Transcript Chapter 1

Schizophrenia
What is Schizophrenia?
• Loss of contact with reality leading to
impaired functioning due to severely
distorted beliefs, perceptions, and thought
processes
• Comes from Greek meaning “split” and “mind”
– ‘split’ refers to loss of touch with reality
– not ‘split personality’
• Equally split between genders, males have
earlier onset
– 18 to 25 for men
– 26 to 45 for women
Categories of Symptoms for 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
Hallucinations
• Hallucinations
– hearing or seeing things that aren’t there (most
common are auditory)
– contributes to delusions
– command hallucinations: voices giving orders
• Disturbances in sensation
– sights, sounds, and other sensations feel
distorted
Common Delusions (False Beliefs)
• 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
Types 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
– Hardest type to treat
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 easily
be fit into one of the 3 subtypes.
Disorganized Symptoms
• 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
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.
• 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
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.
Schizophrenia: An Example
• Watch Module 26 from The Brain dvd (5
min).
• As you watch Jerry write down what
symptoms you see him demonstrating.
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
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.
Potential Causes of
Schizophrenia
Inheritability (Genetics)
Risk increases with genetic similarity
50
40
40
Lifetime risk
of developing
schizophrenia
for relatives of
a schizophrenic
30
30
20
10
10
0
0
Fraternal Children
Identical
of two
twin
General
Siblings
twin
Children
schizophrenia
population
victims
OTHER POSSIBLE
BIOLOGICAL
FACTORS
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
Brain Structure Abnormality
• 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
Brain Activity & Tissue Loss
• 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
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 muchgreater-than-normal loss of cerebral cortex tissue
between the ages of 13 and 18
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
POSSIBLE
ENVIRONMENTAL
FACTORS
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
POSSIBLE
PSYCHOLOGICAL
FACTORS
Psychoanalysis
• Freud thought that it resulted from the
overwhelming of the Ego by the urges of
the Id.
• This causes internal conflict.
• Regression occurs and the adult enters the
oral stage where they can’t discern between
reality and fantasy.
Multifactorial Model of
Schizophrenia
– Several biological and psychological factors
involved
– Genetics may create a vulnerability
– Environment (stress) may lead to development
of schizophrenia.
– Individuals who are genetically predisposed to
develop schizophrenia may be more vulnerable to
the effects of a disturbed or stressful environment
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.)