Hy
per
tensi
vecr
isi
s

c)Sedat
ion/
del
i
rium

d)Agr
anul
ocy
tosi
s

50.Whati
sakeyr
easont
hatSGAsar
ethoughtt
obeef
fect
ivef
ornegat
ive
sy
mpt
oms,
unl
i
keFGAs?

a)Thei
rhi
ghD2ant
agoni
sm

b)Thei
rbl
ockadeofhi
stami
ner
ecept
ors

c)Thei
rhi
gh5-
HT2Aant
agoni
sm

d)Thei
rpar
ti
alD2agoni
sm

────────────────────

21|
Page
Case-
BasedMul
ti
ple-
Choi
ceQuest
ions(
50)

1.A19-
year
-ol
dmal
eisbr
oughtt
otheemer
gencydepar
tmentbyhi
sfami
l
y.For
t
hepastmont
h,hehasbeenexpr
essi
ngbel
i
efst
hatt
heFBIi
smoni
tor
inghi
s
t
hought
s.Heal
sor
epor
tshear
ingv
oicescomment
ingonhi
sact
ions.Hehas
becomesoci
all
ywi
thdr
awn.Thi
sishi
sfi
rstpsy
chot
icepi
sode.Whati
sthemost
l
i
kel
ydi
agnosi
s?

a)Bi
pol
arIDi
sor
der

b)Maj
orDepr
essi
veDi
sor
derwi
thPsy
chot
icFeat
ures

c)Schi
zophr
eni
a

d)Del
usi
onal
Disor
der

2.A22-
year
-ol
dpat
ienti
sdi
agnosedwi
thschi
zophr
eni
a.Ashei
str
eat
ment
-naï
ve,
whi
chmedi
cat
ionwoul
dbeanappr
opr
iat
efi
rst
-l
inechoi
ce?

a)Ri
sper
idone

b)Cl
ozapi
ne

c)Hal
oper
idol

d)Thi
ori
dazi
ne

3.Apat
ientonhal
oper
idoldev
elopsasudden,pai
nfulspasm i
nhi
sneckwher
e
hi
sheadi
stwi
stedt
oonesi
de.Thi
sisanexampl
eof
:

a)Akat
hisi
a

b)Tar
div
eDy
ski
nesi
a

22|
Page
c)Dy
stoni
a

d)Pseudo-
Par
kinsoni
sm

4.A45-
year
-ol
dpat
ientwi
thchr
oni
cschi
zophr
eni
ahasf
ail
edadequat
etr
ial
sof
ol
anzapi
neandr
isper
idone.Accor
dingt
othet
reat
mental
gor
it
hm,whati
sthe
nextr
ecommendedst
ep?

a)Augment
ingr
isper
idonewi
thanant
idepr
essant

b)Swi
tchi
ngt
oal
ow-
pot
encyFGAl
i
kechl
orpr
omazi
ne

c)Di
scont
inui
ngal
lmedi
cat
ions

d)I
nit
iat
ingmonot
her
apywi
thcl
ozapi
ne

5.A pat
ientonahi
ghdoseofanant
ipsy
chot
ici
sbr
oughtt
otheERwi
tha
t
emper
atur
eof104°
F(40°
C),"
lead-
pipe"muscl
eri
gidi
ty,andconf
usi
on.Thi
s
pr
esent
ati
oni
smostconsi
stentwi
th:

a)Akat
hisi
a

b)Tar
div
eDy
ski
nesi
a

c)Neur
olept
icMal
i
gnantSy
ndr
ome(
NMS)

d)Ser
otoni
nSy
ndr
ome

6.A 30-
year
-ol
d woman wi
th schi
zophr
eni
ais st
abl
e on r
isper
idone but
compl
ainsofmi
ssi
nghermenst
rualper
iodsandbr
eastt
ender
ness.Thi
sismost
l
i
kel
yduet
o:

a)Ant
ichol
i
ner
gicef
fect
s

b)Hy
per
prol
act
inemi
a

c)Wei
ghtgai
n

23|
Page
d)Akat
hisi
a

7.Apat
ientwi
thpooradher
encet
oor
alant
ipsy
chot
icsi
sbei
ngconsi
der
edf
ora
l
ong-
act
ingi
nject
abl
e(LAI
A).Thet
eam choosespal
i
per
idonepal
mit
ate.Thi
sis
anexampl
eofwhatt
ypeofant
ipsy
chot
ic?

a)Al
ow-
pot
encyFGA

b)Ahi
gh-
pot
encyFGA

c)AnSGA

d)Anant
ichol
i
ner
gic

8.A 65-
year
-ol
d pat
ienton an ant
ipsy
chot
icdev
elopsi
nvol
unt
ary
,repet
it
ive
chewi
ngandl
i
p-smacki
ngmov
ement
s.Thesesy
mpt
omshav
ebeenpr
esentf
or
sev
eral
mont
hs.Thi
sismostchar
act
eri
sti
cof
:

a)Dy
stoni
a

b)Akat
hisi
a

c)Pseudo-
Par
kinsoni
sm

d)Tar
div
eDy
ski
nesi
a

9.Apat
ienti
sst
art
edonol
anzapi
ne.Whati
sthemosti
mpor
tantpar
amet
ert
o
moni
toratbasel
i
neandr
egul
arl
yther
eaf
ter
?

a)Pr
olact
inl
evel
s

b)Absol
uteneut
rophi
lcount

c)Wei
ght
,bl
oodgl
ucose,
andl
i
pids

d)QTci
nter
val

10.Anacut
elyagi
tat
edandpsy
chot
icpat
ienti
ntheERr
efusesor
almedi
cat
ion.
24|
Page
Whi
choft
hef
oll
owi
ngwoul
dbeanappr
opr
iat
eimmedi
atei
nter
vent
ion?

a)I
M ol
anzapi
ne

b)Or
alcl
ozapi
ne

c)I
M pal
i
per
idonepal
mit
ate(
LAI
A)

d)Or
alchl
orpr
omazi
ne

11.Apat
ientonchl
orpr
omazi
necompl
ainsofsev
eredi
zzi
nessuponst
andi
ng.
Thi
sismostl
i
kel
yduet
o:

a)EPS

b)Or
thost
ati
chy
pot
ensi
onf
rom al
pha-
1bl
ockade

c)Hy
per
prol
act
inemi
a

d)Ant
ichol
i
ner
gicef
fect
s

12.Apat
ientcomest
othecl
i
nicandi
sconst
ant
lypaci
ng,shi
ft
ingt
hei
rwei
ght
,
andst
ates"
Ifeell
i
keI
'
m cr
awl
i
ngoutofmyski
n."Thi
sisacl
assi
cpr
esent
ati
on
of
:

a)Akat
hisi
a

b)Dy
stoni
a

c)Anx
iet
y

d)Psy
chosi
s

13.Apat
ientwi
thschi
zophr
eni
aal
sohasasi
gni
fi
cantsei
zur
edi
sor
der
.Whi
ch
ant
ipsy
chot
icshoul
dbeusedwi
tht
hemostcaut
ionduet
oit
spot
ent
ialt
olower
t
hesei
zur
ethr
eshol
d?

a)Ar
ipi
prazol
e
25|
Page
b)Ri
sper
idone

c)Cl
ozapi
ne

d)Hal
oper
idol

14.Ay
oungmanonahi
ghdoseofhal
oper
idoli
sbei
ngassessedf
orEPS.Whi
ch
oft
he f
oll
owi
ng woul
d be t
he mostappr
opr
iat
e pr
ophy
lact
ict
reat
mentt
o
consi
der
?

a)Abet
a-bl
ocker

b)Anant
idepr
essant

c)Anant
ichol
i
ner
gicl
i
kebenzt
ropi
ne

d)Amoodst
abi
l
izer

15.Apat
ient
'sposi
ti
vesy
mpt
omshav
eresol
ved,butt
heyst
il
lexhi
bitf
lataf
fect
,
al
ogi
a,and av
oli
ti
on.Whi
ch medi
cat
ion cl
ass i
s gener
all
yconsi
der
ed mor
e
ef
fect
ivef
ort
hesesy
mpt
oms?

a)SGAs

b)FGAs

c)Benzodi
azepi
nes

d)Ant
ichol
i
ner
gics

16.Apat
ienti
sst
abl
eoncl
ozapi
nebutt
hei
rweekl
yWBC/
ANCmoni
tor
ingshows
acr
it
ical
l
ylowANC.Whati
sthemostappr
opr
iat
eact
ion?

a)Lowert
hedoseofcl
ozapi
ne

b)Addasecondant
ipsy
chot
ic

c)I
mmedi
atel
ydi
scont
inuecl
ozapi
ne
26|
Page
d)Recheckt
hel
absi
noneweek

17.Apat
ientwi
thaf
ir
stepi
sodeofschi
zophr
eni
ahasachi
evedr
emi
ssi
onand
compl
eted t
he acut
e and st
abi
l
izat
ion phases. How l
ong shoul
d t
hei
r
mai
ntenancet
reat
mentcont
inue?

a)6mont
hs

b)1y
ear

c)Atl
east18mont
hs(
2-3y
ear
s)

d)Forl
i
fe

18.Apat
ient
'sf
ami
l
yrepor
tst
hatt
heonsetofhi
sschi
zophr
eni
csy
mpt
omswas
v
erygr
adualov
ersev
eraly
ear
s,st
art
ingi
near
lyadol
escence.Thi
sisconsi
der
ed
a:

a)Goodpr
ognost
ici
ndi
cat
or

b)Poorpr
ognost
ici
ndi
cat
or

c)Pr
edi
ctorofr
esponset
oFGAs

d)Si
gnofami
sdi
agnosi
s

19.Apat
ienti
sbei
ngi
nit
iat
edonpal
i
per
idonepal
mit
ate(
LAI
A).Whati
sakey
consi
der
ati
onf
ort
hei
nit
ial
dosi
ng?

a)A2-
weekor
alov
erl
api
srequi
red.

b)I
tmustbegi
veni
ntheabdomen.

c)Ani
nit
iall
oadi
ngdosei
sgi
ven,f
oll
owedbyaseconddoseoneweekl
ateri
n
t
hedel
toi
dmuscl
e.

d)Thedosemustbet
aper
edupov
er4weeks.

27|
Page
20.Apat
ientonanFGApr
esent
swi
that
remort
hati
smostnot
iceabl
eatr
est
,
al
ongwi
thasl
ow,
shuf
fl
inggai
t.Thi
sisbestdescr
ibedas:

a)Akat
hisi
a

b)Dy
stoni
a

c)Tar
div
eDy
ski
nesi
a

d)Pseudo-
Par
kinsoni
sm

21.Apat
ientont
hior
idazi
neneedst
ohav
ewhi
choft
hef
oll
owi
ngmoni
tor
ed
cl
osel
yduet
oaspeci
fi
cri
skassoci
atedwi
tht
hisdr
ug?

a)ANC

b)Bl
oodpr
essur
e

c)ECGf
orQTcpr
olongat
ion

d)Li
verf
unct
iont
est
s

22.A pat
ientwhoi
saheav
ysmokeri
sst
art
edonol
anzapi
ne.Thecl
i
nici
an
shoul
dbeawar
ethatsmoki
ngcan:

a)I
ncr
easet
her
iskofEPS

b)Decr
easet
hebl
oodl
evel
sofol
anzapi
nebyi
nduci
ngCYP1A2

c)I
ncr
easet
her
iskofNMS

d)Bl
ockt
heabsor
pti
onoft
hedr
ug

23.Apat
ientwi
thschi
zophr
eni
ahasapar
ti
alr
esponset
oar
ipi
prazol
e.Whi
chof
t
hef
oll
owi
ngi
sthemostappr
opr
iat
enextst
ep?

a)St
opt
hemedi
cat
ioni
mmedi
atel
y

28|
Page
b)Swi
tcht
ocl
ozapi
ne

c) Maxi
mize t
he dose of ar
ipi
prazol
e bef
ore consi
der
ing a swi
tch or
augment
ati
on

d)AddasecondSGA

24.Apat
ientr
epor
tst
hatanext
ernalf
orcei
scont
rol
l
ingt
hei
ract
ions.Thi
sisan
ex
ampl
eofwhatt
ypeofsy
mpt
om?

a)Ahal
l
uci
nat
ion

b)Anegat
ivesy
mpt
om

c)Adel
usi
onofi
nfl
uence

d)Ani
l
lusi
on

25.Thef
ir
stant
ipsy
chot
icdr
ug,
discov
eredi
nthe1950s,
was:

a)Hal
oper
idol

b)Cl
ozapi
ne

c)Chl
orpr
omazi
ne

d)Ri
sper
idone

26.Apat
ientonquet
iapi
neex
per
iencessi
gni
fi
cantsedat
ion.Whati
sthemost
l
i
kel
yrecept
orr
esponsi
blef
ort
hissi
deef
fect
?

a)D2

b)5-
HT2A

c)H1(
Hist
ami
ne)

d)Al
pha-
1

29|
Page
27.An18-
year
-ol
dmal
eisst
art
edonahi
gh-
pot
encyFGA.Hei
sathi
ghestr
iskf
or
whi
chacut
esi
deef
fect
?

a)Wei
ghtgai
n

b)Dy
stoni
a

c)Agr
anul
ocy
tosi
s

d)Tar
div
eDy
ski
nesi
a

28.A pat
ient t
aki
ng an ant
ipsy
chot
ici
s al
so pr
escr
ibed an SSRI
.Thi
s
combi
nat
ioni
ncr
easest
her
iskofdr
ugi
nter
act
ions,especi
all
yinv
olv
ingwhi
ch
enzy
mesy
stem?

a)CYP450

b)Gl
ucur
oni
dat
ion

c)Renal
clear
ance

d)Bi
l
iar
yexcr
eti
on

29.A pat
ientwi
th schi
zophr
eni
a has been st
abl
e on a l
ow dose ofan
ant
ipsy
chot
icf
or5y
ear
s.Theyaski
ftheycanst
opt
hemedi
cat
ion.Whati
sthe
bestadv
ice?

a)Yes,
theycanst
opi
mmedi
atel
ysi
ncet
heyhav
ebeenst
abl
eforal
ongt
ime.

b)Theycanst
opt
hemedi
cat
ionbutshoul
drest
arti
tifsy
mpt
omsr
etur
n.

c)Theyshoul
dbeadv
isedt
hatl
i
fel
ongmai
ntenancei
sli
kel
ynecessar
yand
st
oppi
ngcoul
dleadt
oasev
erer
elapse.

d)Theycanswi
tcht
oal
esspot
entmedi
cat
ionl
i
keabenzodi
azepi
ne.

30|
Page
30.Apat
ientonanFGAi
str
eat
edf
orakat
hisi
a.Whi
choft
hef
oll
owi
ngwoul
dbe
anappr
opr
iat
emedi
cat
ionchoi
ce?

a)Benzt
ropi
ne

b)Pr
opr
anol
ol

c)Hal
oper
idol

d)Donepezi
l

31.Apat
ientwi
thahi
stor
yofhear
tdi
seaseneedsanant
ipsy
chot
ic.Whi
chSGA
i
sassoci
atedwi
thahi
gherr
iskofQTCpr
olongat
ionandshoul
dbeusedwi
th
caut
ion?

a)Ar
ipi
prazol
e

b)Lur
asi
done

c)Zi
prasi
done

d)Br
expi
prazol
e

32.A pat
ienti
sdi
agnosedwi
tht
ardi
vedy
ski
nesi
a.Whati
sthef
ir
stst
epi
n
management
?

a)I
ncr
easet
hedoseoft
heant
ipsy
chot
ic

b)Addanant
ichol
i
ner
gicagent

c)Consi
derswi
tchi
ngt
oanagentwi
thal
owerTDr
isk,
li
kecl
ozapi
neoraVMAT2
i
nhi
bit
or

d)Reassur
ethepat
ientt
hati
twi
l
lresol
veoni
tsown

33.Apat
ienti
sbei
ngi
nit
iat
edonr
isper
idonemi
crospher
es(
Risper
dalConst
a).
Whati
sacr
it
ical
counsel
i
ngpoi
nt?

31|
Page
a)Noor
alant
ipsy
chot
ici
sneeded.

b)A3-
weekov
erl
apwi
thanor
alant
ipsy
chot
ici
srequi
red.

c)Thei
nject
ioni
sgi
veni
ntheabdomen.

d)Thei
nject
ioni
sgi
venev
ery6mont
hs.

34.Apat
ienti
sfoundt
ohav
eenl
argedv
ent
ri
clesonabr
ainscan.I
nthecont
ext
ofschi
zophr
eni
a,t
hisf
indi
ngi
sconsi
der
ed:

a)Apr
edi
ctorofgoodr
esponse

b)Adi
agnost
iccr
it
eri
on

c)Apoorpr
ognost
ici
ndi
cat
or

d)Ar
esul
tofmedi
cat
ionsi
deef
fect
s

35.Whi
choft
hef
oll
owi
ngi
sNOTaf
ir
st-
li
net
reat
mentf
orschi
zophr
eni
a?

a)Ri
sper
idone

b)Ar
ipi
prazol
e

c)Quet
iapi
ne

d)ECT(
Elect
roconv
ulsi
veTher
apy
)

36.Apat
ienti
staki
ngal
ow-
pot
encyFGAandcompl
ainsofbl
urr
edv
isi
onand
ur
inar
yret
ent
ion.Thesear
eduet
othedr
ug'
sef
fectonwhi
chsy
stem?

a)Dopami
ner
gic

b)Ser
otoner
gic

c)Ant
ichol
i
ner
gic

d)Hi
stami
ner
gic

32|
Page
37.The managementofNMS i
ncl
udes di
scont
inui
ng t
he of
fendi
ng agent
,
suppor
ti
vecar
e,andpot
ent
ial
l
yusi
ngwhi
chmedi
cat
iont
oreducer
igi
dit
yand
f
ever
?

a)Benzt
ropi
ne

b)Pr
opr
anol
ol

c)Br
omocr
ipt
ineorDant
rol
ene

d)Lor
azepam

38.A pat
ienti
sbei
ngst
art
edonol
anzapi
ne.Theyshoul
dbecounsel
edt
hat
wei
ghtgai
nismostl
i
kel
ytobesi
gni
fi
cantdur
ing:

a)Thef
ir
sty
earoft
reat
ment

b)Thef
ir
st12weeksoft
reat
ment

c)Af
ter2y
ear
soft
reat
ment

d)Wei
ghtgai
nisnotacommonsi
deef
fect

39.Apat
ientwi
thahi
stor
yofpooradher
encehasagr
eedt
oanLAI
A.Theywant
t
heonewi
tht
hel
ongestdosi
ngi
nter
val
.Whi
choft
hef
oll
owi
ngof
fer
sanev
ery
-2-
mont
hopt
ion?

a)Ri
sper
idonemi
crospher
es

b)Pal
i
per
idonepal
mit
ate

c)Ar
ipi
prazol
elaur
oxi
l

d)Hal
oper
idol
decanoat
e

40.A pat
ientr
epor
tsabel
i
eft
hatt
elev
isi
oncommer
cial
sar
esendi
ngt
hem
secr
etmessages.Thi
sisanexampl
eofa:

33|
Page
a)Hal
l
uci
nat
ion

b)Del
usi
on

c)Negat
ivesy
mpt
om

d)Cogni
ti
vedef
ici
t

41.Whi
ch pat
hway
,when bl
ocked byant
ipsy
chot
ics,i
sresponsi
blef
ort
he
t
her
apeut
icef
fectonposi
ti
vesy
mpt
oms?

a)Mesol
i
mbi
c

b)Mesocor
ti
cal

c)Ni
grost
ri
atal

d)Tuber
oinf
undi
bul
ar

42.Apat
ientwi
thschi
zophr
eni
aandcomor
biddi
abet
esi
sbei
ngst
art
edonan
ant
ipsy
chot
ic.Whi
choft
hef
oll
owi
ngwoul
dbeamet
abol
i
cal
l
ysaf
erchoi
ce?

a)Cl
ozapi
ne

b)Ol
anzapi
ne

c)Zi
prasi
done

d)Quet
iapi
ne

43.Apat
ienti
sadmi
nist
eredanLAI
Aandexper
iencesanadv
erser
eact
ion.Akey
chal
l
engei
nthi
ssi
tuat
ioni
sthat
:

a)Ther
eact
ionwi
l
lbemi
l
dert
hanwi
thor
almedi
cat
ion.

b)Themedi
cat
ioncannotbequi
ckl
yremov
edf
rom t
hebody
.

c)Theadv
erser
eact
ioncanber
ever
sedwi
thanant
idot
e.

34|
Page
d)Thepat
ientwi
l
lnotbeawar
eoft
her
eact
ion.

44.Thef
ir
stst
epi
nthet
reat
mental
gor
it
hm f
oranewl
ydi
agnosed,t
reat
ment
-
naï
vei
ndi
vi
dual
is:

a)Cl
ozapi
nemonot
her
apy

b)Anyant
ipsy
chot
icmonot
her
apyexceptcl
ozapi
ne

c)Combi
nat
iont
her
apywi
thanFGAandSGA

d)Augment
ati
onwi
thanant
idepr
essant

45.Apat
ientonahi
gh-
pot
encyFGAi
sal
sot
aki
ngamedi
cat
ionf
oral
l
ergi
es.Thi
s
combi
nat
ioncoul
dwor
senwhi
chsi
deef
fect
?

a)EPS

b)Ant
ichol
i
ner
gicef
fect
s(sedat
ion,
drymout
h)

c)Wei
ghtgai
n

d)Akat
hisi
a

46.Apat
ientwi
thschi
zophr
eni
ahasadi
agnosi
sofgl
aucoma.Whi
chsi
deef
fect
woul
dbemostconcer
ning?

a)EPS

b)Ant
ichol
i
ner
gicef
fect
s(whi
chcanwor
sennar
row-
angl
egl
aucoma)

c)Met
abol
i
csy
ndr
ome

d)Akat
hisi
a

47.Anacut
elyagi
tat
edpat
ienti
sgi
venanI
Minj
ect
ionofhal
oper
idol
.Wi
thi
nan

35|
Page
hour
,theydev
elopaf
ixedupwar
ddev
iat
ionoft
hei
rey
es.Thi
sisanocul
ogy
ric
cr
isi
s,af
orm of
:

a)Akat
hisi
a

b)Dy
stoni
a

c)Tar
div
eDy
ski
nesi
a

d)NMS

48.Apat
ienthasbeenonast
abl
edoseofanant
ipsy
chot
icf
or10y
ear
s.They
hav
enev
erexper
iencedEPS.Ar
etheyst
il
latr
iskf
orTar
div
eDy
ski
nesi
a?

a)No,
ther
iskdi
sappear
saf
tert
hef
ir
st5y
ear
s.

b)No,
ift
heydi
dn'
tgetEPS,
theywon'
tgetTD.

c)Yes,
ther
iskofTDi
ncr
easeswi
tht
hedur
ati
onoft
reat
ment
.

d)Yes,
butonl
yift
heyswi
tcht
oadi
ff
erentmedi
cat
ion.

49.A pat
ientwi
thschi
zophr
eni
awant
stot
ryanon-
phar
macol
ogi
cther
apy
.
Whi
ch oft
he f
oll
owi
ng has t
he st
rongestev
idence base as an adj
unctt
o
medi
cat
ion?

a)Her
bal
remedi
es

b)Psy
chosoci
alr
ehabi
l
itat
ionpr
ogr
ams(
e.g.
,soci
alski
l
lst
rai
ning)

c)Acupunct
ure

d)Di
etar
ychangesal
one

50.Apat
ienti
sdescr
ibedashav
ing"
alogi
a."Thi
smeanst
heyar
eexper
ienci
ng:

a)Apov
ert
yofspeech

36|
Page
b)Al
ackofpl
easur
e

c)Ani
nabi
l
ityt
osi
tst
il
l

d)Af
ixedf
alsebel
i
ef

────────────────────

###AnswerKey

St
andar
dMul
ti
ple-
Choi
ceQuest
ions(
50)

1.B

2.A

3.C

4.D

5.D

6.B

7.B

8.C

9.B

10.B

11.C

12.B

37|
Page
13.C

14.C

15.C

16.B

17.D

18.A

19.C

20.C

21.B

22.C

23.D

24.C

25.C

26.B

27.C

28.B

29.B

30.C

31.D

32.B

38|
Page
33.D

34.C

35.C

36.C

37.C

38.C

39.C

40.B

41.C

42.C

43.C

44.B

45.C

46.B

47.D

48.C

49.C

50.C

Case-
BasedMul
ti
ple-
Choi
ceAnswer(
50)

39|
Page
1.
C

2.A

3.C

4.D

5.C

6.B

7.C

8.D

9.C

10.A

11.B

12.A

13.C

14.C

15.A

16.C

17.C

18.B

19.C

20.D

40|
Page
21.C

22.B

23.C

24.C

25.C

26.C

27.B

28.A

29.C

30.B

31.C

32.C

33.B

34.C

35.D

36.C

37.C

38.B

39.C

40.B

41|
Page
41.A

42.C

43.B

44.B

45.B

46.B

47.B

48.C

49.B

50.A

42|
Page