History

2. History • The word schizophrenia is less than 100 years old, but the illness has probably accompanied mankind through its history. • Schizophrenia can be traced in written documents to the old Pharaonic Egypt, as far back as the second millennium before Christ • Depression, dementia, as well as thought disturbances found in schizophrenia are described in detail in the Book of Hearts. • The psychical illnesses were regarded as symptoms of the heart and the uterus and originating from the blood vessels or from purulence, fecal matter, a poison or demons. In most cases the Egyptians apparently looked upon the mental diseases as physical illnesses. • The treatment comprised temple sleep, also called incubation. The ill persons spent the night in a holy place.

4. The History of Schizophrenia • Characterized by distortions: perception, thought, language, emotions • Greece – Hippocrates had knowledge of the basic symptoms. • Eugen Bleuler – Swiss psychiatrist – coined “schizophrenia” • Greek words for “split mind” - separation of cognitive and emotional functions – mental confusion, inappropriate or absent emotional expression. • Not the same as multiple personality disorder • Heinz Leshmann – chlorpromazine, first modern anti-psychotic drug – made positive symptoms disappear.

6. Symptoms • Familiar things like colors, sounds, or tastes may appear altered in a strange way. • At first, symptoms may include mild feelings of tension, inability to sleep or concentrate, and a loss of interest in school, work, or friends. • The symptoms of schizophrenia vary from one person to another, and they can appear either gradually or suddenly • As the illness progresses, people with schizophrenia experience symptoms that include psychosis. The person incorrectly evaluates the accuracy of his or her perceptions and thoughts and makes incorrect conclusions about reality.

7. Symptoms • Positive symptoms: common schizophrenia behaviors • Delusions: false beliefs kept despite contrary evidence. (believing you are the Virgin Mary) • Hallucinations: false perceptions (usually hearing voices) • mental disturbance: illogical thought, incoherent speech, word usage shifts. • Negative Symptoms: absence of expected behavior • Physical immobility • No emotional expression • Little speech • Withdrawal from social world

8. What are the symptons associated with the different types of schizophrenia? Paranoid Schizophrenia • Delusions, hallucinations, misinterpretation of facts • Violent, suicidal behavior - high risk • Ex: patient images that he is someone else or someone is trying to harm him. • Imaginary voices

9. Disorganized Schizophrenia • Confused functions • Incoherent speech/thought • Improper emotional expression • Act silly/bizarre • Withdrawal from world

10. Catatonic Schizophrenia • Negative Symptoms • Abnormal posture/movements • Repeated motions • Motionlessness • Inactivity/Excitement periods • Impulsiveness

11. Undifferentiated Schizophrenia Decrease in outside interests/relationships Absence of mental activity Lack of emotion Mixture of symptoms Does not fit any of the categories Residual Schizophrenia Moderate symptoms which occur after partial recovery of an acute episode of schizophrenia Less severe symptoms: flat affect, Absence of emotion, limited speech

12. Etiology of Schizophrenia What exactly might be the cause of Schizophrenia? Is there a concrete explanation? The biological, cognitive, and behaviorist approaches all have their different theories to resolve a cure for this disorder. Research is revealing that schizophrenia is indeed a environmental impact during the the development of the brain during pregnancy and childhood. Another prediction is that is a result of the interaction of certain variations of genes. These would be the damaged portions of genes.

13. The Cause of Schizophrenia: Behaviourist Approach “The Behaviourist Approach interprets abnormal behavior as simply maladaptive learning.” From this, the behaviourist approach would then say that Schizophrenia is not regarded at all differently to other forms of abnormal behaviour. In other words, the behaviourist approach would actually see the term Schizophrenia as having no etiological value. Although the behaviourist approach does not believe that there seems to be an etiology for this disorder, it does have a number of different treatments for it, such as token economy.

14. Risk of developing schizophrenia It seems that Identical Twins hold the highest risk percentage to obtain this disorder…might this have a biological connection?

15. The Cause of Schizophrenia: Biological Approach The biological approach closely looks at the interaction between the environment and genetics. Some might say that the biological perspective is too radical, and reductionist, but it seems that genetics due play a major role in the involvement of this disorder. Research nowadays proposes the idea that schizophrenia is caused by a genetic vulnerability which is coupled with the environmental and psychological stressors. This is also known as the diathesis-stress model. The idea basically says that whether the person develops the disorder or not, for the most part it is determined by the vulnerability. In overall, as said before…the biological approach closely looks at the genetic factors, and how they apply to the disorder. In this case, if there is a genetic vulnerability, it is more likely for the person to develop Schizophrenia.

17. Biological Perspective The Medical Model • Explanations of schizophrenia : • Genetic predisposition • Structural brain abnormalities • (smaller frontal cortex) • Neurotransmitter abnormalities • (the dopamine hypothesis) • Prenatal abnormalities • The vulnerability (Stress Approach) • Explains Schizophrenia in terms of genetic and psychological processes • Emphasizes environmental influences • Try to identify individuals who are defined as being at risk, and observe whether they in fact develop schizophrenia • In that case the results are correlational

18. Genetic Predisposition

19. Risk of developing schizophrenia It seems that Identical Twins hold the highest risk percentage to obtain this disorder…might this have a biological connection?

21. Biological Perspective • Dopamine hypothesis – theory that schizophrenia is related to over activity in neural pathways which depend on dopamine as a neurotransmitter. • Not all patients respond to chlorpromazine. • Even though drugs reach brain after ingestion, it takes days or weeks before improvement. If excess dopamine alone was the problem, behavior should change as soon as dopamine levels drop. • Clozapine – better than chlorpromazine, affects more non-dopamine than dopamine pathways. • Glutamate and serotonin may be involved. • Brain scans have showed less frontal lobe activity in Schizophrenic patients. Also differences in brain structures. • Heredity factor • Identical twins raised together, 50% concordance rate – not purely hereditary. • ‘two hit’ model Mednick – model proposes that first ‘hit’ occurs during second trimester of pregnancy. Genetic defect possibly • i.e. Mother contracting the flu during this stage of pregnancy. • Second ‘hit’ - environmental stress, trauma during birth, negative rearing conditions. • Diathesis-stress model of abnormal behavior – abnormal behavior arises as a result of the combination of a predisposition and a stressful environment. • No stressor, predisposition is not manifested.

22. The Cause of Schizophrenia: Biological Approach The biological approach closely looks at the interaction between the environment and genetics. Some might say that the biological perspective is too radical, and reductionist, but it seems that genetics due play a major role in the involvement of this disorder. Research nowadays proposes the idea that schizophrenia is caused by a genetic vulnerability which is coupled with the environmental and psychological stressors. This is also known as the diathesis-stress model. The idea basically says that whether the person develops the disorder or not, for the most part it is determined by the vulnerability. In overall, as said before…the biological approach closely looks at the genetic factors, and how they apply to the disorder. In this case, if there is a genetic vulnerability, it is more likely for the person to develop Schizophrenia.

24. Biological Treatment: Medication • Antipsychotic drugs do not “cure” schizophrenia, they just treat it. • Are very effective in treating hallucinations and delusions. • Work differently from individual to individual. • Examples: Clozaril, Risperdal, Zyprexa, Haldol, Thorazine, Seroquel. • Long-acting injectable forms. No need to take pills. Eg: Haldol, Prolixin, Trilafon. • Side effects: Drowsiness, restlessness, muscle spasms, tremor, dry mouth, blurring of vision, Tardive dyskinesia, weight gain, social withdrawal and symptoms resembling Parkinson's Disease.

25. The Learning Perspective • Behaviorists interpret abnormal behavior in terms of faulty learning. • Focus on behavior rather than mental processes • Reinforcement (Encouraging or gradually shaping desirable responses. ) • Positive reinforcement – socially rewarding stimuli (e.g. attention and prize), educational feedback (good grades), token systems (merit points, star charts), liked activities • Not Regarded as any different from other forms of abnormal behavior • Social and environmental stressors can make the disorder worse • Although learning by reinforcement is a well demonstrated general principal there is no direct evidence for the acquisition of Schizophrenic Behavior. • Environmental Determinism: We are controlled by external forces • According to behaviorists, we are determined by rewards and punishments; • social learning psychologists will add social models we observe and imitate “blank slate” concept • Skinner: “Free will is an illusion” – implications for psychology and societies: • behaviour control, therapies, creating an ideal state and society • Watson: “Give me a dozen of healthy infants ...”)

26. Learning Perspective • This perspective has many weaknesses in explaining • Schizophrenic parent – children – OK - , but how does separated parent children develop disease. • Particular combinations of symptoms occurs regularly. • Model does not clearly explain the causes • Reinforcement can be used to improve behavior. • Treatment : Shaping behavior of wards, token economy. • Atthowe and Krasner study : patients who were hospitalized for a median duration of 22 years: 90% per cent of the 87 men participated and improved in a two year. • With the discovery of chlorpromazine hospitalization dropped since the 1950 because of its questionable morality of rewarding passivity of patients. • Behaviors modified in studies may be due to institutionalization, not schizophrenia. • Fall of institutions decreased opportunity to implement reinforcement strategies. • Certain behaviors can be modified by reinforcement, and help schizophrenic individuals function better • But learning based in reinforcement does not even come close to explaining the origins of schizophrenia.

27. The Cause of Schizophrenia: Behaviourist Approach “The Behaviourist Approach interprets abnormal behavior as simply maladaptive learning.” From this, the behaviourist approach would then say that Schizophrenia is not regarded at all differently to other forms of abnormal behaviour. In other words, the behaviourist approach would actually see the term Schizophrenia as having no etiological value. Although the behaviourist approach does not believe that there seems to be an etiology for this disorder, it does have a number of different treatments for it, such as token economy.

28. Treatments

29. Education • We learn by association from the environment – the contribution to education involves guidelines on how to alter environmental stimuli, e.g. classroom conditions, presentation of info, teacher behaviour, etc. to provide positive conditioned emotional responses. • Also, providing positive consequences (reinforcement) for correct responses and pointing out associations between new and old stimuli will encourage correct responses. However, teachers can never control all the competing sources of punishment and reinforcement in the learning environment, e.g. from peers and influences outside the classroom.

30. PSYCHOSOCIAL TREATMENTS • Psychosocial treatments help most with psychological, social, and occupational problems. • Useful for patients with less severe symptoms or for patients whose psychotic symptoms are under control. • Focus on improving the patient's social functioning.

31. REHABILITATION • Includes a wide range of non-medical interventions. • Social and vocational training helps patients overcome difficulties. • Vocational counseling, job training, problem-solving and money management skills, use of public transportation, and social skills training. • Provided by Partial Hospital or Day Treatment Programs (4 to 6 hrs per day, several days per week). • Learning is both educational and experiential.

32. COGNITIVE BEHAVIORAL PSYCHOTHERAPY • More effective than other types of psychotherapy in treating depression and panic attacks. • Two approaches combine to effectively treat schizophrenia. • Cognitive treatment helps treat distorted perceptions of the world, including self, and disordered or disorganized thinking. • Behavioral therapy is used within a structured psychosocial rehabilitation program rather than individually because schizophrenia is seen as a life-long illness. • Behavior therapy teaches the social skills never learned, and helps understand when to apply those skills to problems in the world. • Examples of training: Stress Management Training, Assertiveness Training, Communication Skills Training, Problem Solving Skills.

33. FAMILY EDUCATION • It is important for family members to lern all they can about schizophrenia when they have to take care of a family member who has been discharged from the hospital. • Family psycho education includes teaching various coping strategies and problem-solving skills. It is a cognitive-behavioral treatment approach to family therapy. • This approach helps families to deal more effectively with their ill relative and to contribute to an improved outcome for the patient.

34. SELF-HELP GROUPS • Members provide continuing mutual support as well as comfort in knowing that they are not alone in the problems they face. • Families working together can more effectively serve as supporters for needed research and hospital and community treatment programs. • Patients acting as a group rather than individually may be better able to dismiss dishonor and draw public attention to such abuses as discrimination against the mentally ill. • Groups are very active and provide useful information and assistance for patients and families of patients with schizophrenia.

35. COMMUNITY AND SOCIAL SUPPORT • Patients with schizophrenia may need help from people in their family or community. • Ensuring that a person with schizophrenia continues to get treatment after hospitalization is important. • Encouraging the patient to continue treatment and assisting him or her in the treatment process can positively influence recovery. • A positive approach may be helpful and perhaps more effective in the long run than criticism.

36. Cognitive Perspective • Focuses on analyzing the various types of symptom and suggests information based on the faulty cognitive processing. • Suggests interesting insights into the nature of schizophrenic behavior • There are specifically three aspects it focuses on: Delusions, language, and thought disturbances. • Cognitive Symptoms of SchizophreniaCognitive symptoms refer to the difficulties with concentration and memory. These can include: • disorganized thinking • slow thinking • difficulty understanding • poor concentration • poor memory • difficulty expressing thoughts • difficulty integrating thoughts, feelings and behavior

37. Cognitive Perspective • Faulty cognitive processing • Delusions , beliefs contradictory to reality, Roger Brown, found 3 people, believing they were Jesus Christ, each convinced the others were deluded. • Delusional individuals usually recognize false delusions of other patients. Loss of reality only in specifics. • Language – picture of infantile speech is not accurate, • Roger Brown - no child like utterances , words used in incoherent ways. Words have specific meaning to person. Words suggest many connotations, meanings… which might be confused. • A model to explain this use of language is impossible. • Thought disturbances • Faulty references, misinterpretation of significance of stimulus and events. Person attributes meaning to event which most people would not. • Logical errors – lapses in reasoning. • Silvano Arieti – person uses different kind of reasoning. “The Virgin Mary is a virgin. I am a virgin. Therefore I am the virgin Mary.” Logical using unconventional rule of reasoning. • Individuals problem of defective attention - difficulty in selecting and attending to the relevant stimuli in a situation. • Individuals who develop schizophrenia reported early symptoms such as memorizing details, distraction, misinterpreting instructions. Unable to control. • The negative responses o other people would aggravate the social impact of the initial problem of defective attention. • Common mechanism underlying many unrelated symptoms. • Explains why schizophrenic can function normally in some respect and have other bizarre behaviors.

38. Treatments

39. INDIVIDUAL PSYCHOTHERAPY • Involves regularly scheduled talks between the patient and a mental health professional (psychiatrist, psychologist, psychiatric social worker, nurse). • Talks focus on current or past problems, experiences, thoughts, feelings and relationships. • Individuals gradually come to understand more about themselves and their problems. • Psychotherapy is not a substitute for antipsychotic medication. • It is most helpful once a patient’s psychotic symptoms have first been relieved by drug treatment.

40. Credits http://encarta.msn.com/medias_761552061/Schizophrenia.html http://www.hubin.org/facts/history/history_schizophrenia_en.html http://www.psychologyinfo.com/schizophrenia/treatment.htm Newton, David; Olendorf, Donna; Jeryan, Cristine; Boyden, Karen "SCHIZOPHRENIA." SICK! – Diseases and Disorders, Injuries and Infections. 2000. http://www.schizophrenia.com/schizpictures.html Glassman: Approaches to Psychology