Transcript No Slide Title

Mind and brain are two sides of one coin;
Disorders of the mind* are disorders of the brain.
* schizophrenia, depression, anxiety, psychopathy, etc.
Schizophrenia
• Clinical features
• Etiology (cause)
– Genetic
– Environmental
• Neurobiology & Pharmacotherapy
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.
–
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.
–
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?
Delusions: items from Peters Delusion Inventory
Clinical features
• Positive symptoms
– Hallucinations
– Delusion
– Disorganized Speech
High Dopamine
– Socially awkward behavior (disorganized)
• Negative symptoms*
– Poverty of speech
– flat affect, apathy, anhedonia
– Decreased motor activity
• Cognitive symptoms*
– Working memory, attention
* non-specific
A very debilitating disease
Hypofrontality
male
All ethnic groups/geography
Lifetime prevalence = 1%
First diagnosis at 20 yrs of age
Prodrome at 17 yrs of age
female
10
20
30
40
50
years
Jennen-Steinmetz et al 1997
Early detection is key, as delayed
treatment:
- increases brain damage,
- shows less recovery
Some signs present at childhood:
- neuromotor functions
- sociability
- emotions
prodrome 1st acute
episode
relapse
relapse residual
phase
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)
Schizophrenia
• Clinical features
• Etiology (cause)
– Genetic:
– Environmental
• Neurobiology & Pharmacotherapy
Given that somebody is schizophrenic, what is the likelihood that
you will suffer from schizophrenia? (in %)
identical twin
48
fraternal twin
17
1
9
sibling
1
0
20
40
60
general
population
Increased risk with closer genetic distance
If biological parent is schizophrenic: 17%
- 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
Schizophrenia
• Clinical features
• Etiology (cause)
– Genetic:
– Environmental
• Neurobiology & Pharmacotherapy
Viral hypothesis (flu)
• Seasonal (previous slide)
• Urban
• Flu epidemic
Maternal influenza during
fetal development (2nd
trimester)
Stress hypothesis
• Flu is just a stressor
• Other stressors during 2nd 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
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
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
Schizophrenia
• Clinical features
• Etiology (cause)
– Genetic:
– Environmental
• Neurobiology & Pharmacotherapy
Positive symptoms: due to dopamine
• Antipsychotic drugs (D2 blockers)
• DA agonists (e.g., cocaine)
Negative Symptoms: Frontal lobe lesion
20
… some lessons for life
•
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•
•
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)
http://www.sfnsw.org.au/schizophrenia/symptoms.htm
http://www.emory.edu/EMORY_MAGAZINE/spring2000/inquiry.html
Summary