1. Schizophrenia Chapter 12

2. Schizophrenia Broad spectrum of cognitive and emotional dysfunctions that include –Hallucinations –Delusions –Disorganized speech and behavior –Inappropriate emotions

3. Affects about 1 in 100 Complete recovery is rare Costs in 1991 estimated at $65 billion

4. Early figures Emil Kraepelin –Dementia praecox –Distinguished this from manic- depressive illness by emphasizing onset and outcome Eugen Bleuler –Schizophrenia. “split mind” –“Breaking of associative threads” –Recognized inability to keep constant stream of thought

5. Symptoms of heterogeneous: not all people with schizophrenia share the same symptoms Psychotic: delusions or hallucinations Person can display psychosis without having schizophrenia

6. Positive symptoms Active manifestations of abnormal behavior or an excess or distortion of normal behavior Delusions –Delusions of grandeur –Delusions of persecution

7. Positive symptoms… Hallucinations –The experience of sensory events without input from the environment –Auditory hallucinations are the most common –Broca’s area (speech) active not Wernicke’s area (language comprehension)

8. Negative symptoms Absence or insufficiency of normal behavior –Social withdrawal –Apathy –Impoverished speech or thought –Avoliton: apathy –Alogia: poverty of speech

9. Negative symptoms Anhedonia: lack of pleasure Flat affect: lack of emotional expression

10. Disorganized symptoms Rambling speech, erratic behavior, inappropriate affect Disorganized speech –Cognitive slippage –Tangentiality –Loose associations

11. Disorganized symptoms…. Inappropriate affect –Laughing or crying at inappropriate times Disorganized behavior –Catatonia

12. Subtypes of Schizophrenia Paranoid Disorganized Catatonic Undifferentiated residual

13. Paranoid Schizophrenia Hallucinations and delusions Relatively intact cognitive skills and affect Generally do not have disorganized speech Best prognosis Delusions of grandeur and persecution

14. Disorganized type (hebephrenia) Marked disruptions in speech and behavior Flat or inappropriate affect Delusions tend to be fragmented Shows up early and tends to be chronic

15. Catatonic type Unusual motor responses and odd mannerism Echolalia Echopraxia: relatively rare

16. Undifferentiated type “catch all” category Some symptoms but do not meet full criteria for paranoid, disorganized or catatonic types

17. Residual type At least one episode but no longer displaying major symptoms. Often have residual symptoms –Negative beliefs –Unusual or bizarre ideas –Social withdrawal –Flat affect

18. Other psychotic disorders Schizophreniformn disorder Schizoaffective disorder Delusional disorder Brief psychotic disorder Shared psychotic disorder Schizotypal personality disorder

19. Developmental research Early brain damage? Brain plasticity –Compensation in early life more difficult as person gets older

20. Genetic influence More severe the parent’s schizophrenia greater likelihood child will develop schizophrenia Genetic relatedness increases chances Monozygotic twins: 48% Fraternal: 17% Genes predispose person to schizophrenia Smooth movement eye tracking: genetic marker?

21. Neurological considerations Dopamine Excess can cause psychotic symptoms Antipsychotic drugs block dopamine receptors Negative effects of drugs similar to Parkinson's disease

22. Neurological considerations.. dopamine BUT Many with schizophrenia not helped by dopamine antagonists Dopamine blocked quickly, but symptoms remit long after More likely a dopamine/serotonin interaction Virus?

23. Neurological damage….. Positive symptoms: dopamine? Negative symptoms: enlarged ventricles? Can have these abnormalities w/o schizophrenia Less activity in frontal lobes, particularly dopamine pathway Finger tip ridge count: in 1/3 of of discordant twins

24. Psychological and social influences Extreme stress can produce psychotic symptoms May activate predisposition Family interactions: –Schizophrenogenic mother and double bind largely discounted –Expressed emotion related to relapse Criticism, hostility and emotional over- involvement

25. Treatment Institutionalization Prefrontal lobotomy ECT Insulin therapy Neuroleptic drugs –Conventional drugs : unpleasant side effects Atypical antipsychotics

26. New treatment? Transcranial magnetic stimulation

27. Psychosocial interventions Behavioral approaches –Socialization –Self-care –Appropriate emotional responses –Token economies –Independent living skills –Behavioral family therapy –Vocational rehabilitation

28. Cultural factors Differences in family support (Hispanics) China: meds and hospitalization Africa: prisons

29. prevention Genetic markers Early intervention