Is schizophrenia a disorder of mind or body? A mental disorder with changes in perceptions, emotions, thoughts, and consciousness A mental disorder with changes in perceptions, emotions, thoughts, and consciousness w8XnpA w8XnpA

2 Axis I – Schizophrenia - Symptoms symptoms of schizophrenia are positive or negative symptoms of schizophrenia are positive or negative positive = additional behaviour/experience positive = additional behaviour/experience negative = absence of behaviour/experience negative = absence of behaviour/experience Positive Symptoms Positive Symptoms hallucinations – false sensory experiences hallucinations – false sensory experiences bizarre delusions – false beliefs bizarre delusions – false beliefs incoherent speech incoherent speech inappropriate/disorganized behaviours inappropriate/disorganized behaviours

3 Axis I – Schizophrenia – Symptoms cont’d Negative Symptoms Negative Symptoms loss of motivation loss of motivation emotional flatness emotional flatness social withdrawal social withdrawal slowed speech or no speech slowed speech or no speech loss of pleasure in activities loss of pleasure in activities loss of activity loss of activity

Delusions & associated beliefs

DSM-IV subtypes of schizophrenia

6 Theories of Schizophrenia Historically proposed causes: carbohydrate metabolism, muscle fatigue, tooth decay, abnormality of spinal fluid, blood vessel rigidity, iodine in the brain – all seen in hospitalized schizophrenics Historically proposed causes: carbohydrate metabolism, muscle fatigue, tooth decay, abnormality of spinal fluid, blood vessel rigidity, iodine in the brain – all seen in hospitalized schizophrenics Current causal explanations: Genetic predispositions Genetic predispositions Structural brain abnormalities Structural brain abnormalities Neurotransmitter abnormalities Neurotransmitter abnormalities Prenatal abnormalities Prenatal abnormalities Adolescent abnormalities in brain development Adolescent abnormalities in brain development

7 Genetic Vulnerability to Schizophrenia risk increases with genetic relatedness to diagnosed schizophrenic risk increases with genetic relatedness to diagnosed schizophrenic but even identical twins are not 100% concordant but even identical twins are not 100% concordant genetics play a role genetics play a role

8 Structural Brain Abnormalities several abnormalities exist, especially when schizophrenia characterized by primarily negative symptoms: several abnormalities exist, especially when schizophrenia characterized by primarily negative symptoms: decreased brain weight decreased brain weight decreased volume in temporal lobe or hippocampus decreased volume in temporal lobe or hippocampus enlargement of ventricles enlargement of ventricles but 25% do not have observable brain abnormalities but 25% do not have observable brain abnormalities

9 Neurotransmitter Abnormalities candidates: serotonin, glutamate, and dopamine candidates: serotonin, glutamate, and dopamine many schizophrenics have high levels of brain activity in dopaminergic areas and greater numbers of dopamine receptors many schizophrenics have high levels of brain activity in dopaminergic areas and greater numbers of dopamine receptors schizophrenics have harder time filtering out external stimulation schizophrenics have harder time filtering out external stimulation genetic – receptors “ fooled ” by nicotine genetic – receptors “ fooled ” by nicotine schizophrenics often heavy smokers schizophrenics often heavy smokers

10 Prenatal or Birth Complications fetal brain damage increases chances of schizophrenia and other mental disorders fetal brain damage increases chances of schizophrenia and other mental disorders maternal malnutrition or illness maternal malnutrition or illness brain injury or oxygen deprivation at birth brain injury or oxygen deprivation at birth maternal influenza during first 13 weeks pregnancy maternal influenza during first 13 weeks pregnancy schizophrenics have increased physical anomalies schizophrenics have increased physical anomalies more likely to be born in winter more likely to be born in winter

11 Adolescent Abnormalities in Brain Development normal pruning of excessive synapses during adolescence normal pruning of excessive synapses during adolescence schizophrenics show greater synaptic pruning schizophrenics show greater synaptic pruning first episode occurs in adolescence or early adulthood first episode occurs in adolescence or early adulthood

12 Axis II - Personality Disorders Personality Disorders Personality Disorders Rigid, maladaptive patterns of behaviour, emotions, and thinking that cause personal distress or inability to get along with others Rigid, maladaptive patterns of behaviour, emotions, and thinking that cause personal distress or inability to get along with others cannot adjust behaviour to situation cannot adjust behaviour to situation begins early in life begins early in life less likely to be happy, have a happy marriage, be a good parent less likely to be happy, have a happy marriage, be a good parent more likely to get into trouble with law, at work, in relationships, substance abusing, depressed, self-harming more likely to get into trouble with law, at work, in relationships, substance abusing, depressed, self-harming comorbidity occurs frequently comorbidity occurs frequently

Axis II - Personality Disorders cont’d Three clusters: 1. Odd or Eccentric 2. Dramatic, Emotional, Erratic 3. Anxious or Fearful up to 15% of adults have one or more up to 15% of adults have one or more 13

Axis II – Personality Disorders – Odd or Eccentric Paranoid Personality Disorder Paranoid Personality Disorder characterized by habitually unreasonable and excessive suspiciousness and jealousy characterized by habitually unreasonable and excessive suspiciousness and jealousy Schizoid Personality Disorder Schizoid Personality Disorder indifferent to and avoids relationships, lacks empathy, flat affect, detached indifferent to and avoids relationships, lacks empathy, flat affect, detached Schizotypal Personality Disorder Schizotypal Personality Disorder perceptual dysfunction, magical thinking, eccentric dress and speech, indifferent to others perceptual dysfunction, magical thinking, eccentric dress and speech, indifferent to others 14

15 Axis II – Personality Disorders – Dramatic, Emotional, Erratic Narcissistic Personality Disorder Narcissistic Personality Disorder exaggerated sense of self-importance, self-absorption, manipulative, excessive anger to criticism, lacks empathy exaggerated sense of self-importance, self-absorption, manipulative, excessive anger to criticism, lacks empathy Borderline Personality Disorder Borderline Personality Disorder stormy relationships, fear of abandonment, dramatic mood and opinion changes, feels empty inside, self-harming stormy relationships, fear of abandonment, dramatic mood and opinion changes, feels empty inside, self-harming

16 Axis II – Personality Disorders – Dramatic, Emotional, Erratic Histrionic Personality Disorder Histrionic Personality Disorder overly dramatic, attention-seeking, temper tantrums, false sense of intimacy, demanding and manipulative overly dramatic, attention-seeking, temper tantrums, false sense of intimacy, demanding and manipulative Anti-Social Personality Disorder lying, stealing, manipulating others, and sometimes violence lying, stealing, manipulating others, and sometimes violence lack of guilt, shame and empathy lack of guilt, shame and empathy 3% of males and 1% of females 3% of males and 1% of females more extreme form = psychopathy more extreme form = psychopathy

17 Axis II – Personality Disorders – Anxious and Fearful Obsessive-Compulsive Personality Disorder Obsessive-Compulsive Personality Disorder inflexible, perfectionist, controlling, detail-focussed, unwilling to compromise inflexible, perfectionist, controlling, detail-focussed, unwilling to compromise Avoidant Personality Disorder Avoidant Personality Disorder inhibited and introverted, hypersensitive to rejection, mistrustful, socially awkward inhibited and introverted, hypersensitive to rejection, mistrustful, socially awkward Dependent Personality Disorder Dependent Personality Disorder pervasive and excessive need to be taken care of, submissive, clingy, difficulty making decisions pervasive and excessive need to be taken care of, submissive, clingy, difficulty making decisions

Risk Factors for PDs childhood history of abuse childhood history of abuse family history of schizophrenia family history of schizophrenia family history of personality disorder family history of personality disorder childhood head injury childhood head injury chaotic childhood chaotic childhood 18

Criticism #1 Criticism #1 Too much overlap with Axis I disorders Too much overlap with Axis I disorders E.g., avoidant personality disorder sounds a lot like a social phobia E.g., avoidant personality disorder sounds a lot like a social phobia Criticism #2 Criticism #2 Only difference with a lot of personality disorders from normal behavior is the quantity of symptoms (i.e., symptoms in moderation are regarded as ‘ normal ’ ) Only difference with a lot of personality disorders from normal behavior is the quantity of symptoms (i.e., symptoms in moderation are regarded as ‘ normal ’ )

Clinical features of borderline personality disorder