Schizophrenia

1. Schizophrenia If depression is the common cold of psychological disorders, schizophrenia is the cancer. Nearly 1 in a 100 suffer from schizophrenia. Schizophrenia strikes young people as they mature into adults. It affects men and women equally, but men suffer from it more severely than women.

2. Symptoms of Schizophrenia The literal translation is “split mind.” A group of severe disorders characterized by the following: Disorganized and delusional thinking. Disturbed perceptions. Inappropriate emotions and actions.

3. Disorganized & Delusional Thinking This morning when I was at Hillside [Hospital], I was making a movie. I was surrounded by movie stars … I’m Marry Poppins. Is this room painted blue to get me upset? My grandmother died four weeks after my eighteenth birthday.” (Sheehan, 1982) Other forms of delusions include, delusions of persecution (“someone is following me”) or grandeur (“I am a king”). This monologue illustrates fragmented, bizarre thinking with distorted beliefs called delusions (“I’m Mary Poppins”).

4. Disorganized & Delusional Thinking Many psychologists believe disorganized thoughts occur because of selective attention failure (fragmented and bizarre thoughts).

5. Disturbed Perceptions A schizophrenic person may perceive things that are not there (hallucinations). Frequently such hallucinations are auditory and lesser visual, somatosensory, olfactory, or gustatory. L. Berthold, Untitled. The Prinzhorn Collection, University of Heidelberg August Natter, Witches Head. The Prinzhorn Collection, University of Heidelberg Photos of paintings by Krannert Museum, University of Illinois at Urbana-Champaign

6. Inappropriate Emotions & Actions A schizophrenic person may laugh at the news of someone dying or show no emotion at all (apathy). Patients with schizophrenia may continually rub an arm, rock a chair, or remain motionless for hours (catatonia).

7. Subtypes of Schizophrenia Schizophrenia is a cluster of disorders. These subtypes share some features, but there are other symptoms that differentiate these subtypes.

8. Positive and Negative Symptoms Schizophrenics have inappropriate symptoms (hallucinations, disorganized thinking, deluded ways) that are not present in normal individuals (positive symptoms). Schizophrenics also have an absence of appropriate symptoms (apathy, expressionless faces, rigid bodies) that are present in normal individuals (negative symptoms).

9. Chronic and Acute Schizophrenia When schizophrenia is slow to develop (chronic/process) recovery is doubtful. Such schizophrenics usually display negative symptoms. When schizophrenia rapidly develops (acute/reactive) recovery is better. Such schizophrenics usually show positive symptoms.

10. Effects of Schizophrenia • Disrupt social relationships • Makes it difficult to hold a job • Often live in a private inner world • With support, some may recover to enjoy a normal life or only experience bouts of schizophrenia intermittently

11. Types of Schizophrenia • Paranoid • Disorganized • Catatonic • Undifferentiated • Share some common features • Also have some distinguishing symptoms (see textbook)

12. Subtypes

13. Understanding Schizophrenia Schizophrenia is a disease of the brain exhibited by the symptoms of the mind. Brain Abnormalities Dopamine Overactivity: Researchers found that schizophrenic patients express higher levels of dopamine D4 receptors in the brain.

14. What Causes Schizophrenia?

15. Causes: Brain Abnormality • Excess of receptors for dopamine • May intensify brain signals, which would create the positive symptoms of hallucinations and paranoia • Drugs that block dopamine receptors often lessen positive symptoms • Drugs that increase dopamine activity (amphetamines and cocaine) can intensify them • But dopamine is also linked to Parkinson’s disease, so patients who take drugs to block dopamine develop Parkinson’s like symptoms • Dopamine blocking drugs have little effect on negative symptoms • Investigating the role of glutamate (excitatory neurotransmitter) • Drugs that interfere with glutamate receptors can produce schizophrenia-like negative symptoms

16. Cause: Brain cont. • People with schizophrenia have abnormal brain activity in several areas • NOT one isolated area • Low brain activity in frontal lobes • PET scans during hallucinations showed activity in the thalamus • Temporal lobe is activated during auditory hallucinations • People with paranoia showed increased activity in the amygdala • Brain size • Enlarged, fluid-filled areas in brains of patients • Smaller cerebral cortex • Smaller thalamus • Can show these BEFORE onset! • What causes these abnormalities? Famineduring pregnancy

17. Abnormal Brain Morphology Schizophrenia patients may exhibit morphological changes in the brain like enlargement of fluid-filled ventricles. Both Photos: Courtesy of Daniel R. Weinberger, M.D., NIH-NIMH/ NSC

18. Abnormal Brain Activity Brain scans show abnormal activity in the frontal cortex, thalamus, andamygdala of schizophrenic patients. Adolescent schizophrenic patients also have brain lesions. Paul Thompson and Arthur W. Toga, UCLA Laboratory of Neuro Imaging and Judith L. Rapport, National Institute of Mental Health

19. Genetic Factors • If your parent or siblings have schizophrenia, your odds of developing it are 1 in 10 • If your identical twin has it, your odds are 1 in 2 (even when reared apart) • Those who share a placenta have an increased risk • Children adopted by someone who develops schizophrenia, seldom “catch” the disorder • Genes could affect dopamine levels or production of myelin • Identifying specific genes is difficult • Other factors (viruses, oxygen deprivation at birth, etc) may “turn off” or “turn on” the genes that predispose people to the disease

20. 0 10 20 30 40 50 Identical Both parents Fraternal One parent Sibling Nephew or niece Unrelated Genetic Factors The likelihood of an individual suffering from schizophrenia is 50% if their identical twin has the disease (Gottesman, 1991).

21. Genetic Factors The following shows the prevalence of schizophrenia in identical twins as seen in different countries.

22. Psychological Factors Psychological and environmental factors can trigger schizophrenia if the individual is genetically predisposed (Nicols & Gottesman, 1983). The genetically identical Genain sisters suffer from schizophrenia. Two more than others, thus there are contributing environmental factors. Courtesy of Genain Family Genain Sisters

23. Psychological Factors • “No environmental causes have been discovered that will invariably, or even with moderate probability, produce schizophrenia in persons who are not related to a person with schizophrenia” • Susan Nicol and Irving Gottesman in 1983

24. Viral Infection Schizophrenia has also been observed in individuals who contracted a viral infection (flu) during the middle of their fetal development.

25. Early Warning Signs • Study of “at risk” children/young adults who had relatives with schizophrenia • A mother whose schizophrenia was severe and long lasting • Birth complications, often involving oxygen deprivation and low birth weight • Separation from parents • Short attention span and poor muscle coordination • Disruptive or withdrawn behavior • Emotional unpredictability • Poor peer relations and solo play

26. Personality Disorders Personality disorders are characterized by inflexible and enduring behavior patterns that impair social functioning. They are usually without anxiety, depression, or delusions.

27. Antisocial Personality Disorder A disorder in which the person (usually men) exhibits a lack of conscience for wrongdoing, even toward friends and family members. Formerly, this person was called a sociopath or psychopath.

28. Understanding Antisocial Personality Disorder Like mood disorders and schizophrenia, antisocial personality disorder has biological and psychological reasons. Youngsters, before committing a crime, respond with lower levels of stress hormones than others do at their age.

29. Understanding Antisocial Personality Disorder PET scans of 41 murderers revealed reduced activity in the frontal lobes. In a follow-up study repeat offenders had 11% less frontal lobe activity compared to normals (Raine et al., 1999; 2000). Courtesy of Adrian Raine, University of Southern California Normal Murderer

30. Understanding Antisocial Personality Disorder The likelihood that one will commit a crime doubles when childhood poverty is compounded with obstetrical complications (Raine et al., 1999; 2000).

31. Rates of Psychological Disorders

32. Rates of Psychological Disorders The prevalence of psychological disorders during the previous year is shown below (WHO, 2004).

33. Risk and Protective Factors Risk and protective factors for mental disorders (WHO, 2004).

34. Risk and Protective Factors