Schizophrenia

1. Schizophrenia A Closer Look at Psychological Disorders

2. Schizophrenia • The term schizophreniacomes from the Greek word schizein (“to split”) and phren (“mind”). • The split represents a breaking away from reality, not a division of _____________. • Schizophrenia occurs in about 1% of the population (1 in every 100 people). • It affects both men and women at the same rate, and it occurs around the world at the same rate. • It is perhaps the most frightening and misunderstood psychological disorder.

3. What is schizophrenia? • Schizophrenia is not one disorder. • It is a family of related disorders involving: • Disorganized and delusional thinking • Disturbed perceptions • Inappropriate emotions or behaviors.

4. What is schizophrenia? • Disorganized thinking is fragmented and bizarre, and it is believed to come from a breakdown in selective attention • Cannotfilter out information • The person has lost contact with reality to a considerable extent. • Someone with depression or severe anxiety problems dreams in an unreal way about life. • While a person with schizophrenia lives life as an unreal dream.

5. Onset and Prognosis • Schizophrenia tends to develop in adolescence or early adulthood. • It strikes young people as they mature into adults. • It affects men and women equally, but men suffer from it more severely than women. • 1/3 of people diagnosed with schizophrenia improve with treatment and are able to function reasonably well • 1/3 will continue to get worse • 1/3 will be in and out of institutions for a long time, displaying symptoms that permanently impair their functioning.

6. Onset and Prognosis • Chronic vs. Acute Schizophrenia: • Chronic – When schizophrenia is slow to develop (chronic/process) recovery is doubtful. • Such schizophrenics usually display negative symptoms. • Acute – When schizophrenia rapidly develops (acute/reactive) recovery is better. • Such schizophrenics usually show positive symptoms. • Overall, a more favorable prognosis exists when the onset of the disorder is sudden and at a later age, the individual’s social and work adjustment was good prior to onset, the proportion of negative symptoms is low, and the patient has a good social support system.

7. Disorganized & Delusional Thinking This morning when I was at Hillside [Hospital], I was making a movie. I was surrounded by movie stars … I’m Mary Poppins. Is this room painted blue to get me upset? My grandmother died four weeks after my eighteenth birthday.” • This monologue illustrates fragmented, bizarre thinking with distorted beliefs called delusions (“I’m Mary Poppins”).

8. Symptoms of Schizophrenia • Many sufferers experience delusions – false beliefs maintained in the face of contrary evidence. There are several types of delusions: • Delusions of grandeur – false beliefs that you are more important than you really are (may believe you are Jesus or Abraham Lincoln, for example) • Delusions of persecution – false beliefs that people are out to get you (may believe that you are being followed, CIA is after you, etc.) • Delusions of sin or guilt – false beliefs of being responsible for some misfortune (may believe you are responsible for a plane crash because you forgot to brush your teeth) • Delusions of influence – false beliefs of being controlled by outside forces (“the devil made me do it”) • Delusion of reference – false belief that random events, objects, behaviors of others, etc. have a particular and unusual significance to oneself (may believe that headlines or stories in newspapers are written especially for you, may believe that events (even world events) have been deliberately contrived for you, etc.)

9. Symptoms of Schizophrenia (cont.) • David Berkowitz (“Son of Sam”) killed six people and seriously wounded seven others in a one year long killing spree in New York. • He was diagnosed as a potential paranoid schizophrenic when he claimed that his neighbor (Sam Carr, the “Sam” mentioned in the first letter Berkowitz sent to police) owned a dog that was possessed by an ancient demon. • When the dog barked, it issued irresistible commands that Berkowitz must kill people. Berkowitz said he once tried to kill the dog, only to see his aim spoiled due to supernatural interference. • This is an example of a delusion of ___________.

10. Symptoms of Schizophrenia (cont.) • Many sufferers might also experience hallucinations – perceptions in the absence of corresponding sensation. There are several kinds of hallucinations as well: • Auditory – may hear voices, and sometimes the voices tell them what to do. • Visual – may see nonexistent objects, or distorted images of items or people. • Tactile– may feel skin stimulation, such as a tingling or burning or touch that is not real. • Hallucinations can also distort taste and smell. • Note the difference: • Delusions are beliefs with no logical basis • Hallucinations are perceptions with no outside stimulation. • However, hallucinations often provide “evidence” for delusions.

11. Symptoms of Schizophrenia (cont.) • Another symptom could be inappropriate emotions or behaviors: • Laughing uncontrollably when sadness is called for • Very flat emotions, showing little or no emotional response • Not speaking at all • Waxy flexibility– if you place them in a position, they might hold that position for hours • Withdrawal from the affairs of the real world, which limits their knowledge of current events and their social skills • Producing word salad– nonsense talk

12. Symptoms of Schizophrenia (cont.) • Examples of word salad: • A woman was delighted to receive a letter from her son abroad, but distraught when she read it: “Dear mother… I am writing on paper. The pen I am using is from a factory called Perry and Co. The factory is in England. The city of London is in England. I know this from my school days. Then I always liked geography. My last teacher in that subject was Professor August A. He was a man with black eyes. There are also blue and grey eyes and other sorts too. I have heard it said that snakes have green eyes. All people have eyes. There are some, too, who are blind.” • Emilio was hospitalized 12 times by the time he was 40. When interviewed, he just kept repeating that he had been “eating wires and lightning fires.”

13. Symptoms of Schizophrenia: Recap Watch Janssen’s MINDSTORM: http://www.youtube.com/watch?v=LWYwckFrksg

14. Louis Wain: Late Onset Schizophrenia • An artist named Louis Wain experienced late onset schizophrenia (he was 57). • Wain was famous for his drawings of cats, which began as very realistic portrayals or anthropomorphic scenes (cats in human clothing, situations, etc.). • As the illness progressed, Wain’s symptoms can be seen in his paintings.

15. Louis Wain’s art • Wain’s pre-schizophrenic period featured cats dressed in human clothes or engaged in human activity:

16. Louis Wain’s art • During the onset of his disease at 57, Wain continued to paint, draw and sketch cats, but the focus changed from fanciful situations, to focus on the cats themselves.

17. Louis Wain’s art • Characteristic changes in the art began to occur, changes common to schizophrenic artists. • Jagged lines of bright color began emanating from his feline subjects. The outlines of the cats became sever and spiky, and their outlines persisted well throughout the sketches, as if they were throwing off energy.

18. Louis Wain’s art • Soon the cats became abstracted, seeming now to be made up of hundreds of small repetitive shapes, coming together in a clashing jangles of color that transform the cat into something resembling an Eastern diety.

19. Louis Wain’s art • The abstraction continued, the cats now being seen as made up by small repeating patterns, almost fractal in nature. Until finally they ceased to resemble cats at all, and became the ultimate abstraction, an indistinct form made up by near symmetrical repeating patterns.

20. John Nash (A Beautiful Mind) Types of Schizophrenia • Paranoid schizophrenia – characterized by delusions, particularly delusions of grandeur and persecution. Auditory and other hallucinations often support the delusions. • Catatonic schizophrenia– characterized largely by variations in voluntary movements. • Sufferers alternate between two phases – Catatonic excitement(rapid movement, delusions, and hallucinations) • Catatonic stupor(very little activity or speech). Flat emotion and waxy flexibility are often part of the stupor phase. Parrot-like repeating of another’s speech and movements. • Disorganized schizophrenia – characterized by bizarre behavior, delusions, and hallucinations. Sufferers are visibly disturbed. • In historical times they were thought to have “gone mad.” In disorganized schizophrenia, a particularly severe deterioration of adaptive behavior is seen…incoherence, complete social withdrawal, delusions centering on bodily functions, etc. • Undifferentiated schizophrenia – characterized by symptoms that are disturbed but are not clearly consistent with the paranoid, catatonic, or disorganized types. Sufferers show clear evidence of the symptoms of schizophrenia.

21. Criticisms of the Current Classification System of Schizophrenia • There are many critics of the current subtyping system for schizophrenia in the DSM. • Some theorists argue that the disorder should be conceptualized along two categories: • Positive symptoms – behavioral excesses or peculiarities, such as hallucinations, delusions, bizarre behavior, and wild flights of ideas • Negative symptoms – behavioral deficits, such as flattened emotions, social withdrawal, apathy, impaired attention, and poverty of speech.

22. Examples of People Diagnosed with Schizophrenia ABC 20/20 – Part 1 (http://www.youtube.com/watch?v=74vTftboC_A ) ABC 20/20 – Part 2 (http://www.youtube.com/watch?v=YXimT5CHCDE)

23. Etiology of Schizophrenia Possible Causes

24. Once again… a bit nature, a bit nurture! • Psychological and environmental factors can trigger schizophrenia if the individual is genetically predisposed (Nicol & Gottesman, 1983). • The genetically identical Genain sisters suffer from schizophrenia. • However, two of the women have more severe cases than the others; thus, there are contributing environmental factors. Courtesy of Genain Family Genain Sisters

25. Biological Explanations – Heredity • Genetics – the risk of schizophrenia increases substantially if relatives have the disorder (about a 10% chance). • This risk is greater among closer relatives. • Although environment also plays a role in the etiology of schizophrenia, the concordance rates shown to the right suggest that there must be a genetic vulnerability to the disorder. These concordance estimates are based on pooled data from 40 studies conducted between 1920 and 1987. • The likelihood of an individual suffering from schizophrenia is 50% if their identical twin has the disease (Gottesman, 2001).

26. Biological Explanations – The Brain • Brain structure – the brain structure of people with schizophrenia differs markedly from normal brain structure. • For example, they have smaller amounts of brain tissue, larger fluid-filled spaces around that tissue, and a smaller thalamus (responsible for routing incoming information). • Brain function – PET scans show that the frontal lobes(center of our most advanced thinking abilities) show less activityin schizophrenics. • Also, there are as many as 6 times the normal number of receptive sites for the neurotransmitter dopamine. This may explain the delusions and hallucinations.

27. Biological Explanations – The Brain Schizophrenia patients may exhibit morphological changes in the brain like enlargement of fluid-filled ventricles (15% larger). Figure 14.19: Schizophrenia and the ventricles of the brain. Cerebrospinal fluid (CSF) circulates around the brain and spinal cord. The hollow cavities in the brain filled with CSF are called ventricles. The four ventricles in the human brain are depicted here. Recent studies with CT scans and MRI scans suggest that an association exists between enlarged ventricles in the brain and the occurrence of schizophrenic disturbance.

28. Figure 14.18: The dopamine hypothesis as an explanation for schizophrenia. Decades of research have implicated overactivity at dopamine synapses as a key cause of schizophrenic disorders. However, the evidence on the exact mechanisms underlying this overactivity, which is summarized in this graphic, is complex and open to debate. Recent hypotheses about the neurochemical bases of schizophrenia go beyond the simple assumption that dopamine activity is increased. For example, one theory posits that schizophrenia may be accompanied by decreased dopamine activity in one area of the brain (the prefrontal cortex) and increased activity or dysregulation in other areas of the brain (Egan & Hyde, 2000). Moreover, abnormalities in other neurotransmitter systems may also contribute to schizophrenia.

29. Environmental Factors • Psychological factors: • Freud mistakenly thought that mothers who were cold, domineering, and selfish caused schizophrenia in their children. • Stress may be a trigger that sets off the series of events that convert schizophrenia from a possibility into a reality. • Disturbed family communications are also correlated with the development of the disorder, but it’s impossible to tell whether they are a cause of schizophrenia or a result of schizophrenia.

30. Environmental Factors • Sociocultural factors: • Poverty and other adverse living situations, maladaptive learning experiences, dysfunctional cognitive habit, and stressful family communication patterns may influence the onset of schizophrenia. • Such stressors may actually increase the chances that disruptive or odd behaviors will persist or worsen. • Patients who are helped to cope with these potentially damaging influences tend to have better long-term outcomes.

31. Figure 14.23: The stress-vulnerability model of schizophrenia. Multifactorial causation is readily apparent in current theories about the etiology of schizophrenic disorders. A variety of biological factors and personal history factors influence one’s vulnerability to the disorder, which interacts with the amount of stress one experiences. Schizophrenic disorders appear to result from an intersection of high stress and high vulnerability.