Schizophrenia

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Schizophrenia
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What is Schizophrenia?

• Loss of contact with reality leading to impaired
  functioning due to severely distorted beliefs,
  perceptions, and thought processes
• Comes from Greek meaning split and mind
• split refers to loss of touch with reality
• not split personality
• Equally split between genders, males have
  earlier onset
• 18 to 25 for men
• 26 to 45 for women

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Categories of Symptoms for Schizophrenia

• Positive symptoms
• Excess of or distortion of normal functions
• Hallucinations false perceptions (auditory or
  visual)
• Delusions false beliefs
• Negative symptoms
• absence of normal cognition or affect
• flat affect emotionally flat
• alogia - poverty of speech
• avolition inability to do simple goal-directed
  behaviors (dressing, bathing, social activities)
• Disorganized Symptoms
• Disorganized Speech or Behavior

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Hallucinations

• Hallucinations
• hearing or seeing things that arent there (most
  common are auditory)
• contributes to delusions
• command hallucinations voices giving orders
• Disturbances in sensation
• sights, sounds, and other sensations feel
  distorted

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Common Delusions (False Beliefs)

• Delusions of reference - believes that other
  people are constantly talking about her or that
  everything that happens is somehow related to her
  
• Delusions of persecution - believes that others
  are plotting against or trying to harm him or
  someone close to him
• theyre out to get me
• paranoia
• Delusions of grandeur - believes he is extremely
  important, powerful, or wealthy.
• God complex
• megalomania
• Delusions of being controlled
• the CIA is controlling my brain with a radio
  signal

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Types of Schizophrenia

• Paranoid type
• delusions of persecution
• believes others are spying and plotting
• delusions of grandeur
• believes others are jealous, inferior,
  subservient
• no cognitive impairment, disorganized behavior,
  or negative symptoms
• Catatonic typeunresponsive to surroundings,
  purposeless movement, parrot-like speech
• waxy flexibility
• highly disturbed movements or actions
• Hardest type to treat

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Types of Schizophrenia

• Disorganized type
• delusions and hallucinations with little meaning
• disorganized speech, behavior, and flat affect
• Undifferentiated type exhibits symptoms of
  schizophrenia but cant easily be fit into one of
  the 3 subtypes.

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Disorganized Symptoms

• Disorganized behavior and affect
• behavior is inappropriate for the situation
• e.g., wearing sweaters and overcoats on hot days
• affect is inappropriately expressed
• flat affectno emotion at all in face or speech
• inappropriate affectlaughing at very serious
  things, crying at funny things
• catatonic behavior
• unresponsiveness to environment, usually marked
  by immobility for extended periods

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Disorganized Speech

• Word Salad - a string of words that vaguely
  resembles language, and may or may not be
  grammatically correct, but is utterly
  meaningless.
• Tramway flogging into my question, are you why
  is it thirty letters down under peanut butter,
  what is it.
• Watch this example from Boston Legal (1 min)
• Neologisms - Making up words
• I am going to the park to ride the wallywhoop.
• Clang Speech - Rhyming all the words .
• Deck the halls with boughs of holly, folly,
  polly, dolly, hello Dolly, want a lollipop?
• Echolalia - Repeating exactly what someone else
  has said
• Echopraxia - Repeating exactly what someone else
  has done.
• Over-inclusionjumping from idea to idea without
  the benefit of logical association
• Paralogicon the surface, seems logical, but
  seriously flawed
• e.g., Jesus was a man with a beard, I am a man
  with a beard, therefore I am Jesus

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Frequency of positive and negative symptoms in
individuals at the time they were hospitalized
for schizophrenia. Source Based on data
reported in Andreasen Flaum, 1991.
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Schizophrenia An Example

• Watch Module 26 from The Brain dvd (5 min).
• As you watch Jerry write down what symptoms you
  see him demonstrating.

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Prevalence of Schizophrenia

• Onset of schizophrenia typically occurs during
  young adulthood.
• Approximately 1 million Americans are treated for
  schizophrenia annually
• Worldwide, about 1 of the population will
  experience at least one episode of schizophrenia
  at some point in life

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Course of SchizophreniaThe ¼, ¼, ½ Rule

• Enormous individual variability
• About 1/4 of those who experience an episode of
  schizophrenia recover completely another 1/4
  experience recurrent episodes, but often with
  only minimal impairment of functioning
• The other one-half, schizophrenia becomes a
  chronic mental illness, and the ability to
  function normally in society may be severely
  impaired.

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Potential Causes of Schizophrenia
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Inheritability (Genetics)

• Risk increases with genetic similarity

40 30 20 10 0
Lifetime risk of developing schizophrenia for
relatives of a schizophrenic
Children of two schizophrenia victims
Fraternal twin
Identical twin
General population
Siblings
Children
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OTHER POSSIBLE BIOLOGICAL FACTORS
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The Dopamine Theory

• Theory Schizophrenia is caused by excess
  dopamine
• Drugs that reduce dopamine reduce symptoms
• Drugs that increase dopamine produce symptoms
  even in people without the disorder
• Dopamine theory not enough other
  neurotransmitters involved as well

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Brain Structure Abnormality

• About half the people with schizophrenia show
  some type of brain structure abnormality
• Brain structure and function
• enlarged cerebral ventricles and reduced neural
  tissue around the ventricles
• PET scans show reduced frontal lobe activity
• Early warning signs
• nothing very reliable has been found yet
• certain attention deficits can be found in
  children who are at risk for the disorder

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Brain Activity Tissue Loss

• Gray matter tissue loss ranged from about 1
  percent in the normal teens to more than 5
  percent in the schizophrenic teens
• The amount of gray matter loss was directly
  correlated to the teenage patients clinical
  symptoms
• More rapid gray matter losses in the temporal
  lobes were associated with more severe positive
  symptoms
• More rapid gray matter losses in the frontal
  lobes were strongly correlated with the severity
  of negative symptoms

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The Shrinking of the Schizophrenic Brain
Among adolescents who suffer a relatively rare
childhood - onset schizophrenia, MRI scans by
Paul Thompson and his colleagues (2001) revealed
a much-greater-than-normal loss of cerebral
cortex tissue between the ages of 13 and 18
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Not Just Biology at Fault

• Some people with schizophrenia do NOT show brain
  structure abnormalities
• The evidence is correlational
• The kinds of brain abnormalities seen in
  schizophrenia are also seen in other mental
  disorders

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POSSIBLE ENVIRONMENTAL FACTORS
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Viral Infection Theory

• Might be caused by exposure to an influenza virus
  or other viral infection during prenatal
  development or shortly after birth
• Children whose mothers were exposed to a flu
  virus during the second trimester of pregnancy
  show an increased rate of schizophrenia
• Schizophrenia occurs more often in people who
  were born in the winter and spring months, when
  upper respiratory infections are most common

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POSSIBLE PSYCHOLOGICAL FACTORS
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Psychoanalysis

• Freud thought that it resulted from the
  overwhelming of the Ego by the urges of the Id.
• This causes internal conflict.
• Regression occurs and the adult enters the oral
  stage where they cant discern between reality
  and fantasy.

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Multifactorial Model of Schizophrenia

• Several biological and psychological factors
  involved
• Genetics may create a vulnerability
• Environment (stress) may lead to development of
  schizophrenia.
• Individuals who are genetically predisposed to
  develop schizophrenia may be more vulnerable to
  the effects of a disturbed or stressful
  environment

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Development Model of Schizophrenia
This model depicts researchers' understanding of
the contributions of genes, environmental
experiences, and the person's present neural and
behavioral condition to the development of
schizophrenia and, in some cases, its progression
into a chronic condition. (Based on a model
depicted by Tsuang others, 2001, p. 22.)