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

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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 much-greater-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 most common

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 SchizophreniaThis 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.)