This Knowledge Check reviews the topics in Module 6 and is formative in nature. It is
worth 20 points where each question is worth 1 point. You are required to submit a
sufficient response of at least 2-4 sentences in length for each question.
Scenario 1: Schizophrenia
A 21-year-old male college student was brought to Student Health Services by his
girlfriend who was concerned about changes in her boyfriend’s behaviors. The girlfriend
says that recently he began hearing voices and believes everyone is out to get him. The
student says he is unable to finish school because the voices told him he was not smart
enough. The girlfriend relates episodes of unexpected rage and crying. Past medical
history noncontributory but family history positive for a first cousin who “had mental
problems”. Denies current drug abuse but states he smoked marijuana every day during
his junior and senior years of high school. He admits to drinking heavily on weekends at
various fraternity houses. Physical exam reveals thin, anxious disheveled male who,
during conversations, stops talking, cocks his head and appears to be listening to
something. There is poor eye contact and conversation is rambling.
Based on the observed behaviors and information from girlfriend, the APRN believes
the student has schizophrenia.
Question 1 of 4:
Describe the positive symptoms of schizophrenia and relate those symptoms to the
case study patient.
Positive symptoms of schizophrenia include hallucinations that may be auditory, olfactory,
somatic-tactile, visual, voices commenting, and voices conversing. Delusions including delusion
of being controlled, delusion of mind reading, delusion of reference, delusion of grandiosity,
guilt, persecution, somatic thought broadcasting, thought insertion and thought withdrawal.
Thought disorder symptoms include distractible speech, incoherence, illogicality,
circumstantially, and derailment. Bizarre behaviors that include aggressiveness and agitated
states, clothing appearance, repetitive stereotyped, and social and sexual behavior. The patient in
the scenario exhibit signs of auditory hallucinations, disheveled appearance, and persecution.
Question 2 of 4:
Explain the genetics of schizophrenia.
Schizophrenia is a heritable disorder. Schizophrenia is not a simple genetic disorder in which
inherited disease alleles will always lead to illness. Schizophrenia likely involves several genes
located on different chromosomes and differs from mendelian disorders, in which genes are fully
penetrant and recognized as the primary cause of disease. Increased paternal age is associated
with a greater risk of schizophrenia. The risk of schizophrenia is elevated in biologic relatives of
persons with schizophrenia but not in adopted relatives. The risk of schizophrenia in first-degree
relatives of persons with schizophrenia is 10%. If both parents have schizophrenia, the risk of
, schizophrenia in their child is 40%. Concordance for schizophrenia is about 10% for dizygotic
twins and 40-50% for monozygotic twins.
Question 3 of 4:
The APRN reviews recent literature and reads that neurotransmitters are involved in the
development of schizophrenia. What roles do neurotransmitters play in the development
of schizophrenia?
The onset of schizophrenia was initially hypothesized to stem from abnormally high
concentrations of the brain neurotransmitter dopamine. This dopamine hypothesis of
schizophrenia was proposed on the basis of pharmacologic studies showing that antipsychotic
drugs were potent blockers of brain dopamine receptors. A strong correlation was found between
the clinical potencies of first-generation antipsychotic drugs and their affinity for the dopamine
D2 receptor.
Another neurotransmitter system that may underlie the pathogenesis of schizophrenia is the
excitatory neurotransmitter glutamate and its actions on the NMDA receptor subtype. The
glutamate hypothesis of schizophrenia proposes that under activation of glutamate receptors
contribute to schizophrenia. In schizophrenia, glutamate concentrations in the CSF are reduced
along with in a decrease in cortical glutamate synthesis.
Question 4 of 4:
The APRN reviews recent literature and reads that structural problems in the brain may
be involved in the development of schizophrenia. Explain what structural abnormalities
are seen in people with schizophrenia.
Advances in neuroimaging studies show differences between the brains of those with
schizophrenia and those without this disorder. In people with schizophrenia, the ventricles are
larger, decrease in brain volume in medial temporal areas, and changes in the hippocampus.
Magnetic resonance imaging (MRI) studies show anatomic abnormalities in a network of
neocortical and limbic regions and interconnecting white-matter tracts. Some studies using
diffusion tensor imaging (DTI) to examine white matter found that 2 networks of white-matter
tracts are reduced in schizophrenia. Brain imaging showed reductions in whole-brain volume and
in left and right prefrontal and temporal lobe volumes in many people who are at high genetic
risk for schizophrenia. The changes in prefrontal lobes are associated with increasing severity of
psychotic symptoms.
Scenario 2: Bipolar Disorder
A 34-year-old female was brought to the Urgent Care Center by her husband who is
very concerned about the changes he has seen in his wife for the past 3 months. He
states that his wife has had been depressed and irritable, has complaints of extreme
fatigue, has lost 10 pounds and has had insomnia. He has come home from work to find
his wife sitting in front of the TV and not moving for hours. In the past few days, she
suddenly has become very hyperactive, has been talking incessantly, has been easily
distracted and seems to “flit from one thing to another.”. She hasn’t slept in 3 days. The
wife went on an excessive shopping spree for new clothes that resulted in their credit
card being denied for exceeding the line of credit. The wife is unable to sit in the exam
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