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Is schizophrenia a disorder ofIs schizophrenia a disorder ofmind or body?mind or body?
A mental disorder with changes A mental disorder with changes in perceptions, emotions, in perceptions, emotions, thoughts, and consciousnessthoughts, and consciousness
http://www.youtube.com/watch?v=bWaFqw8XnpA
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Axis I – Schizophrenia - Axis I – Schizophrenia - SymptomsSymptoms
symptoms of schizophrenia are symptoms of schizophrenia are positivepositive or or negativenegative
positive = additional behaviour/experiencepositive = additional behaviour/experience negative = absence of behaviour/experiencenegative = absence of behaviour/experience Positive SymptomsPositive Symptoms
hallucinations – false sensory experienceshallucinations – false sensory experiences bizarre delusions – false beliefsbizarre delusions – false beliefs incoherent speechincoherent speech inappropriate/disorganized behavioursinappropriate/disorganized behaviours
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Axis I – Schizophrenia – Axis I – Schizophrenia – Symptoms cont’dSymptoms cont’d
Negative SymptomsNegative Symptoms loss of motivationloss of motivation emotional flatnessemotional flatness social withdrawalsocial withdrawal slowed speech or no speechslowed speech or no speech loss of pleasure in activitiesloss of pleasure in activities loss of activityloss of activity
Delusions & associated Delusions & associated beliefsbeliefs
DSM-IV subtypes of DSM-IV subtypes of schizophreniaschizophrenia
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Theories of SchizophreniaTheories of Schizophrenia
Historically proposed causes: carbohydrate Historically proposed causes: carbohydrate metabolism, muscle fatigue, tooth decay, abnormality metabolism, muscle fatigue, tooth decay, abnormality of spinal fluid, blood vessel rigidity, iodine in the brain of spinal fluid, blood vessel rigidity, iodine in the brain – all seen in hospitalized schizophrenics– all seen in hospitalized schizophrenics
Current causal explanations:Current causal explanations: Genetic predispositionsGenetic predispositions Structural brain abnormalitiesStructural brain abnormalities Neurotransmitter abnormalitiesNeurotransmitter abnormalities Prenatal abnormalitiesPrenatal abnormalities Adolescent abnormalities in brain developmentAdolescent abnormalities in brain development
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Genetic Vulnerability to Genetic Vulnerability to SchizophreniaSchizophrenia
risk increases with risk increases with genetic relatedness genetic relatedness to diagnosed to diagnosed schizophrenicschizophrenic
but even identical but even identical twins are not 100% twins are not 100% concordantconcordant
genetics play a rolegenetics play a role
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Structural Brain AbnormalitiesStructural Brain Abnormalities
several abnormalities exist, especially several abnormalities exist, especially when schizophrenia characterized by when schizophrenia characterized by primarily negative symptoms:primarily negative symptoms: decreased brain weightdecreased brain weight decreased volume in temporal lobe or decreased volume in temporal lobe or
hippocampushippocampus enlargement of ventriclesenlargement of ventricles
but 25% do not have observable brain but 25% do not have observable brain abnormalitiesabnormalities
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Neurotransmitter Neurotransmitter AbnormalitiesAbnormalities
candidates: serotonin, glutamate, and dopaminecandidates: serotonin, glutamate, and dopamine many schizophrenics have high levels of brain many schizophrenics have high levels of brain
activity in dopaminergic areas and greater activity in dopaminergic areas and greater numbers of dopamine receptorsnumbers of dopamine receptors
schizophrenics have harder time filtering out schizophrenics have harder time filtering out external stimulationexternal stimulation
genetic – receptors genetic – receptors ““fooledfooled”” by nicotine by nicotine schizophrenics often heavy smokersschizophrenics often heavy smokers
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Prenatal or Birth ComplicationsPrenatal or Birth Complications
fetal brain damage increases chances of fetal brain damage increases chances of schizophrenia and other mental disordersschizophrenia and other mental disorders maternal malnutrition or illnessmaternal malnutrition or illness brain injury or oxygen deprivation at birthbrain injury or oxygen deprivation at birth maternal influenza during first 13 weeks maternal influenza during first 13 weeks
pregnancypregnancy schizophrenics have increased physical schizophrenics have increased physical
anomaliesanomalies more likely to be born in wintermore likely to be born in winter
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Adolescent Abnormalities in Adolescent Abnormalities in Brain DevelopmentBrain Development
normal pruning of excessive normal pruning of excessive synapses during adolescencesynapses during adolescence
schizophrenics show greater synaptic schizophrenics show greater synaptic pruningpruning first episode occurs in adolescence or first episode occurs in adolescence or
early adulthoodearly adulthood
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Axis II - Personality Axis II - Personality DisordersDisorders
Personality DisordersPersonality Disorders Rigid, maladaptive patterns of behaviour, emotions, and Rigid, maladaptive patterns of behaviour, emotions, and
thinking that cause personal distress or inability to get thinking that cause personal distress or inability to get along with othersalong with others
cannot adjust behaviour to situationcannot adjust behaviour to situation begins early in lifebegins early in life less likely to be happy, have a happy marriage, be a less likely to be happy, have a happy marriage, be a
good parentgood parent more likely to get into trouble with law, at work, in more likely to get into trouble with law, at work, in
relationships, substance abusing, depressed, self-relationships, substance abusing, depressed, self-harmingharming
comorbidity occurs frequentlycomorbidity occurs frequently
Axis II - Personality Disorders Axis II - Personality Disorders cont’dcont’d
Three clusters:Three clusters:1.1. Odd or EccentricOdd or Eccentric
2.2. Dramatic, Emotional, ErraticDramatic, Emotional, Erratic
3.3. Anxious or FearfulAnxious or Fearful
up to 15% of adults have one or moreup to 15% of adults have one or more
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Axis II – Personality Axis II – Personality Disorders – Odd or EccentricDisorders – Odd or Eccentric Paranoid Personality DisorderParanoid Personality Disorder
characterized by habitually unreasonable and characterized by habitually unreasonable and excessive suspiciousness and jealousyexcessive suspiciousness and jealousy
Schizoid Personality DisorderSchizoid Personality Disorder indifferent to and avoids relationships, lacks indifferent to and avoids relationships, lacks
empathy, flat affect, detachedempathy, flat affect, detached Schizotypal Personality DisorderSchizotypal Personality Disorder
perceptual dysfunction, magical thinking, perceptual dysfunction, magical thinking, eccentric dress and speech, indifferent to eccentric dress and speech, indifferent to othersothers
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Axis II – Personality Disorders – Axis II – Personality Disorders – Dramatic, Emotional, ErraticDramatic, Emotional, Erratic
Narcissistic Personality DisorderNarcissistic Personality Disorder exaggerated sense of self-importance, self-exaggerated sense of self-importance, self-
absorption, manipulative, excessive anger to absorption, manipulative, excessive anger to criticism, lacks empathycriticism, lacks empathy
http://www.youtube.com/watch?v=f9jRDHGabp8
Borderline Personality DisorderBorderline Personality Disorder stormy relationships, fear of abandonment, dramatic stormy relationships, fear of abandonment, dramatic
mood and opinion changes, feels empty inside, self-mood and opinion changes, feels empty inside, self-harmingharming
http://www.youtube.com/watch?v=_-nQ7qWO6Tshttp://www.youtube.com/watch?v=_-nQ7qWO6Ts
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Axis II – Personality Disorders – Axis II – Personality Disorders – Dramatic, Emotional, ErraticDramatic, Emotional, Erratic
Histrionic Personality DisorderHistrionic Personality Disorder overly dramatic, attention-seeking, temper tantrums, overly dramatic, attention-seeking, temper tantrums,
false sense of intimacy, demanding and manipulativefalse sense of intimacy, demanding and manipulative http://www.youtube.com/watch?v=ib5gqnNL_yshttp://www.youtube.com/watch?v=ib5gqnNL_ys
Anti-Social Personality DisorderAnti-Social Personality Disorder lying, stealing, manipulating others, and sometimes lying, stealing, manipulating others, and sometimes
violenceviolence lack of guilt, shame and empathylack of guilt, shame and empathy 3% of males and 1% of females3% of males and 1% of females more extreme form = more extreme form = psychopathypsychopathy http://www.youtube.com/watch?v=iPuxDYOWvj0http://www.youtube.com/watch?v=iPuxDYOWvj0
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Axis II – Personality Disorders – Axis II – Personality Disorders – Anxious and FearfulAnxious and Fearful
Obsessive-Compulsive Personality Disorder Obsessive-Compulsive Personality Disorder inflexible, perfectionist, controlling, detail-inflexible, perfectionist, controlling, detail-
focussed, unwilling to compromisefocussed, unwilling to compromise
Avoidant Personality DisorderAvoidant Personality Disorder inhibited and introverted, hypersensitive to inhibited and introverted, hypersensitive to
rejection, mistrustful, socially awkwardrejection, mistrustful, socially awkward Dependent Personality Disorder Dependent Personality Disorder
pervasive and excessive need to be taken care pervasive and excessive need to be taken care of, submissive, clingy, difficulty making of, submissive, clingy, difficulty making decisionsdecisions
Risk Factors for PDsRisk Factors for PDs
childhood history of abusechildhood history of abuse family history of schizophreniafamily history of schizophrenia family history of personality disorderfamily history of personality disorder childhood head injurychildhood head injury chaotic childhoodchaotic childhood
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Criticism #1Criticism #1 Too much overlap with Axis I disordersToo much overlap with Axis I disorders E.g., avoidant personality disorder E.g., avoidant personality disorder
sounds a lot like a social phobiasounds a lot like a social phobia Criticism #2Criticism #2
Only difference with a lot of personality Only difference with a lot of personality disorders from normal behavior is the disorders from normal behavior is the quantity of symptoms (i.e., symptoms in quantity of symptoms (i.e., symptoms in moderation are regarded as moderation are regarded as ‘‘normalnormal’’))
Clinical features of Clinical features of borderline borderline
personality disorderpersonality disorder