MCQ Quiz: Management of Psychotic Spectrum Disorders

The management of psychotic spectrum disorders, such as schizophrenia, is a complex and long-term process that requires a comprehensive, patient-centered approach. Pharmacists are integral members of the healthcare team, responsible for optimizing pharmacotherapy, managing side effects, and promoting adherence to improve a patient’s quality of life. This quiz will test your knowledge on the evidence-based management strategies for these challenging but treatable conditions.

1. What is the first-line pharmacologic treatment for a first episode of psychosis?

• a. A first-generation (“typical”) antipsychotic
• a. A second-generation (“atypical”) antipsychotic
• c. A long-acting injectable antipsychotic
• d. A combination of two antipsychotics

Answer: b. A second-generation (“atypical”) antipsychotic

2. The primary goal of the acute phase of treatment for schizophrenia is to:

• a. Cure the disease.
• b. Reduce acute, severe positive symptoms like hallucinations and agitation.
• c. Eliminate all negative symptoms.
• d. Find the highest tolerable dose of medication.

Answer: b. To reduce acute, severe positive symptoms like hallucinations and agitation.

3. A patient who fails to respond adequately to trials of at least two different antipsychotics may be considered a candidate for which highly effective agent?

• a. Haloperidol
• b. Aripiprazole
• c. Clozapine
• d. Lurasidone

Answer: c. Clozapine

4. A patient on an atypical antipsychotic complains of weight gain. In addition to counseling on diet and exercise, what is a potential medication management strategy?

• a. Increasing the dose of the current antipsychotic.
• b. Adding a second antipsychotic.
• c. Switching to an agent with a lower risk of metabolic side effects, like aripiprazole or ziprasidone.
• d. Adding metformin to the regimen.

Answer: c. Switching to an agent with a lower risk of metabolic side effects, like aripiprazole or ziprasidone.

5. Long-acting injectable (LAI) antipsychotics are a key management strategy for which common problem in schizophrenia?

• a. Acute agitation
• b. Medication non-adherence
• c. Metabolic side effects
• d. Drug-induced parkinsonism

Answer: b. Medication non-adherence

6. A patient on haloperidol develops a shuffling gait and resting tremor. This can be managed with:

• a. An increase in the haloperidol dose.
• b. The addition of an anticholinergic agent like benztropine.
• c. A switch to another high-potency first-generation agent.
• d. The addition of levodopa.

Answer: b. The addition of an anticholinergic agent like benztropine.

7. Which of the following is NOT a primary goal of the stabilization and maintenance phases of schizophrenia treatment?

• a. To prevent relapse.
• b. To improve social and occupational functioning.
• c. To minimize medication side effects.
• d. To discontinue all antipsychotic medication.

Answer: d. To discontinue all antipsychotic medication.

8. The choice between different second-generation antipsychotics is often based on:

• a. The patient’s side effect tolerance profile.
• b. The medication’s side effect profile.
• c. The patient’s prior response to treatment.
• d. All of the above.

Answer: d. All of the above.

9. What is a key non-pharmacologic intervention that is a crucial part of a comprehensive schizophrenia treatment plan?

• a. A high-fat diet.
• b. Social isolation.
• c. Psychoeducation for the patient and family.
• d. Strenuous, high-intensity exercise.

Answer: c. Psychoeducation for the patient and family.

10. A pharmacist’s role in the management of psychotic disorders includes:

• a. Counseling on the importance of adherence.
• b. Monitoring for and managing side effects.
• c. Educating patients and caregivers about their medications.
• d. All of the above.

Answer: d. All of the above.

11. A patient on clozapine must have which lab parameter monitored regularly due to the risk of agranulocytosis?

• a. Serum creatinine
• b. Liver function tests
• c. Absolute Neutrophil Count (ANC)
• d. Fasting lipid panel

Answer: c. Absolute Neutrophil Count (ANC)

12. A patient complains of severe inner restlessness and an inability to sit still. This side effect, akathisia, can be managed with:

• a. An increase in the antipsychotic dose.
• b. A beta-blocker like propranolol.
• c. An anticholinergic agent.
• d. An antidepressant.

Answer: b. A beta-blocker like propranolol.

13. Assertive Community Treatment (ACT) is an evidence-based, team-based model of care for patients with severe mental illness.

• a. True
• b. False

Answer: a. True

14. A patient develops tardive dyskinesia (TD). The first step in management is:

• a. To increase the dose of the antipsychotic.
• b. To evaluate the possibility of switching to an agent with a lower risk of TD, like clozapine, or adding a VMAT2 inhibitor.
• c. To add an anticholinergic agent.
• d. To reassure the patient that it is a harmless side effect.

Answer: b. To evaluate the possibility of switching to an agent with a lower risk of TD, like clozapine, or adding a VMAT2 inhibitor.

15. A pharmacist counseling a patient starting an antipsychotic should discuss:

• a. The expected timeline for symptom improvement.
• b. The importance of not stopping the medication abruptly.
• c. Key side effects to monitor for.
• d. All of the above.

Answer: d. All of the above.

16. Which of the following is NOT a goal of managing an acute psychotic episode?

• a. To ensure the safety of the patient and others.
• b. To reduce the severity of psychosis and agitation.
• c. To develop a long-term therapeutic alliance.
• d. To immediately start a long-acting injectable medication.

Answer: d. To immediately start a long-acting injectable medication.

17. The management of psychotic disorders is a complex, long-term process that often requires treatment adjustments over time.

• a. True
• b. False

Answer: a. True

18. A key to managing metabolic side effects from atypical antipsychotics is:

• a. Regular monitoring of weight, glucose, and lipids.
• b. Counseling on a healthy diet and exercise.
• c. Both a and b.
• d. Neither a nor b, as these side effects cannot be managed.

Answer: c. Both a and b.

19. A patient is being switched from oral risperidone to its long-acting injectable formulation. A key management point is:

• a. No oral overlap is needed.
• b. The patient must continue the oral antipsychotic for several weeks after the first injection.
• c. The injectable form has fewer side effects.
• d. The dose of the injection is the same as the oral dose.

Answer: b. The patient must continue the oral antipsychotic for several weeks after the first injection.

20. The primary reason for medication non-adherence in schizophrenia is often:

• a. High cost of medication.
• b. Troublesome side effects.
• c. The patient’s lack of insight into their illness.
• d. All of the above are major contributors.

Answer: d. All of the above are major contributors.

21. “Shared decision-making” in schizophrenia treatment involves:

• a. The physician making all the decisions.
• b. A collaborative process where the clinician and patient (and often family) work together to choose a treatment plan.
• c. The pharmacist choosing the medication for the patient.
• d. The patient making all decisions without clinical input.

Answer: b. A collaborative process where the clinician and patient (and often family) work together to choose a treatment plan.

22. A patient with a first episode of psychosis should generally be treated for how long after remission is achieved?

• a. 1 month
• b. 6 months
• c. At least 1-2 years
• d. Indefinitely

Answer: c. At least 1-2 years

23. A key part of managing a patient on clozapine is monitoring for:

• a. Myocarditis
• b. Seizures
• c. Severe constipation
• d. All of the above

Answer: d. All of the above

24. The management of psychotic disorders requires a team-based approach, including pharmacists, physicians, therapists, and case managers.

• a. True
• b. False

Answer: a. True

25. A pharmacist’s role in managing these disorders is crucial for:

• a. Improving adherence.
• b. Minimizing adverse effects.
• c. Improving patient safety and quality of life.
• d. All of the above.

Answer: d. All of the above.

26. Which of the following is NOT a first-line treatment for schizophrenia?

• a. Risperidone
• b. Olanzapine
• c. Aripiprazole
• d. A benzodiazepine as monotherapy.

Answer: d. A benzodiazepine as monotherapy.

27. A patient on an antipsychotic develops hyperprolactinemia. This can lead to what symptoms?

• a. Gynecomastia and galactorrhea
• b. Hypertension
• c. Weight loss
• d. Insomnia

Answer: a. Gynecomastia and galactorrhea

28. Which antipsychotic has a particularly high risk for causing hyperprolactinemia?

• a. Aripiprazole
• b. Quetiapine
• c. Risperidone
• d. Clozapine

Answer: c. Risperidone

29. The overall goal of maintenance therapy is:

• a. Relapse prevention.
• b. To use the highest tolerated dose.
• c. To use at least three different antipsychotics.
• d. To cure the disease.

Answer: a. Relapse prevention.

30. A key component of managing a patient with schizophrenia is addressing comorbid:

• a. Substance use disorders.
• b. Cardiovascular disease.
• c. Diabetes.
• d. All of the above.

Answer: d. All of the above.

31. Smoking can induce the metabolism of which antipsychotic, potentially requiring higher doses?

• a. Risperidone
• b. Haloperidol
• c. Olanzapine
• d. Aripiprazole

Answer: c. Olanzapine

32. The management of a first psychotic episode should include:

• a. A focus on minimizing the duration of untreated psychosis.
• b. A low starting dose of a second-generation antipsychotic.
• c. Extensive psychoeducation for the patient and family.
• d. All of the above.

Answer: d. All of the above.

33. The management of psychotic disorders is a lifelong process for most patients.

• a. True
• b. False

Answer: a. True

34. The use of Cognitive Behavioral Therapy for psychosis (CBTp) is an evidence-based non-pharmacologic intervention.

• a. True
• b. False

Answer: a. True

35. A pharmacist counseling on a long-acting injectable should ensure the patient understands:

• a. The injection schedule.
• b. That they must come to the clinic for their injection.
• c. The potential for injection site reactions.
• d. All of the above.

Answer: d. All of the above.

36. A patient with schizophrenia should be monitored for which of the following?

• a. Positive symptoms
• b. Negative symptoms
• c. Medication side effects
• d. All of the above

Answer: d. All of the above

37. A key challenge in the management of schizophrenia is the treatment of:

• a. Positive symptoms, as they respond poorly to medication.
• b. Negative and cognitive symptoms, as they respond poorly to currently available medications.
• c. Agitation.
• d. Hallucinations.

Answer: b. Negative and cognitive symptoms, as they respond poorly to currently available medications.

38. The use of a standardized rating scale, like the PANSS, is helpful for:

• a. Diagnosing schizophrenia.
• b. Objectively monitoring the severity of symptoms over time.
• c. Choosing an antipsychotic.
• d. Predicting relapse.

Answer: b. Objectively monitoring the severity of symptoms over time.

39. A pharmacist can help manage metabolic syndrome by:

• a. Counseling on diet and exercise.
• b. Advocating for a switch to a metabolically friendlier agent if appropriate.
• c. Monitoring lab values like glucose and lipids.
• d. All of the above.

Answer: d. All of the above.

40. The management of schizophrenia requires a recovery-oriented approach.

• a. True
• b. False

Answer: a. True

41. Which of the following is NOT a primary goal of schizophrenia management?

• a. To reduce or eliminate symptoms.
• b. To improve social and occupational functioning.
• c. To achieve a complete cure and cessation of all therapy.
• d. To minimize adverse effects.

Answer: c. To achieve a complete cure and cessation of all therapy.

42. A patient is stable on their antipsychotic medication. The pharmacist’s role includes:

• a. Encouraging continued adherence.
• b. Ongoing monitoring for long-term side effects like tardive dyskinesia.
• c. Both a and b.
• d. Recommending the patient stop their medication.

Answer: c. Both a and b.

43. A pharmacist’s role includes identifying medications that can induce or worsen psychosis.

• a. True
• b. False

Answer: a. True

44. What is a key reason to prefer a second-generation antipsychotic over a first-generation one for a first episode?

• a. They are more effective.
• b. They have a lower risk of causing acute and long-term motor side effects, which can improve adherence.
• c. They are cheaper.
• d. They work faster.

Answer: b. They have a lower risk of causing acute and long-term motor side effects, which can improve adherence.

45. Which of the following is NOT a good counseling point for a patient on an antipsychotic?

• a. “This medication is not addictive, but you should not stop it suddenly.”
• b. “It’s important to take this every day to prevent your symptoms from coming back.”
• c. “You will be cured in 6 months and can stop this medication.”
• d. “Let’s talk about some side effects to watch out for, like feeling drowsy or dizzy.”

Answer: c. “You will be cured in 6 months and can stop this medication.”

46. The management of psychotic disorders often involves treating comorbid conditions like:

• a. Cardiovascular disease
• b. Diabetes
• c. Substance use disorders
• d. All of the above

Answer: d. All of the above

47. A pharmacist helping a patient enroll in a patient assistance program for their long-acting injectable is addressing what barrier to care?

• a. Side effects
• b. Adherence
• c. Stigma
• d. Cost

Answer: d. Cost

48. A key aspect of managing these disorders is building a strong therapeutic alliance with the patient and their caregivers.

• a. True
• b. False

Answer: a. True

49. The overall management of a psychotic spectrum disorder is a:

• a. Short-term, curative process.
• b. Long-term, collaborative process focused on recovery and quality of life.
• c. Process that only involves medication.
• d. Process that is the same for every patient.

Answer: b. Long-term, collaborative process focused on recovery and quality of life.

50. The ultimate goal of learning about the management of psychotic disorders is to:

• a. Be able to provide safe, effective, evidence-based, and compassionate care for a vulnerable patient population.
• b. Pass the psychiatry exam.
• c. Memorize all the antipsychotic side effects.
• d. Be able to diagnose schizophrenia.

Answer: a. Be able to provide safe, effective, evidence-based, and compassionate care for a vulnerable patient population.