1. Schizophrenia

2. What is Schizophrenia?
Ability to function is impaired by severely distorted beliefs, perceptions, and thought processes
Comes from Greek meaning “split” and “mind”
‘split’ refers to loss of touch with reality
not dissociative state
not ‘split personality’
Equally split between genders, males have earlier onset
18 to 25 for men
26 to 45 for women
keywords: schizophrenia, definition

3. Symptoms of Schizophrenia
Positive symptoms
Excess of or distortion of normal functions
Hallucinations – false perceptions (auditory or visual)
Delusions – false beliefs
Negative symptoms
absence of normal cognition or affect
flat affect – emotionally “flat”
alogia - poverty of speech
avolition – inability to do simple goal-directed behaviors (dressing, bathing, social activities)
Disorganized Symptoms
Disorganized Speech or Behavior
keywords: schizophrenia, symptoms, types

4. Disorganized Speech
Word Salad - a string of words that vaguely resembles language, and may or may not be grammatically correct, but is utterly meaningless.
“Tramway flogging into my question, are you why is it thirty letters down under peanut butter, what is it.”
Watch this example from Boston Legal (1 min)
Neologisms - Making up words
“I am going to the park to ride the wallywhoop.”
Clang Speech - Rhyming all the words .
“Deck the halls with boughs of holly, folly, polly, dolly, hello Dolly, want a lollipop?”
Echolalia - Repeating exactly what someone else has said
Echopraxia - Repeating exactly what someone else has done.

5. Disorganized Behavior
Perseveration - Repeating the same activity (word or behavior) over and over again.
Dressing oddly, such as wearing many sets of clothing one over the other or wearing hats, gloves, and heavy coats in the summer.
Doing things in public that are usually done only in private. For example: urinating on a street corner.

6. Common Delusions
Delusions of reference - believes that other people are constantly talking about her or that everything that happens is somehow related to her
Delusions of persecution - believes that others are plotting against or trying to harm him or someone close to him
‘they’re out to get me’
paranoia
Delusions of grandeur - believes he is extremely important, powerful, or wealthy.
“God” complex
megalomania
Delusions of being controlled
the CIA is controlling my brain with a radio signal
keywords: schizophrenia, symptoms, delusions

7. Symptoms of Schizophrenia
Hallucinations
hearing or seeing things that aren’t there (most common are auditory)
contributes to delusions
command hallucinations: voices giving orders
Disorganized thought
Over-inclusion—jumping from idea to idea without the benefit of logical association
Paralogic—on the surface, seems logical, but seriously flawed
e.g., Jesus was a man with a beard, I am a man with a beard, therefore I am Jesus
Disturbances in sensation
sights, sounds, and other sensations feel distorted
keywords: schizophrenia, symptoms, hallucinations, disorganized speech

8. Symptoms of Schizophrenia
Disorganized behavior and affect
behavior is inappropriate for the situation
e.g., wearing sweaters and overcoats on hot days
affect is inappropriately expressed
flat affect—no emotion at all in face or speech
inappropriate affect—laughing at very serious things, crying at funny things
catatonic behavior
unresponsiveness to environment, usually marked by immobility for extended periods
keywords: schizophrenia, symptoms, disorganized behavior, disorganized affect

9. Frequency of positive and negative symptoms in individuals at the time they were hospitalized for schizophrenia. Source: Based on data reported in Andreasen & Flaum, 1991.

10. Subtypes of Schizophrenia
Paranoid type
delusions of persecution
believes others are spying and plotting
delusions of grandeur
believes others are jealous, inferior, subservient
no cognitive impairment, disorganized behavior, or negative symptoms
Catatonic type—unresponsive to surroundings, purposeless movement, parrot-like speech
waxy flexibility
highly disturbed movements or actions
keywords: schizophrenia, subtypes

11. Types of Schizophrenia
Disorganized type
delusions and hallucinations with little meaning
disorganized speech, behavior, and flat affect
Undifferentiated type – exhibits symptoms of schizophrenia but can’t be fit into one of the 3 subtypes.

12. Schizophrenia: An Example
Watch Module 26 from The Brain dvd (5 min).
As you watch Gerry write down what symptoms you see him demonstrating.

14. Prevalence of Schizophrenia
Onset of schizophrenia typically occurs during young adulthood.
Approximately 1 million Americans are treated for schizophrenia annually
Worldwide, about 1% of the population will experience at least one episode of schizophrenia at some point in life

15. Course of Schizophrenia: The ¼, ¼, ½ Rule
Enormous individual variability
About 1/4 of those who experience an episode of schizophrenia recover completely; another 1/4 experience recurrent episodes, but often with only minimal impairment of functioning
The other one-half, schizophrenia becomes a chronic mental illness, and the ability to function normally in society may be severely impaired.

16. Schizophrenia and Genetics
Risk increases with genetic similarity 40 30 20 10
Lifetime risk
of developing
schizophrenia
for relatives of
a schizophrenic
keywords: genetics of schizophrenia
Discovering Psy2e slides, Shulman
Discovering Psy2e Slides (Shulman)
Fraternal
twin
Children
of two
schizophrenia
victims
Identical
twin
General
population
Siblings
Children

18. Developing Schizophrenia
The lifetime risk of developing schizophrenia varies with one's genetic relatedness to someone having this disorder. Across countries, barely more than 1 in 10 fraternal twins, but some 5 in 10 identical twins, share a schizophrenia diagnosis. (Adapted from Gottesman, 2001.)

19. The Heritability of Schizophrenia
The researchers looked for signs of schizophrenia in the biological and adoptive relatives of people who had been adopted at an early age and either did or did not subsequently develop schizophrenia. The results here are the percentage of relatives who showed either schizophrenia or a milder disorder now called schizotypal personality disorder. (Data from Kety & others, 1976.)

20. POSSIBLE BIOLOGICAL FACTORS

21. Paternal age: Older fathers and the risk of schizophrenia
Because schizophrenia often occurs in individuals with no family history of mental disorders, no genetic model explains all the patterns of schizophrenia
Researchers in Jerusalem reviewed data on 87,000 people and found that paternal age was a strong and significant predictor of the schizophrenia diagnosis. (Mother’s age appeared to play no role.)
Paternal age failed to account for three-quarters of the cases of schizophrenia.

22. Biological Bases of Schizophrenia
Other congenital influences
difficult birth (e.g., oxygen deprivation)
prenatal viral infection
Brain chemistry
neurotransmitter excesses or deficits
dopamine theory
keywords: schizophrenia, congenital influences
Increased risk has been observed for those born in a country where there was a flu epidemic during their gestation. The months of above average risk births are reversed between the northern and southern hemispheres, as are the flu seasons.

23. The Dopamine Theory Theory: Schizophrenia is caused by excess dopamine
Drugs that reduce dopamine reduce symptoms
Drugs that increase dopamine produce symptoms even in people without the disorder
Dopamine theory not enough; other neurotransmitters involved as well
keywords: schizophrenia, the dopamine theory
A problem for the theory: Drugs that reduce dopamine do reduce Sz symptoms, but the effects on dopamine function in the brain and on behavior have different time courses. On treatment with dopamine blocking drugs receptor function in the brain is affected almost immediately but reduction of symptoms is delayed by days or weeks.
Some drugs that increase dopamine and that may induce sz-like positive symptoms include amphetamines and cocaine.
When drug therapy first became available it was regarded as a major breakthrough in the treatment of mental disease by medical means

24. Other Biological Factors
About half the people with schizophrenia show some type of brain structure abnormality
Brain structure and function
enlarged cerebral ventricles and reduced neural tissue around the ventricles
PET scans show reduced frontal lobe activity
Early warning signs
nothing very reliable has been found yet
certain attention deficits can be found in children who are at risk for the disorder
keywords: schizophrenia, brain structure, behavioral precursors

25. Brain Activity & Tissue Loss
One five-year prospective study compared brain structure changes in normal adolescents and adolescents with early onset schizophrenia
Gray matter tissue loss ranged from about 1 percent in the normal teens to more than 5 percent in the schizophrenic teens
The amount of gray matter loss was directly correlated to the teenage patient’s clinical symptoms
More rapid gray matter losses in the temporal lobes were associated with more severe positive symptoms
More rapid gray matter losses in the frontal lobes were strongly correlated with the severity of negative symptoms
PET scans of brain activity during schizophrenic hallucinations reveal activity in the left auditory and visual areas of the brain, but not in the frontal lobe, which is normally involved in organized thought processes.

26. The Shrinking of the Schizophrenic Brain
Among adolescents who suffer a relatively rare childhood - onset schizophrenia, MRI scans by Paul Thompson and his colleagues (2001) revealed a much-greater-than-normal loss of cerebral cortex tissue between the ages of 13 and 18

27. The Schizophrenic Brain
Doctors view X-rays of the brains of identical twins, one of whom has schizophrenia. The X-ray of the schizophrenic twin shows shrinkage of the brain tissue and an accumulation of cerebrospinal fluid.
Click HERE or on the box to the Right to view.

28. The Schizophrenic Brain: Questions
What does the difference in brain structures of these identical twins indicate about the cause of brain abnormality and schizophrenia in this case?
Research suggests that prenatal viral infection may play a role in schizophrenia. Suggest some ways in which this hypothesis could be tested.
What types of studies could look into the possible genetic factors in development of schizophrenia?

29. Not Just Biology at Fault
Some people with schizophrenia do not show brain structure abnormalities
The evidence is correlational
The kinds of brain abnormalities seen in schizophrenia are also seen in other mental disorders

30. POSSIBLE ENVIRONMENTAL FACTORS

31. Viral Infection Theory
Might be caused by exposure to an influenza virus or other viral infection during prenatal development or shortly after birth
Children whose mothers were exposed to a flu virus during the second trimester of pregnancy show an increased rate of schizophrenia
Schizophrenia occurs more often in people who were born in the winter and spring months, when upper respiratory infections are most common

32. Malnutrition & Schizophrenia
Children who were in their mothers' wombs during the period of great famine in China later developed schizophrenia at roughly twice the usual rate. (Data from St. Clair & others, 2005.)

33. POSSIBLE PSYCHOLOGICAL FACTORS

34. Unhealthy Families
Individuals who are genetically predisposed to develop schizophrenia may be more vulnerable to the effects of disturbed family environments

35. Finnish Adoptive Family Study of Schizophrenia
Found that children whose biological mother had schizophrenia had a much higher rate of schizophrenia than did the control group when they were raised in a psychologically disturbed adoptive family
When raised in a psychologically healthy adoptive family, they were no more likely than the control group to develop schizophrenia.
One-third of the adopted children with no genetic history of schizophrenia developed symptoms of a serious psychological disorder if they were raised in a psychologically disturbed family environment
Conclusion: a healthy psychological environment may counteract a person’s inherited vulnerability for schizophrenia, but a psychologically unhealthy family environment can act as a catalyst for the onset of schizophrenia

36. Other Family Influences on Schizophrenia
Family variables
parental communication that is disorganized, hard-to-follow, or highly emotional
expressed emotion
• highly critical, over-enmeshed families
keywords: schizophrenia, family variables

37. Cultural Differences in Schizophrenia
Prevalence of symptoms is similar no matter what the culture
Less industrialized countries have better rates of recovery than industrialized countries
families tend to be less critical of the patients
less use of antipsychotic medications, which may impair full recovery
think of it as transient, rather than chronic and lasting disorder
keywords: schizophrenia, cross-cultural issues

38. Development Model of Schizophrenia
This model depicts researchers' understanding of the contributions of genes, environmental experiences, and the person's present neural and behavioral condition to the development of schizophrenia and, in some cases, its progression into a chronic condition. (Based on a model depicted by Tsuang & others, 2001, p. 22.)

39. Summary of Schizophrenia
Many biological factors seem involved
heredity
neurotransmitters
brain structure abnormalities
Family and cultural factors also important
Combined model of schizophrenia
biological predisposition combined with psychosocial stressors leads to disorder
Is schizophrenia the maladaptive coping behavior of a biologically vulnerable person?
keywords: schizophrenia, summary