Schizophrenia

❖ Ultimate in psychological breakdown ❖ The “Mad” ❖ Characterized by:

– Gross distortions in reality – Withdrawal from relationships – Disorganization and fragmentation of

perception, thought, emotion

❖ Typically early onset in adolescence early adulthood

Kraeplin (1898)

❖ Dementia Praecox – Praecox: early onset – Dementia: deteriorating course

Bleuler (1911)

❖  “Schizophrenia” à split mind or split between thought and emotions

❖  Not split in personality not multiple personality! ❖  Primary Characteristics (4 A’s):

–  Affect (blunt, flat, inappropriate) –  Associations (loosening of associations) –  Ambivalence (abnormal psychomotor state in which the

patient physically vacillates between two opposing courses of action like catanoia)

–  Autism (loss of contact with reality, withdrawal)

Schizophrenia – Major Characteristics

❖ Emotion/Affect: – Emotional blunting –  Inappropriate affect – Flat affect

Schizophrenia – Major Characteristics

❖ Thought – Disorder of Thought Form

◆ Neologisms ◆ Loose Associations ◆ Clang Associations ◆ Perseveration ◆ Blocking

Neologism

❖  I am here from a foreign university.. And you have to have a plausity of all acts of amendment to go through for the children’s code…it is an amorition law… there is nothing to disturb me… it is like their privatilinia.. And the children have to have this accentuative law so they don’t go into the mortite law of the church (Vetter, 1969)

Loose Associations

❖ The problem is insects…My brother used to collect insects...He’s a man 5 foot and 10 inches... You know, 10 is my favourite number… I also like to dance, draw, and watch television

Clang Associations

❖ How are you feeling: – Well, hell, its well to tell

❖ The weather: –  So hot, you know it runs on a cot

Perseveration

❖ Repeat words and statements again and again

Blocking

❖  I may be thinking quite clearly and tellling someone something and suddenly I get stuck. You hve seen me do this and you may think I am just lost for words or that I have gone into a trance, but that is not what happens. I suddenly stick on a word or an idea in my head and I just can’t move past it. It seems to fill my mind and there’s no room for anything else. This might go on for a while and suddenly its over.

Disorganized Speech

❖ Word Salad: complete breakdown of associational process –  Its all over for a squab true tray and there

ain’t no music, there ain’t no nothing besides my mother and father who stand alone upon the Island of Capri where there is no ice, there is no nothing.

Schizophrenia – Major Characteristics

❖ Thought: – Lack of insight – Disorder of Thought Content

◆ Delusions –  Thought Broadcasting –  Thought Insertion –  Thought Withdrawal –  Delusions of Control –  Persecutory Delusions –  Delusions of Grandeur –  Delusions of Reference

Thought Broadcasting

❖  21 year old student: As I think, my thoughts leave my head on a type of mental ticker tape. Everyone has only to pass the tape through their mind and they know my thoughts

Thought Withdrawal

❖  22 year old female: I am thinking about my mother and suddenly my thoughts are sucked out of my mind by a phrenological vacuum extractor and there is nothing in my mind. It is empty

Delusion of Control

❖  The inmates here hate me because I am sane…by telepathy and imagination they force me to say orally whatever they desire. I never said a word of my own. I never created a thought or image of my own.

Positive & Negative Symptoms ❖  Positive and

Disorganization Symptoms:

❖  Thoughts, sensory experiences, and behaviors not ordinarily present in individuals— an excess or distortion of normal functions

❖  Negative Symptoms:

❖  Absence or diminution of normal cognitions, feelings or behaviors normally present in individuals

The Three Christs of Ypsilanti (1964)

❖ Case study by Milton Rokeach, ❖ Ypsilanti State Hospital (Michigan) ❖ Rokeach brought together three men

who each claimed to be Jesus Christ and confronted them with each other's conflicting claims

❖ Not helpful

Schizophrenia – Major Characteristics

❖ Perception and Attention –  Information filtering – Hallucinations

◆ Visual ◆ Auditory ◆ Taste ◆ Smell ◆ Touch

Auditory Hallucinations

❖  The voices…were mostly in my head, though I often heard them in the air or in different parts of the room. Every voice was different and each beautiful and, generally, speaking or singing in a different tone and measure and resembling those of relations or friends. There seemed to be many in my head. I should say upwards of fourteen. I divide them as they styled themselves, or one another, into voices of contrition and voices of joy and honour.

Schizophrenia – Major Characteristics

❖ Volition – Motivation

Schizophrenia – Major Characteristics

❖ Motor Behaviour: – Catatonia – Waxy Flexibility

Schizophrenia – Broad Subtypes

❖ Process ❖ Reactive

❖ Other subtypes listed in text

Erotomania (de Clerambault’s Syndrome

❖  Delusional disorder in which person believes he or she is loved by someone else

❖  May have passing or nonexistent relationship ❖  Predominantly female ❖  Reported in early work even by Hippocrates ❖  1623: Maladie d’Amour or Melancolic

Erotique

Examples

❖  John Hinckley, Jr. ❖ Ann Murray

Stalkers

Schizophrenia Treatment

❖ Before 1950 à prognosis poor ❖ Advent of Major Tranquillizers ❖ Now

–  80% of admitted discharged within a month or two

–  re-admission rates still very high

Social Recovery

❖ Ability to manage independently as an economically effective and interpersonally connected member of society

Treatments

❖ Family Therapy ❖  Individual ❖ Social Skills Training

Viral Infection Model

❖ Schizophrenia result of brain infection –  Incidence increase in late 1800’s

(suggestion due to virus) ◆ Finger print data: among MZ twins discordant

1/3 have different fingerprints ◆ One drug, clozapine, is a powerful antiviral ◆  Inconsistent research on maternal exposure to

influenza