PowerPoint® Presentation by Jim Foley

© 2013 Worth Publishers

Psychological Disorders

Module 50: Schizophrenia

Mr. James believes that people are constantly laughing at him and that FBI

agents are trying to steal his life savings. Mr. James is most clearly

suffering from: A. compulsions.

B. catatonia.

C. delusions.

D. hallucinations.

Schizophrenia:the mind is split from reality, e.g. a split from one’s own thoughts so that they appear as hallucinations.

Psychosis refers to a mental split from reality and

rationality.Schizophrenia symptoms include:disorganized and/or delusional thinking.disturbed perceptions.inappropriate emotions and actions.

Positive + presence of problematic behaviors

Negative - absence of

healthy behaviors

Hallucinations (illusory perceptions), especially auditory

Delusions (illusory beliefs), especially persecutory

Disorganized thought and nonsensical speech

Bizarre behaviors

Flat affect (no emotion showing in the face)

Reduced social interaction

Anhedonia (no feeling of enjoyment)

Avolition (less motivation, initiative, focus on tasks)

Alogia (speaking less) Catatonia (moving less)

Positive and Negative Symptoms of Schizophrenia

Schizophrenia Symptoms:Problems in Thinking and Speaking Disorganized speech, including the

“word salad” of loosely associated phrases

Delusions (illusory beliefs), often bizarre and not just mistaken; most common are delusions of grandeur and of persecution

Problems with selective attention, difficulty filtering thoughts and choosing which thoughts to believe and to say out loud

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People with schizophrenia often experience hallucinations, that is, perceptual experiences not shared by others.

The most common form of hallucination is hearing voices that no one else hears, often with upsetting (e.g. shaming) content.

Hallucinations can also be visual, olfactory/smells, tactile/touch, or gustatory/taste.

You’re evil!Am I evil?

Schizophrenia Symptoms:Disturbed Perceptions

Odd and socially inappropriate responses such as looking bored or amused while hearing of a death

Flat affect: facial/body expression is “flat” with no visible emotional content

Impaired perception of emotions, including not “reading” others’ intentions and feelings

Schizophrenia Symptoms:Inappropriate Emotions

Odd and socially inappropriate behavior can be caused by symptoms such as:errors in social perception. disorganized, unfiltered thinking. delusions and hallucinations.

The schizophrenic body exhibits symptoms such as: repetitive behaviors such as rocking and rubbing. catatonia, such as sitting motionless and unresponsive for hours.

Schizophrenia Symptoms:Inappropriate Actions/Behavior

Onset and Development of Schizophrenia

Onset: Typically, schizophrenic symptoms appear at the end of adolescence and in early adulthood, later for women than for men.

Prevalence: Nearly 1 in 100 people develop schizophrenia, slightly more men than women.

Development: The course of schizophrenia can be acute/reactive or chronic.

Course of Schizophrenia

Acute/Reactive Schizophrenia In reaction to stress, some people develop positive symptoms such as hallucinations.

– Recovery is likely.Chronic/Process Schizophrenia develops slowly, with more negative symptoms such as flat affect and social withdrawal.

– With treatment and support, there may be periods of a normal life, but not a cure.

– Without treatment, this type of schizophrenia often leads to poverty and social problems.

Subtypes of Schizophrenia

What’s going on in the brain in schizophrenia?

Too many dopamine/D4 receptors help to explain paranoia and hallucinations; it’s like taking amphetamine overdoses all the time.

Poor coordination of neural firing in the frontal lobes impairs judgment and self-control.

The thalamus fires during hallucinations as if real sensations were being received.

There is general shrinking of many brain areas and connections between them.

Abnormal brain structure and

activity

Understanding Schizophrenia

Understanding Schizophrenia

Are there biological risk factors affecting early development?

low birth weight maternal diabetes older paternal age famine oxygen deprivation during delivery maternal virus during mid-pregnancy

impairing brain development

Biological Risk Factors

Schizophrenia is more likely to develop in babies born: during and after flu epidemics.in densely populated areas.a few months after flu season.after mothers had the flu during the second trimester, or had antibodies showing viral infection.The lesson is to:

Schizophrenia is somewhat more likely to develop when one or more of these factors is present:

get flu shots with early fall pregnancies.

Understanding SchizophreniaAre there genetic risk factors? If so, we would see more similar schizophrenia risk shared between identical twins than fraternal twins (graph below). Do we?

Having adoptive siblings (or parents) with schizophrenia does not increase the likelihood of developing schizophrenia.

Genetic FactorsIf one twin has schizophrenia, the chance of the other one also having it are much greater if the twins are identical.

Even in identical twins, genetics do not fully predict schizophrenia.

This could be because of environmental differences.

First difference: twins in separate placentas.

Genetic and Prenatal Causes

Only one of two twins has the enlarged ventricles seen in schizophrenia.

Even if maternal flu during the second trimester doubles the risk of schizophrenia, this means only 2 percent of these babies develop the disorder.

Genetics may differentiate these 2 percent.

Research shows many genes linked to schizophrenia, but it may take environmental factors to turn on these genes.

Understanding Schizophrenia

Are there psychological causes?

Research does not support the idea that social or psychological factors (such as parenting) alone can cause schizophrenia.

However, there may be factors such as stress that affect the onset of schizophrenia.

Until we find a mechanism of causation, all we may have is a list of factors which correlate with increased risk.

Social-Psychological

Factors

Understanding Schizophrenia

Predicting Schizophrenia: Early Warning Signs

early separation from parents

short attention span disruptive OR withdrawn

behavior emotional unpredictability poor peer relations and/or

solitary play

having a mother with severe chronic schizophrenia

birth complications, including oxygen deprivation and low birth weight

poor muscle coordination

Social/psychological factors which tend to

appear before the onset of

schizophrenia:

Biological factors which tend to appear before the onset of

schizophrenia:

You have a patient who has been suffering from schizophrenia. He has had the

symptoms for several years after they slowly appeared over a period of time. In

addition, you know that one of his grandparents suffered from similar

symptoms. Your patient seems generally withdrawn and emotionless. In fact, he

rarely moves from his chair during the day.

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He rarely exhibits the bizarre delusions and hallucinations. What prognosis can you give his

family?A. The prognosis is good because the symptoms are

not very bizarre.B. The prognosis is good because new medications

have been shown to alleviate these symptoms completely.

C. The prognosis is poor because of the chronic nature of the disorder.

D. The prognosis is poor because very few people with schizophrenia ever have remissions.

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