What is Schizophrenia?

1. What is Schizophrenia? • Comes from Greek meaning “split” and “mind” • ‘split’ refers to loss of touch with reality • not dissociative state • not ‘split personality’ • Equally common among men and women but men have earlier onset • 18 to 25 for men • 26 to 45 for women Sample videos

2. Symptoms of Schizophrenia • Positive symptoms: • hallucinations • Delusions • Disordered thinking and speech • Heightened or distorted perceptions • Inappropriate affect • Negative symptoms • absence of normal cognition or affect (e.g., flat affect, poverty of speech, social withdrawal, loss of motivation) • Psychomotor Symptoms • Awkward movement, grimaces, posturing, gestures

3. Examples from “Rose Garden” • Positive symptoms: • Hallucinations • in Yr a voice shrieked out of the deep Pit: Innocent! Innocent! • after a while the smell of people in the heavy ether-and-chloroform stench of the Pit made her think that she should try to see them. • Delusions – the construction of Yr & Midworld, her Yr name (Januce), her Yr name for Dr. Fried, others?

4. Examples from “Rose Garden” • Disordered thinking/loose associations • Deborah sat down, while the Censor said in Yri: Listen Bird-one … The tables have no defense against your clumsiness. ‘Do you know why you are here?’ the doctor asked. ‘Clumsiness. Clumsiness is first and then we have a list: lazy, wayward, headstrong, self-centered, fat, ugly, mean, tactless, and cruel … • Deborah looked at the Nose. “Obstacle,” she said. • Disordered perceptions • Deborah had looked about and found that she could not see except in outlines, gray against gray, and with no depth, but flatly, like a picture. • She could only see in gray now, and she could barely hear. Her sense of touch was also leaving …

5. Examples from “Rose Garden” • Psychomotor Symptoms - Catatonic • that day and the next she spent on Yr’s plains, simple long sweeps of land where the eye was soothed by the depth of space. • A few days later, Deborah returned to the Midworld looking down on Earth.

6. DSM-IV Criteria • Criteria A – Two or during “significant portion of the time” during a 1-month period: • Delusions • Hallucinations • Disorganized speech • Disorganized/catatonic behavior • Negative symptoms • B - Social/occupational dysfunction • C - Continuous disturbance for at least 6 months • D - Not Schizoaffective or Mood disorder • E - Not due to substance use/medical condition • F - Can have a co-occuring pervasive developmental disorder if hallucinations/delusions > 1 month

7. Symptoms of Schizophrenia • Delusions of persecution • ‘they’re out to get me’ • paranoia • Delusions of grandeur • Delusions of being controlled • the CIA is controlling my brain with a radio signal

8. Symptoms of Schizophrenia • Hallucinations • hearing or seeing things that aren’t there • contributes to delusions • command hallucinations: voices giving orders • Disorganized speech • overinclusion - 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

9. Symptoms of Schizophrenia • Disorganized behavior and affect • behavior is inappropriate for the situation • e.g., wearing sweaters and overcoats on hot days • Affect(emotion) 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

10. DSM-IV Criteria • 5 subtypes: • Disorganized –confusion, incoherence, and flat or inappropriate affect • Catatonic –psychomotor disturbance of some sort • Paranoid –an organized system of delusions and auditory hallucinations • Undifferentiated –symptoms cross subtypes • Residual – symptoms have lessened in strength and number

11. Subtypes of Schizophrenia • Paranoid type • delusions of persecution • believes others are spying and plotting • delusions of grandeur • believes others are jealous, inferior, subservient • Catatonic type - unresponsive to surroundings, purposeless movement, parrot-like speech • Disorganized type • delusions and hallucinations with little meaning • disorganized speech, behavior, and flat affect

12. Other Psychotic Disorders • Schizophreniform Disorder – Criteria A, D, E from Schizophrenia met • Lasts between 1 and 6 months • Schizoaffective Disorder • Major Depressive, Manic, or Mixed episode at the same time Criteria A from Schizophrenia met • At least 2 weeks with hallucinations/delusions without significant mood symptoms

13. Other Psychotic Disorders • Delusional Disorder – “Non Bizarre” Delusions lasting at least 1 month • Erotomanic, Grandiose, Jealous, Persecutory, Somatic Types • Schizophrenia criteria A never met • Aside from delusions, functioning not impaired • Brief Psychotic Disorder - Lasts between 1 day and 1 month

14. Lifetime risk of developing schizophrenia for relatives of a schizophrenic 40 30 20 10 0 General population Siblings Children of two schizophrenia victims Children Fraternal twin Identical twin Schizophrenia and Genetics • Sz risk increases with genetic similarity

15. Cultural Differences in Schizophrenia • Prevalence of Sz symptoms is similar no matter what the culture (1-2%) • Less industrialized countries have better rates of recovery than industrialized countries • families tend to be more accepting and less critical of the Sz patients (humanistic) • less use of antipsychotic medications, which may impair full recovery • think of Sz as transient, rather than chronic and lasting disorder: see it as a temporary exaggeration of normal feelings