Test Your Knowledge: Ten Questions about Schizophrenia

Question 6. Which of the following best refl ects the evidence on olanzapine as a treatment for schizophrenia? There is good evidence that the drug is better than standard antipsychotic drugs at reducing psychotic symptoms over six to eight weeks Olanzapine is better than clozapine at reducing suicidal behavior over two years in patients with a high risk of suicide Olanzapine is better than amisulpiride at reducing psychotic symptoms at two months Olanzapine is associated with fewer extrapyramidal adverse effects than standard antipsychotic drugs Question 7. Which of the following drugs has been found consistently in clinical trials to reduce the negative symptoms of schizophrenia (de-motivation, self-neglect, and reduced emotion)? Chlorpromazine Perazine Zotepine Risperidone None of the above


Question 4. Is the prognosis of schizophrenia better in developing or developed countries?
Developing countries Developed countries Question 5. Which of the following best refl ects the evidence on the sex ratio of schizophrenia?
The disease is equally as likely to affect men and women The incidence of the disease is higher in women The incidence of the disease is higher in men Question 6.Which of the following best refl ects the evidence on olanzapine as a treatment for schizophrenia?
There is good evidence that the drug is better than standard antipsychotic drugs at reducing psychotic symptoms over six to eight weeks Olanzapine is better than clozapine at reducing suicidal behavior over two years in patients with a high risk of suicide Olanzapine is better than amisulpiride at reducing psychotic symptoms at two months Olanzapine is associated with fewer extrapyramidal adverse effects than standard antipsychotic drugs

Question 9. Which of the following best refl ects the evidence on the value of cognitive behavioral therapy (CBT) and behavioral therapy in treating schizophrenia?
There is no evidence that behavioral therapy can help to improve rates of adherence to antipsychotic medication The best available evidence suggests that CBT is no better than standard care at reducing relapse rates There is very good evidence that CBT is better than standard care at reducing relapse rates Question 10.Which of the following best refl ects the evidence on drug therapy for people with schizophrenia who are resistant to standard antipsychotic drugs?
There is good evidence that clozapine is better than standard drugs at improving symptoms There is good evidence that clozapine is better than other newer "atypical" antipsychotic drugs at improving symptoms There is good evidence that olanzapine is better than standard drugs at improving symptoms Answer 1.About 15 per 100,000 persons per year In a systematic review of studies on the incidence of schizophrenia, McGrath and colleagues found that the median value was 15.2 per 100,000 persons per year [1].

Answer 4. Developing countries
The better prognosis of patients in developing countries has been well documented [1,2].For example, a fi ve-year follow-up of patients initially included in the International Pilot Study of Schizophrenia found that clinical and social outcomes were signifi cantly better for patients in centers in Agra and Ibadan than for those in centers in developed countries [2].Answer 6. Olanzapine is associated with fewer extrapyramidal adverse effects than standard antipsychotic drugs One systematic review found no signifi cant difference in psychotic symptoms over six to eight weeks between olanzapine and standard antipsychotic drugs [1].The review and one subsequent randomized controlled trial (RCT) [2] found that olanzapine was associated with fewer extrapyramidal adverse effects than standard antipsychotic drugs.One RCT, involving 890 people with schizophrenia at high risk of suicide, found that clozapine signifi cantly reduced suicidal behavior over two years compared with olanzapine [3].One RCT, involving 377 people, compared amisulpiride with olanzapine over two months and found no signifi cant difference in symptoms at two months (assessed by the Brief Psychiatric Rating Scale score) [4].Answer 9.The best available evidence suggests that CBT is no better than standard care at reducing relapse rates A systematic review of two RCTs (123 people) found no signifi cant difference in relapse rates between cognitive behavioral therapy plus standard care versus standard care alone [1].One small RCT (36 men) found limited evidence that behavioral interventions improved adherence to antipsychotic medication compared with usual treatment and with psychoeducational therapy [1], and a second RCT found that behavioral interventions improved adherence more than psychoeducational therapy [2].
Answer 10.There is good evidence that clozapine is better than standard drugs at improving symptoms One systematic review (six RCTs) in people resistant to standard antipsychotic drugs found that clozapine improved symptoms after 12 weeks and after two years compared with standard antipsychotic drugs [1].One systematic review (eight RCTs, fi ve in people with treatment-resistant schizophrenia) found no signifi cant difference in symptoms between clozapine and other newer antipsychotic drugs in people resistant to standard antipsychotic drugs [2].One systematic review (one RCT) found no signifi cant difference in psychotic symptoms over eight weeks between olanzapine and chlorpromazine [3].

Question 7 .
Which of the following drugs has been found consistently in clinical trials to reduce the negative symptoms of schizophrenia (de-motivation, self-neglect, and reduced emotion)?Which of the following best refl ects the evidence on giving multiple sessions of a family intervention in the treatment of schizophrenia?Multiple sessions are no better than a single session at reducing the relapse rate at 12 months Multiple sessions of a family intervention are no better than standard psychiatric care at reducing the relapse rate at 12 months Multiple sessions of a family intervention reduce relapse rates at 12 months compared with usual care, single-session family interventions, or psychoeducational interventions

Citation:
Yamey G (2005) Test your knowledge: Ten questions about schizophrenia.PLoS Med 2(5): e175.Copyright: © 2005 Gavin Yamey.This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.Gavin Yamey is a senior editor at PLoS Medicine.E-mail: gyamey@plos.orgDOI: 10.1371/journal.pmed.0020175

Answer 8 .
Multiple sessions of a family intervention reduce relapse rates at 12 months compared with usual care, single-session family interventions, or psychoeducational interventions One systematic review of 11 RCTs compared multiple family interventions (usually involving education about the illness and training in problem solving over at least six weekly sessions) against usual care, single-session family interventions, and psychoeducational interventions [1].The review found that multiple family interventions signifi cantly reduced relapse rates at 12 months compared with other interventions.