Schizophrenia

1. Schizophrenia A little bit more....

2. Fact #1:There are different types. • Paranoid Schizophrenia- Delusions&/or hallucinations • Hebephrenic Schizophrenia- Aimless behaviour & disorganised. • Catatonic schizophrenia-Motor abnormality • Undifferentiated Schizophrenia-Insufficient no. of symptoms from other subtypes. • Post- Schizophrenia-Within last 12mths but not present. • Residual Schizophrenia-Criteria currently, although not in past. • Simple Schizophrenia- Slow progressive decline (over 12 mths) of e.g. sociability occupation etc.

3. 2# Criteria needs to be met for diagnosis • In all cases the general criteria for a diagnosis must be met as well as the specific criteria for each subtype. • The only exception being simple schizophrenia. • Within Britain schizophrenia is usually diagnosed using Schizophrenia as a overarching illness/label. However Crow (1985) proposed additional categories Type I or Type II. • Type I = Acute disorder with positive symptoms • Type II = Chronic disorder with negative symptoms.

4. #3 The subtypes are not without their problems!! • There can be a blurred distinction between the two. Certain individuals are diagnosed with one type and develop the symptoms from another, thus invalidating the reliability the of the original diagnosis. • These individuals do not therefore fit any specific category. The distinction may be useful but is not a 100% reliable.

5. What sub type am I? • Helen suffers from acute discomfort in close relationships, cognitive & perceptual distortion. She often displays odd, some may say, eccentric behaviour, such as wearing bright coloured clothes, and often organises her clothes and food cupboards. • She has little sense of humour and is vague in conversation.

6. What sub type am I? • Dave is a 19 year old student. He has been unresponsive fro the whole duration of his hospital stay (4 weeks). His body has been very rigid and he has stared at the ceiling for long periods of time and spends most of the day in a trance like state. • The only behaviour that can be investigated happened prior to the hospitalisation when he was ranting and raving that his psychology teacher was a demon.

7. What sub type am I? • Daisy is a unmarried woman who lives with her elderly mother. She believes that the world is filled with radio waves that are trying to penetrate her brain and plant evil thoughts into her brain. Because of this belief Daisy rarely leaves the house. Her windows have ‘protection’ with foil, they deflect the radio waves. The voices in her head comment on the radio waves all the time.

8. So what does a schizophrenia sufferers brain look like? This map reveals the 3-dimensional profile of gray matter loss in the brains of teenagers with early-onset schizophrenia, with a region of greatest loss in the temporal and frontal brain regions that control memory, hearing, motor functions, and attention Source: http://www.loni.ucla.edu/Research/Projects/Schizophrenia.shtml

9. Source: http://images.google.co.uk/imgres?imgurl=http://www.schizophrenia.com/images/schizophrenia_brain_large.gif&imgrefurl=http://www.schizophrenia.com/schizpictures.html&usg=__n5FqNV6P0yjjAssAC6TbzC2Tn5c=&h=600&w=700&sz=86&hl=en&start=2&um=1&itbs=1&tbnid=B9S2Juc-v6DobM:&tbnh=120&tbnw=140&prev=/images%3Fq%3Dthe%2Bbrain%2Bin%2Bschizophrenia%26um%3D1%26hl%3Den%26lr%3D%26sa%3DN%26rlz%3D1R2ACPW_enGB364%26tbs%3Disch:1

10. Biochemical explanation. Source: http://images.google.co.uk/imgres?imgurl=http://www.schizophrenia.com/images/schizophrenia_brain_large.gif&imgrefurl=http://www.schizophrenia.com/schizpictures.html&usg=__n5FqNV6P0yjjAssAC6TbzC2Tn5c=&h=600&w=700&sz=86&hl=en&start=2&um=1&itbs=1&tbnid=B9S2Juc-v6DobM:&tbnh=120&tbnw=140&prev=/images%3Fq%3Dthe%2Bbrain%2Bin%2Bschizophrenia%26um%3D1%26hl%3Den%26lr%3D%26sa%3DN%26rlz%3D1R2ACPW_enGB364%26tbs%3Disch:1

11. Dopamine is a neurotransmitter that transports signals between nerve endings in the brain. It is thought that the brains of people with schizophrenia and other psychotic disorders produce too much dopamine. There is evidence that supports and counters the dopamine hypothesis.

12. Dopamine hypothesis • However, several factors challenge the dopamine hypothesis. E.G. dopamine-related psychosis occurs in many disorders, not exclusively in schizophrenia. • People with schizophrenia are not the only ones who respond to antipsychotic medication. • Antipsychotic medication may not significantly affect the negative symptoms of schizophrenia, which suggests that there is more involved than abnormal dopamine levels alone. • Moreover, dopamine levels might actually be lower rather than higher in the frontal lobes of the brain. At any rate, antipsychotic medication only treats the symptoms of schizophrenia; it does not eliminate its underlying causes. • The main support for the theory that too much dopamine causes schizophrenia is the fact that antipsychotic medications, which are used to treat schizophrenia, block dopamine receptors. The medications are designed to bind to dopamine receptors in the brain, and their effects have helped many people cope with symptoms. Secondly, drugs that increase levels of dopamine, like amphetamines, often cause psychotic symptoms and a schizophrenic-like paranoid state.

13. But we must remember there is evidence to suggest otherwise!!

14. Underactive frontal lobes and overactive parietal lobes are thought to cause some of schizophrenia’s associated symptoms. For example, when frontal lobes are underactive, planning, organization, and volition are all impaired. Frontal lobe abnormalities are probably related to schizophrenia’s negative symptoms. Parietal lobes are involved in sensory perception, like voice recognition, the ability to distinguish patterns, and spatial orientation. Overactive parietal lobes may cause distortion of these senses, which is seen in many people with schizophrenia. Parietal lobe abnormalities are probably more closely related to positive symptoms. Abnormal brain structure is found consistently in people with schizophrenia. This includes enlarged ventricles and asymmetrical hemispheres. Using imaging researchers have discovered decreased blood flow to the frontal lobes of people with schizophrenia. These types of brain abnormalities forecast certain symptoms, like loss of attention, difficulty with abstract thinking, and the inability to solve problems. Evidence?? Brown et al (1986) Buschbaum (1990) Woodruff et al (1997) Wood et al (2005)

15. Some evidence suggests that infants who experience birth trauma or complications while in the womb are at greater risk for schizophrenia. Maternal illness may play a part as well. A mother who contracts a virus like the flu, especially during her second trimester, may increase the risk for her child. It is not known, whether the virus itself or the immune response to it increases the risk. (Chicken & egg scenario!) • Some studies have shown that winter birth may be associated with schizophrenia, especially during immune response and illness. Furthermore, viruses in the womb are more common during the winter months. This has led some researchers to consider intrauterine viral infection during the winter as a risk factor. The same link, however, is found for major mood disorders, like bipolar disorder. • Evidence?? Hope-Simpson (1981) Bradbury & Miller (1985) Jones & cannon (1998) Torrey et al (1988)

16. How is the evidence investigated/gathered? • Well...ethically you cannot perform lobotomy's as such or prod and poke...so the information to support the biological explanations as a whole are collected using a variety of tests/procedures including blood tests and brain scans.

17. Scanning..... • MRI = Magnetic resonance imaging (MRI) is an imaging technique used primarily in medical settings to produce high quality images of the inside of the human body. • It is a massive breakthrough as it shows clear pictures of the living brain.

18. Scanning... • PET/CT = PET stands for Positron Emission Tomography. • PET scans measure metabolic activity and molecular function by using a radioactive glucose injection. • The F-18 FDG is injected into the patient. • The PET scanner detects the radiation emitted from the patient, and the computer generates three-dimensional images of tissue function or cell activity in the tissues of your body.

19. Could it be Genetic? Evidence is based upon three specific areas: • Twin studies • Concordance rates are investigated,(Maudsley twin register 58% were concordant) • Fischer (1971) 9.4% of offspring developed schizophrenia. • Cardno et el (1999) 40& concordance in MZ twins compared with 5.3 in DZ twins.

20. Could it be Genetic? Evidence is based upon three specific areas: Adoption study. • Finnish adoption study (Tienari 1969) adopted off spring of biological mothers with schizophrenia vs. Matched pairs group found 7% of adoptees in index group developed schizophrenia vs. 1.5% in control group. • Aged 5-7yrs at start of study, all sep from mum before the age of 4). • Danish study also supports findings Kety et al (1994)

21. Could it be Genetic? Evidence is based upon three specific areas: Family study. 1st degree relatives (parents, siblings and offspring) share an average of 50% of their genes 2nd degree relatives (half siblings, grandparents/children, aunts/uncles) share approx 25% of their genes To investigate genetic transmission of schizophrenia, studies compare rates of schizophrenia in relatives of diagnosed cases compared to controls Kendler et al (1985)

22. AO2/AO3 should be made up of the following point/issues. • What does ?? suggest about schizophrenia? • Problems with family studies? • Twins often reared in same environment so cant separate genetic and environmental factors • Data provided by prospective studies suggest a strong genetic link for schizophrenia • No twin study has yet shown 100% concordance in MZ twins • Twin, adoption and family studies continues to provide reliable evidence that the degree of risk increases with degree of genetic relatedness • Even twins reared apart shared the same environment in the womb before birth = environmental factors cant be discounted • Longitudinal studies are hampered as diagnostic criteria for schizophrenia is constantly being updated and changed • More effective in separating effects of genetic and environmental factors • Studies conducted so far don’t tell us which genes might be important for the transmission of schizophrenia. • Individual differences. • Role of other neurotransmitters (Clozapine). • Role of Dopamine in other disorders. • Don’t forget!!! APPROACHES ISSUES DEBATES