1. Mind and brain are two sides of one coin; Disorders of the mind* are disorders of the brain. * schizophrenia, depression, anxiety, psychopathy, etc.

2. Schizophrenia Clinical features Etiology (cause) –Genetic –Environmental Neurobiology & Pharmacotherapy

3. Clinical features Positive symptoms : Characteristics displayed by schizophrenics that are not typical present in healthy individuals. Negative symptoms: Absence of characteristics that are typical present in healthy individuals. –

4. Clinical features Positive symptoms : Characteristics displayed by schizophrenics that are not typical present in healthy individuals. –Hallucinations – Delusions –Disorganized speech - Socially awkward behavior Negative symptoms: Absence of characteristics that are typical present in healthy individuals. –

5. Hallucinations: Sample item from Scale for the assessment of positive symptoms Have you ever heard voices commenting on what you are thinking or doing? –What do they say?

6. Delusions: items from Peters Delusion Inventory

7. Clinical features Positive symptoms –Hallucinations –Delusion –Disorganized Speech –Socially awkward behavior (disorganized) Negative symptoms* –Poverty of speech –flat affect, apathy, anhedonia –Decreased motor activity Cognitive symptoms* –Working memory, attention A very debilitating disease * non-specific High Dopamine Hypofrontality

8. All ethnic groups/geography Lifetime prevalence = 1% First diagnosis at 20 yrs of age Prodrome at 17 yrs of age Early detection is key, as delayed treatment: -increases brain damage, -shows less recovery Some signs present at childhood: - neuromotor functions - sociability - emotions 1020304050 years Jennen-Steinmetz et al 1997

9. Time course: - positive symptoms are evident in the acute episodes - negative symptoms increase gradually (although they can precede the positive ones, as in the prodrome) 1 st acute episode prodromerelapseresidual phase relapse

10. Schizophrenia Clinical features Etiology (cause) –Genetic: –Environmental Neurobiology & Pharmacotherapy

11. Increased risk with closer genetic distance Given that somebody is schizophrenic, what is the likelihood that you will suffer from schizophrenia? (in %) If biological parent is schizophrenic: 17%

12. -Age of father (not of mother) -Spermatocytes divide more frequently than oocytes, so increase chance of mutation (it’s not a Y chromosome mutation) -Environmental impact on a genetic factor

13. Schizophrenia Clinical features Etiology (cause) –Genetic: –Environmental Neurobiology & Pharmacotherapy

14. Viral hypothesis (flu) Seasonal (previous slide) Urban Flu epidemic Maternal influenza during fetal development (2 nd trimester)

15. Stress hypothesis Flu is just a stressor Other stressors during 2 nd trimester also increase risk: –Underweight mother –Underweight newborn –Famine ( due to thiamine deficiency post-famine?) –Your husband is killed –Increased cortisol stress video may also explain disease onset in adolescence

16. Pre-morbid development Schizotypal personality disorder at adolescence –Social anxiety –Affective abnormalities –Eccentric behavior –Unusual ideas (e.g., persistent belief in ESP) –Unusual sensory experiences (not strong enough to be delusions or hallucinations) Relation between SPD and schizo (20-40% of SPD -> schizo), familial link

17. Of those showing warning signs (prodromal phase) 1/3 gets better as they enter adulthood 1/3 continues to experience mild symptoms 1/3 develops schizophrenia or other psychosis This latter group has the higher cortisol levels at prodrome Cortisol levels increase with puberty (even in normal kids) a disruptive family environment (stressor) is a risk factor. Further evidence for cortisol hypothesis: in animal models, cortisol increase during pregnancy leads to abnormal hippocampus in the offspring

18. Schizophrenia Clinical features Etiology (cause) –Genetic: –Environmental Neurobiology & Pharmacotherapy

19. Positive symptoms: due to dopamine Antipsychotic drugs (D2 blockers) DA agonists (e.g., cocaine)

20. 20 Negative Symptoms: Frontal lobe lesion

21. … some lessons for life Flu Vaccine Reduce maternal stress (physical & psychological) Reduce teenager’s stress Raise concern about friend/relative when you deem doing so is warranted. Support early treatment (when onset is evident)

22. http://www.sfnsw.org.au/schizophrenia/symptoms.htm http://www.emory.edu/EMORY_MAGAZINE/spring2000/inquiry.html

23. Summary