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Schizophrenia Module 39 Online link

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1 Schizophrenia Module 39 Online link
A talk by a schizophrenic…a bit dry… Module

2 Psychological Disorders
Schizophrenia overview Symptoms of Schizophrenia Onset and Development of Schizophrenia Understanding Schizophrenia QR code for next SG Module

3 Schizophrenia The literal translation is “split mind” which refers to a split from reality. A group of severe disorders characterized by the following: Mnemonic for types of schizophrenia Dr. Cup treats schizophrenia Disorganized Residual Catatonic undifferentiated Paranoid Which of the following is most characteristic of individuals with chronic schizophrenia? (AP94) (A) Extreme mood swings (B) Disordered thinking (C) Profound sadness (D) Unaccountable loss of body function (E) Loss of memory AM World of Abnormal Psychology 9. The Schizophrenias In emotionally moving interviews, this program visits people who suffer from the hallucinations, paranoia, and psychological disarray of these disabling illnesses. In addition to examining symptoms and treatments, the program helps debunk some of the myths associated with the disorder and shows its human side and the strength of those who fight to overcome it. Disorganized and delusional thinking. Disturbed perceptions. Inappropriate emotions and actions. Link 58:42 Module

4 Symptoms of Schizophrenia
Positive symptoms: the presence of inappropriate behaviors (hallucinations, disorganized or delusional talking) Negative symptoms: the absence of appropriate behaviors (expressionless faces, rigid bodies) Schizophrenia vid: 4 Schizophrenics 9:23 Preview Question 11: What patterns of thinking, perceiving, feeling, and behaving characterize schizophrenia? The difference between "positive" and "negative" symptoms is not whether they are bad--they all are. The difference is whether they are "visible."  The positive symptoms are delusions, hallucinations, disorganized speech, disorganized behavior and catatonia.  The negative symptoms are lack of emotional responsiveness, extreme apathy--not visible. AM The Brain #26 schizophrenia, the symptoms AM The Brain #27 schizophrenia: etiology 28. Schizophrenia: Pharmacological Treatment Vid used to be at Module

5 Disorganized & Delusional Thinking
This morning when I was at Hillside [Hospital], I was making a movie. I was surrounded by movie stars … I’m Mary Poppins. Is this room painted blue to get me upset? My grandmother died four weeks after my eighteenth birthday.” Delusions – false beliefs Word Salad Link to you tube Part 2 (Sheehan, 1982) Other forms of delusions include, delusions of persecution (“someone is following me”) or grandeur (“I am a king”). This monologue illustrates fragmented, bizarre thinking with distorted beliefs called delusions (“I’m Mary Poppins”). Link Gerald 8:12 Part 2 7:11 Female Schizophrenic Module

6 Disorganized & Delusional Thinking
Unable to focus or attend Psychologist Jordan Peterson has proposed that the individual predisposed to schizophrenia may suffer from an influx of experiential sensations and possess insufficient executive functioning to cope with the influx, whereas the healthy individual low in LI and open to experience may be better able to use the information effectively while not becoming overwhelmed or stressed out by the incongruity of the situation. Indeed, this idea of "sensory gating" has been quite influential in the literature on schizophrenia. Many psychologists believe disorganized thoughts occur because of selective attention failure (fragmented and bizarre thoughts). Module

7 Disturbed Perceptions
A schizophrenic person may perceive things that are not there (hallucinations). Most such hallucinations are auditory and lesser visual, somatosensory, olfactory, or gustatory. Art by schizophrenics “I felt like I was walking through a dream…” Psychotic disorders frequently involve perceptions of nonexistent sensory stimulation, such as voices. Symptoms such as these are called (AP99) (A) Delusions (B) paraphilias (C) Hallucinations (D) Paranormal images (E) Psychic phenomena 68. Hallucinations are characteristic of (AP12) A. fugue B. clinical depression C. panic attacks D. psychotic disorders E. personality disorders In three other cases, Zulueta s patients had disordered thoughts or heard voices in the language they had learned first and used most. Using a language that they spoke less frequently overall and learned later dismissed their delusions. In another case, a patient was equally psychotic in Italian and English, but heard voices only in Italian, her mother tongue. Not only that—in English she denied that she heard voices at all, whereas in Italian, she readily admitted hearing them. Other patients hear friendly voices in their native languages, hostile ones in their second languages. A subsequent researcher quipped that the more competent an insane person was in a language, the higher their degree of psychosis. Some scientists have suggested that the extra effort of using a second language jolts people out of a deluded state into reality. Others suggest that the deeper relationship to your first language makes you less inhibited, and so more likely to express what's troubling you. In a language learned later, you can hide from your true self. Babel No More by Michael Erard Photos of paintings by Krannert Museum, University of Illinois at Urbana-Champaign August Natter, Witches Head. The Prinzhorn Collection, University of Heidelberg L. Berthold, Untitled. The Prinzhorn Collection, University of Heidelberg Module

8 …of Korean using a term, paran sekj, or "blue, to refer to a greener, less purple color than Korean-English bilinguals think of as "blue." Other scientists have since seen how bilinguals categorize common containers and even conceptualize time differently from monolinguals. But this evidence is controversial, and the effects of language on cognition haven’t been isolated precisely. One question that polyglots don't get asked is, "When you go crazy, what language do you go crazy in? "Which is too bad, because it's been demonstrated that psychotic polyglots, it turns out, aren't equally disordered in each of their languages. In one case recorded by British psychiatrist Felicity de Zulueta, her psychotic patient, a native English speaker, switched into Spanish because he knew that Zulueta also spoke the language. Both were then surprised that his hallucinations and disordered thoughts disappeared. "In Spanish ... he felt he was 'sane,' but when he spoke in English, he went mad," Zulueta wrote. From Babel No More Module

9 …schizophrenics can tickle themselves because of a problem with their timing that does not allow their motor actions and resulting sensations to be correctly sequenced. This predictability that you develop between your own actions and the resulting sensations is the reason you cannot tickle yourself. Other people can tickle you because their tickling maneuvers are not predictable to you. And if you'd really like to, there are ways to take predictability away from your own actions so that you can tickle yourself. Imagine controlling the position of a feather with a time-delay joystick: when you move the stick, at least one second passes before the feather moves accordingly. This takes away the predictability and grants you the ability to self-tickle. Interestingly, schizophrenics can tickle themselves because of a problem with their timing that does not allow their motor actions and resulting sensations to be correctly sequenced. Incognito: The Secret Lives of the Brain, David Eagleman Module

10 A 20th-century artist, Louis Wain, who was fascinated by cats, painted these pictures over a period of time in which he developed schizophrenia. The pictures mark progressive stages in the illness and exemplify what it does to the victim's perception. Module

11 Wikipedia on Louis Wain
Dr. Michael Fitzgerald disputes the claim of schizophrenia, indicating Wain more than likely had Asperger syndrome (AS). Of particular note, Fitzgerald indicates that while Wain's art takes on a more abstract nature as he grew older, his technique and skill as a painter did not diminish as one would expect from a schizophrenic.[7] Moreover, elements of visual agnosia are demonstrated in his painting, a key element in some cases of AS. If Wain had visual agnosia, it may have manifested itself merely as an extreme attention to detail.[8] A series of five of his paintings is commonly used as an example in psychology textbooks to putatively show the change in his style as his psychological condition deteriorated. However, it is not known if these works were created in the order usually presented, as Wain did not date them. Rodney Dale, author of Louis Wain: The Man Who Drew Cats, has criticized the belief that the five paintings can be used as an example of Wain's deteriorating mental health, writing: "Wain experimented with patterns and cats, and even quite late in life was still producing conventional cat pictures, perhaps 10 years after his [supposedly] 'later' productions which are patterns rather than cats."[9] Module

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13 Inappropriate Emotions & Actions
A schizophrenic person may laugh at the news of someone dying or show no emotion at all (flat affect). Some recover, some remain isolated Patients with schizophrenia may continually rub an arm, rock a chair, or remain motionless for hours (catatonia). Childhood schizophrenia at 20/20 9:18 Module

14 Onset and Development of Schizophrenia
Nearly 1 in a 100 suffer from schizophrenia, and throughout the world over 24 million people suffer from this disease (WHO, 2002). Preview Question 12: What forms does schizophrenia take? Men struck earlier, 4 years (Rasanen) & slightly more often (Aleman). If your parent is schizophrenic your chances of being schizophrenic are 1 in 10. Schizophrenia strikes young people as they mature into adults. It affects men and women, but men suffer from it more severely than women. Module

15 Chronic and Acute Schizophrenia
When schizophrenia is slow to develop (chronic/process) recovery is doubtful. Such schizophrenics usually display negative symptoms. Slow developing schizophrenics tend to be on the lower end of social levels due to their long histories of social inadequacy. If you suddenly “went crazy” someone would notice, but if you had been going crazy a bit at a time for many years it might slip by… When schizophrenia rapidly develops (acute/reactive) recovery is better. Such schizophrenics usually show positive symptoms. Module

16 Understanding Schizophrenia
Schizophrenia is a disease of the brain exhibited by the symptoms of the mind. Preview Question 13: What causes schizophrenia? 6x more dopamine receptors (Seeman). Drugs that block dopamine reduce symptoms (Swerdlow) One suspected cause of schizophrenia is the abnormal increase of which of the following neurotransmitters in the brain? (AP99) (A) Acetylcholine (B) Somatotropin (C) Dopamine (D) Norepinephrine (E) Serotonin Which of the following has been most effective in the treatment of schizophrenia? (AP94) (A) Administration of L-dopa (B) Prefrontal lobotomy (C) Psychoanalytic therapy (D) Drug therapy that blocks neurotransmitter sites (E) Drug therapy that increases the activity of limbic system neurons AM the Brain #28 Schizophrenia: pharmacological treatment Brain Abnormalities Dopamine Overactivity: Researchers found that schizophrenic patients express higher levels of dopamine D4 receptors in the brain. Drugs that block these sites help schizophrenic patients. Module

17 Abnormal Brain Activity
Brain scans show abnormal activity in the frontal cortex, thalamus, and amygdala of schizophrenic patients. Low brain activity in frontal lobes (Morey) Decline in brain waves that reflect synchronization in frontal lobes (Speinier) may disrupt neural networks. Neuroreport Jun 3;10(8): Elevated endogenous cannabinoids in schizophrenia. Leweke FM, Giuffrida A, Wurster U, Emrich HM, Piomelli D. SourceDepartment of Clinical Psychiatry and Psychotherapy, Medizinische Hochschule Hannover, Germany. Abstract Evidence suggests that cannabinoid receptors, the pharmacologcial target of cannabis-derived drugs, and their accompanying system of endogenous activators may be dysfunctional in schizophrenia. To test this hypothesis, we examined whether endogenous cannabinoid concentrations in cerebrospinal fluid of schizophrenic patients are altered compared to nonschizophrenic controls. Endogenous cannabinoids were purified from cerebrospinal fluid of 10 patients with schizophrenia and 11 non-schizophrenic controls by high-performance liquid chromatography, and quantified by isotope dilution gas-chromatography/mass-spectrometry. Cerebrospinal concentrations of two endogenous cannabinoids (anandamide and palmitylethanolamide) were significantly higher in schizophrenic patients than non-schizophrenic controls (p < 0.05). By contrast, levels of 2-arachidonylglycerol, another endogenous cannabinoid lipid, were below detection in both groups. The findings did not seem attributable to gender, age or medication. Elevated anandamide and palmitylethanolamide levels in cerebrospinal fluid of schizophrenic patients may reflect an imbalance in endogenous cannabinoid signaling, which may contribute to the pathogenesis of schizophrenia. PMID: [PubMed - indexed for MEDLINE] Paul Thompson and Arthur W. Toga, UCLA Laboratory of Neuro Imaging and Judith L. Rapport, National Institute of Mental Health Module

18 Mapping Brain Tissue Loss in Adolescents with Schizophrenia. This map reveals the 3-dimensional profile of gray matter loss in the brains of teenagers with early-onset schizophrenia, with a region of greatest loss in the temporal and frontal brain regions that control memory, hearing, motor functions, and attention. Using novel image analysis algorithms, dramatic reductions in the profiles of gray matter were detected, based on a database of 96 images from schizophrenic patients scanned repeatedly with MRI. The parallel extraction of anatomical models from all patients in the image database required 60 CPU hours, when running in parallel on an SGI RealityMonster with 32 internal CPUs. [Image by Paul Thompson, Christine Vidal, Judy Rapoport, and Arthur Toga]. Grey matter loss The Californian team used a new way of analyzing MRI images to reveal very subtle changes in brain matter. They found that in healthy teenagers, approximately 1% of tissue called "grey matter" is lost each year from a part of the brain called the parietal regions - the outer regions of the brain. Professor Paul Thompson, UCLA However, in schizophrenics, they detected accelerated grey matter loss - over six years, the patients lost 10% in the parietal region. In addition, this destructive process spread to other parts of the brain, with areas such as the temporal lobe, and areas which control the senses and movement - particularly eye movement, particularly affected. The brain fields responsible for eye movement lost as much as 5% of their grey matter a year. These findings would tally with many of the symptoms, such as involuntary eye movement, frequently felt by schizophrenics. Professor Paul Thompson, at UCLA, said: "This is the first study to visualize how schizophrenia develops in the brain. "Scientists have been perplexed about how schizophrenia progresses and whether there are any physical changes in the brain. "It moved across the brain like a forest fire, destroying more tissue as the disease progressed." Module

19 Frontal composite variability of normal and schizophrenia brains by gender Module

20 Image Source: UCLA Laboratory of Neuro Imaging, UCLA, Derived from high-resolution magnetic resonance images (MRI scans), the above images were created after repeatedly scanning 12 schizophrenia subjects over five years, and comparing them with matched 12 healthy controls, scanned at the same ages and intervals. Severe loss of gray matter is indicated by red and pink colors, while stable regions are in blue. STG denotes the superior temporal gyrus, and DLPFC denotes the dorsolateral prefrontal cortex. Note: This study was of Childhood onset schizophrenia (defined as schizophrenia diagnosed in children under the age of 13 or so) which occurs in approximately 1 of every 40,000 people and is frequently a significantly more aggressive form of schizophrenia (than regular schizophrenia that typically begins when people are aged 15 to 25 (slightly later for women) - and impacts approximately 1 of every 100 people). Module

21 Abnormal Brain Morphology
Schizophrenia patients may exhibit morphological changes in the brain like enlargement of fluid-filled ventricles. Found in people who would later develop Schizophrenia (Pantelis) The more the shrinkage of the tissue the greater the disorder The cortex is smaller than normal. Thalamus smaller than normal, possible difficulty filtering sensory information, difficulty attending Which of the following is associated with schizophrenia? (AP04) (A) Enlarged, fluid filled areas in the brain (B) Damage to the medulla (C) Malfunction of the endocrine system (D) Impairment of the spinal reflexes (E) Injury to the parasympathetic nervous system Both Photos: Courtesy of Daniel R. Weinberger, M.D., NIH-NIMH/ NSC Module

22 The image to the left shows an MRI image of unaffected and schizophrenic identical twins. The brain structures pointed out are the ventricles (which are much larger in the person affected by schizophrenia) Module

23 Viral Infection Schizophrenia has also been observed in individuals whose mothers contracted a viral infection (flu) during the middle of their fetal development. Risk factors… Low birth weight Oxygen deprivation during delivery (Buka) Conception during famine (St. Claire) Fetal development during flu epidemic = increased risk (Mednick) Born after flu season = increased risk (Torrey) Patterns in N. Hemisphere reversed in S. Hemisphere (McGrath) “Marijuana has been vaguely associated with schizophrenia over the years. People who abuse marijuana in their younger years have higher risk for it later in life,” Jones said. Furthermore, he said, symptoms of schizophrenia manifest in some adults who receive a dose of THC. Module

24 Genetic Factors The likelihood of an individual suffering from schizophrenia is 50% if their identical twin has the disease (Gottesman, 2001). Schizophrenia gene mutation found; target for new drugs February 2, 2011 In a major advance for schizophrenia research, an international team of scientists, led by Jonathan Sebat, PhD, assistant professor of psychiatry and cellular and molecular medicine at the University of California, San Diego School of Medicine, has identified a gene mutation strongly linked to the brain disorder – and a signaling pathway that may be treatable with existing compounds. The latest study goes much further. Researchers scanned for CNVs in the genomes of 8,290 individuals with diagnosed cases of schizophrenia and 7,431 healthy controls. "We found very strong links to multiple sites in the genome," said Sebat. "Some had been picked up before in earlier studies, but we uncovered a very important new finding: duplications at the tip of chromosome 7q were detected in individuals with schizophrenia at a rate 14 times higher than in healthy individuals. These CNVs impact a gene that is important for brain development – the neuropeptide receptor VIPR2." Identical Both parents Fraternal One parent Sibling Nephew or niece Unrelated Module

25 Genetic Factors The following shows the prevalence of schizophrenia in identical twins as seen in different countries. Module

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27 In fact in a September, 2004 presentation Dr. Daniel Weinberger, Director of the Genes, Cognition and Psychosis Program, at the National Institute of Mental Health" stated that he estimated the current number of genes variations linked to schizophrenia was approximately 10. The gene variations that have been identified as being linked to schizophrenia are common in every population - but he believes that it is likely that if a person has a number of these gene variations then the risk of developing schizophrenia begins to rise. The more of these gene variations that a person has, the greater the risk of developing schizophrenia. For example, in 2002 researchers led by NIMH’s Dr. Daniel Weinberger linked a gene on chromosome 22 to a near-doubled risk of schizophrenia. When the gene, called COMT, is abnormal, it effectively depletes the frontal lobes of the neurochemical dopamine. That can both unleash hallucinations and impair the brain’s reality check. Given the constant interplay of genes and environment - the greater the exposure to schizophrenia-linked environmental factors (e.g. lead exposure during pregnancy, birth complications, extremely high stress experiences in life while young, drug use while a teenager, etc.) the greater the likelihood that a person with a given level of genetic predisposition will actually develop schizophrenia. A person with fewer of the gene variants linked with schizophrenia, if exposed to more environmental factors linked with schizophrenia - may pass the threshold for development of schizophrenia just as a person with more gene variants, and lower environmental factor exposure could also pass the threshold to develop schizophrenia. Research is still being done on the risk contribution to the development of schizophrenia that is associated with the different gene variations and environmental impacts. Module

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29 Psychological Factors
Psychological and environmental factors can trigger schizophrenia if the individual is genetically predisposed (Nicol & Gottesman, 1983). Two more severe than others, thus there are contributing environmental factors. The genetically identical Genain sisters suffer from schizophrenia. Courtesy of Genain Family Genain Sisters Module

30 Differences in How Schizophrenia Impacts Men and Women
Differences in How Schizophrenia Impacts Men and Women There are many ways in which schizophrenia affects men and women differently. For example, some of the well known facts are that schizophrenia tends to begin in men/boys at an earlier age than women/girls; men who have schizophrenia generally begin showing signs of the illness between ages 15 and 20, compared to ages 20 to 25 for women. Additionally, men overall are less responsive to medication and schizophrenia also tends to have a larger impact on men than on women - the long term outcome tends to be worse for men than women. Researchers have hypothesized that estrogen may play a protective role in women against schizophrenia. Recent research also tends to suggest that schizophrenia is more prevalent in men than women - with women developing schizophrenia at a rate of approximately 50% to 75% that of men, overall. Women, however, have a rate of developing schizophrenia almost twice that of men for people over the age of 45 years. Again, a protective effect of estrogen may be involved here, researchers suggest. Following are some stories and resources on the differences of schizophrenia's impact in men and women. As this is a relatively new area of research, we'll be adding more information here in the future. Why Schizophrenia Impacts Men harder than Women? Book: (Scientific Book): Women and Schizophrenia , Edited by David J. Castle, John McGrath and Jayashri Kukarni, 151 pages ; Publisher: Cambridge University Press; 1st edition (September 15, 2000) , ISBN: Module

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32 EXPLORING PSYCHOLOGY (7th Edition in Modules) David Myers
PowerPoint Slides Aneeq Ahmad Henderson State University Worth Publishers, © 2008 Module

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