1. Schizophrenia Kimberley Clow kclow2@uwo.ca http://instruct.uwo.ca/psychology/155b/

2. Outline What is Schizophrenia? –Positive Symptoms –Negative Symptoms –Subtypes –Phases Development Causes Treatment

3. What Is Schizophrenia? Most severe of adult psychiatric disorders –Interferes with the ability to think, manage emotions, & relate to others History –Kraepelin –Bleuler

4. Course of Schizophrenia

5. Schizophrenia Psychotic Disorder –Characterized by major disturbances in thought, emotion, and behaviour Positive symptoms Negative symptoms –3 Main Clusters Withdrawal Magical Thinking Disorganization

6. Positive Symptoms Excesses or Distortions Disorganized or Catatonic Disorder Disorganized Speech –Loose Associations –Tangential Thinking –Word Salad Hallucinations Delusions

7. Types of Delusions –Persecutory delusions –Delusions of being controlled –Thought broadcasting –Thought insertion –Thought withdrawal –Delusions of guilt or sin –Somatic delusions –Grandiose delusions

8. First of all thank you very much for your desire to help me. I am twenty eight years old Men. My specialty is theoretical physic, I have finished university in spite of the fact that deficit of conscious mental acts means sharp reduction of creative activity and on the other hand it very impedes social communications (I do not know how modern psychiatrists call my disturbance, thinking not clearly?). From childhood I was very active and creative boy, I studded in the physic and mathematical school and participated in many Olympiads. At the beginning reduction of psychic activity took place very slowly and mental exercise which required learning (for example studding of verses or text by heart) facilitate my deficit of subjective psychic activity but one day (in one second) occurred sharp lowering of intentionality. My age was sixteen years then and since my disturbance remains without any change. I was treated by best psychiatrist of my country and Russian. At the beginning they think I have depersonalization disorder but then they changed their opinion and now think that I have “schizophrenic ego-dysfunction”. Of course, they do not mean that I have schizophrenia. I tried risperidone and zyprexa and I am sure they cannot be effective for treatment my disturbance, moreover probably my disturbance is not linked with hypoactivity of the cortico-striato-thalamo-cortical network and as Andreasen thinks disturbance of creative activity is not characteristic for schizophrenia at all. There are not neither books nor journals in my country, I have read only abstract of your article from Behavioral and Brain Science and decided to ask you advice.

9. Negative Symptoms Blunted Affect Alogia Avolition Impaired Social Skills Withdrawal & Antisocial Anhedonia

10. Development of Schizophrenia Process Schizophrenia –Chronic –Slow onset, develops gradually over time –evidences of oddity from early in childhood –poor prognostic outlook Reactive Schizophrenia –Acute –Sudden and dramatic onset marked by intense emotional and intellectual upheaval –Diathesis-Stress Model

11. Phases of Schizophrenia

12. Subtypes Are there really subtypes? Seem to be some grouping of symptoms –Disorganized –Catatonic –Paranoid Other categories –Undifferentiated –Residual

13. What is Going On? Excessive amounts of dopamine in frontal lobes Differences in Processing Information –Novelty processing –Difficulty inhibiting stimuli –Smooth pursuit eye movements disrupted Eye Tracking

14. Myths False assumptions about schizophrenia –Violence –Multiple personalities –Homelessness –Due to frigid mother –Due to conflicting messages –Due to conflict resolution in relationships –Sex abuse

15. Causes Biology –Genetics Heritability –Neurotransmitters Dopamine –Abnormal brain structures –Infection

16. Psychological Stress –Social Class Sociogenic Hypothesis Social Selection Theory –Cannabis –The Family Expressed Emotion (EE)

17. Treatment Biological –Antipsychotic Drugs Akinesia Akathesis Tardive Dyskinesia Cognitive-Behavioural Therapy –Target bizarre behaviour –Counter irrational thoughts –Social-Skills Training

18. Family Therapy –Attempt to reduce expressed emotion General Trends –Families and patients can be given realistic and scientifically sound information –Medication is only part of treatment –Early intervention affects course and treatment –Integrated treatment is not widely available

19. Concluding Remarks It is an all consuming disorder –Thoughts, feelings & behaviour Drug therapy is most common –Nasty side-effects –Life-long treatment With current treatments –About 25% of schizophrenics recover fully –About 10% have chronic deterioration –About 65% have partial recoveries