Psychopathology and Psychopathology and the Brainthe Brain

SchizophreniaSchizophrenia

Comes from Greek words meaning Comes from Greek words meaning “split” and “mind”“split” and “mind”

People with schizophrenia do NOT People with schizophrenia do NOT have split personalitieshave split personalities

““split mind” refers to the fact that split mind” refers to the fact that people with schizophrenia are split people with schizophrenia are split off from reality and can’t distinguish off from reality and can’t distinguish what is real from what is not realwhat is real from what is not real

DemographicsDemographics

One of the most common mental One of the most common mental illnessesillnesses

Affects 1 % of the populationAffects 1 % of the population Men show first signs in early 20’s Men show first signs in early 20’s

while women in late 20’swhile women in late 20’s US spends $32.5 billion per yearUS spends $32.5 billion per year

SymptomsSymptoms

““psychosis” – psychotic element; psychosis” – psychotic element; state in which people cannot tell state in which people cannot tell what is real and what is notwhat is real and what is not

Delusions – bizarre, false beliefs; Delusions – bizarre, false beliefs; paranoia, grandiosityparanoia, grandiosity

Hallucinations – unreal Hallucinations – unreal perceptions of environment; perceptions of environment; auditory, visual, olfactory, tactileauditory, visual, olfactory, tactile

More SymptomsMore Symptoms

Disorganized Thinking/SpeechDisorganized Thinking/Speech Negative Symptoms – the Negative Symptoms – the

absence of normal behaviorabsence of normal behavior Catatonia – immobility and “waxy Catatonia – immobility and “waxy

flexibility”flexibility”

Types of SchizophreniaTypes of Schizophrenia

Disorganized Schizophrenia Disorganized Schizophrenia Catatonic Schizophrenia Catatonic Schizophrenia Paranoid SchizophreniaParanoid Schizophrenia

Brain and Brain and SchizophreniaSchizophrenia

Larger than normal lateral ventricles – Larger than normal lateral ventricles – part of the ventricular system; contain part of the ventricular system; contain cerebrospinal fluidcerebrospinal fluid

Causes of Causes of Schizophrenia: Schizophrenia: GeneticsGenetics Twin studies have shown that tendency Twin studies have shown that tendency

for both monozygotic twins to develop for both monozygotic twins to develop schizophrenia is between 30 to 50%; the schizophrenia is between 30 to 50%; the tendency for dizygotic twins and siblings tendency for dizygotic twins and siblings to develop schizophrenia is 15%to develop schizophrenia is 15%

Adoption Studies – 13% of biological Adoption Studies – 13% of biological relatives of adoptees with schizophrenia relatives of adoptees with schizophrenia had the disease, but only 2% of biological had the disease, but only 2% of biological relatives of normal adoptees had relatives of normal adoptees had schizophreniaschizophrenia

Causes of Causes of Schizophrenia: Schizophrenia: EnvironmentEnvironment Family StressFamily Stress Poor social interactionsPoor social interactions Infections or viruses at an early Infections or viruses at an early

ageage Trauma at an early ageTrauma at an early age Genetic makeup combines with Genetic makeup combines with

non-genetic factors to cause non-genetic factors to cause schizophreniaschizophrenia

Causes of Causes of Schizophrenia: Schizophrenia: NeurotransmittersNeurotransmitters Dopamine Theory – schizophrenia Dopamine Theory – schizophrenia

caused by an overactive dopamine caused by an overactive dopamine system in the brain; dopamine is a system in the brain; dopamine is a neurotransmitter that allows nerve neurotransmitter that allows nerve cells in the brain to send messages to cells in the brain to send messages to each other; dopamine imbalance may each other; dopamine imbalance may affect the way a person’s brain can affect the way a person’s brain can react to stimulireact to stimuli

Many drugs for schizophrenia block Many drugs for schizophrenia block dopamine receptorsdopamine receptors

Schizophrenia: Schizophrenia: MedicationMedication Antipsychotic medications – drugs Antipsychotic medications – drugs

do not cure disease, but reduce do not cure disease, but reduce symptomssymptoms

Some drugs have Parkinson’s Some drugs have Parkinson’s Disease-like side effectsDisease-like side effects

Counseling also helpsCounseling also helps

Bipolar DisorderBipolar Disorder

Characterized by changes in mood, Characterized by changes in mood, behavior, and energy levelsbehavior, and energy levels

Affects approximately 1.2% of the Affects approximately 1.2% of the populationpopulation

First episode often occurs in First episode often occurs in adolescence and can be triggered by adolescence and can be triggered by a traumatic event; some people are a traumatic event; some people are symptom-free in between episodessymptom-free in between episodes

Symptoms: Mania Symptoms: Mania phasephase Abnormally elevated moodAbnormally elevated mood Inflated self-esteemInflated self-esteem Reduced need for sleepReduced need for sleep Excessive talkativenessExcessive talkativeness Racing thoughtsRacing thoughts DistractibilityDistractibility Activities done to excessActivities done to excess Pursuit of risky behavior or activitiesPursuit of risky behavior or activities

Symptoms: Depression Symptoms: Depression PhasePhase Mania can quickly and without warning Mania can quickly and without warning

change to depression/sadnesschange to depression/sadness Loss of interestLoss of interest Changes in appetite – weight gain/lossChanges in appetite – weight gain/loss Changes in sleep patternsChanges in sleep patterns AgitationAgitation Loss of energyLoss of energy Trouble concentrating/thinkingTrouble concentrating/thinking Repeated thoughts of suicide/deathRepeated thoughts of suicide/death

Accompanying Accompanying SymptomsSymptoms PsychosisPsychosis DelusionsDelusions

Bipolar Disorder and Bipolar Disorder and the Brainthe Brain

Examination of brain tissue after people with BD have diedExamination of brain tissue after people with BD have died Brain imagingBrain imaging New theory – mitochondrial malfunctionNew theory – mitochondrial malfunction Mitochondria – vital organelle for energy productionMitochondria – vital organelle for energy production 2000 – Kato, University of Tokyo – based on abnormal 2000 – Kato, University of Tokyo – based on abnormal

brain energy metabolism in bipolar patients measured by brain energy metabolism in bipolar patients measured by brain scans and mitochondrial depletion in autopsied brain scans and mitochondrial depletion in autopsied bipolar brains; searched for mutant mitochondrial DNA – bipolar brains; searched for mutant mitochondrial DNA – two suspect genestwo suspect genes

March 2004, March 2004, Archives of General PsychiatryArchives of General Psychiatry, Christine , Christine Konradi - Harvard and McLean Hospital - studied brain Konradi - Harvard and McLean Hospital - studied brain tissue in hippocampus and found expression of genes that tissue in hippocampus and found expression of genes that coded for mitochondrial proteins in bipolar patients coded for mitochondrial proteins in bipolar patients decreaseddecreased

Famous People with Famous People with BDBD Abraham Lincoln and Theodore Abraham Lincoln and Theodore

RooseveltRoosevelt George Handel, Robert Schumann, George Handel, Robert Schumann,

Ludwig van BeethovenLudwig van Beethoven Leo Tolstoy, Virginia Woolf, Ernest Leo Tolstoy, Virginia Woolf, Ernest

Hemingway, Charles DickensHemingway, Charles Dickens Sir Isaac NewtonSir Isaac Newton Patty Duke, Linda Hamilton, Jean-Patty Duke, Linda Hamilton, Jean-

Claude van DammeClaude van Damme

Multiple Personality Multiple Personality DisorderDisorder Presence of two or more distinct Presence of two or more distinct

identities, each with its own unique, and identities, each with its own unique, and enduring way of relating to the world or enduring way of relating to the world or selfself

At least two of these identities recurrently At least two of these identities recurrently take control of the person’s behaviortake control of the person’s behavior

An inability to recall important personal An inability to recall important personal information to an extent that is more information to an extent that is more than ordinary forgetfulnessthan ordinary forgetfulness

History of MPDHistory of MPD

Virtually unknown 30 years ago – Virtually unknown 30 years ago – became more common about 10 years became more common about 10 years agoago

Why?Why? W. S. Taylor and Mabel Martin in 1944 W. S. Taylor and Mabel Martin in 1944

– fewer than 100 documented cases– fewer than 100 documented cases 1985 to 1995 – abuot 40,000 new 1985 to 1995 – abuot 40,000 new

casescases

Why More Common?Why More Common?

previously not diagnosedpreviously not diagnosed does mind choose pathology from does mind choose pathology from

options presented by culture?options presented by culture? was called something different in was called something different in

the past – came in form of dead the past – came in form of dead relative possession in 19relative possession in 19thth century century European cultureEuropean culture

CausesCauses

Childhood trauma – usually sexual Childhood trauma – usually sexual abuse before age 5abuse before age 5

Experts believe alter arises to Experts believe alter arises to protect person from protect person from overwhelming memories and overwhelming memories and protect secrets from outsidersprotect secrets from outsiders

Case Study: EveCase Study: Eve

Thigpen and Cleckley, 1953Thigpen and Cleckley, 1953 Rooted from traumatic events Rooted from traumatic events

witnessed growing up in South witnessed growing up in South during Depressionduring Depression

Eve White – wife and mother; Eve Eve White – wife and mother; Eve Black – party girl; Jane – mature Black – party girl; Jane – mature intellectualintellectual

Total of 22 personalitiesTotal of 22 personalities

Case Study: SybilCase Study: Sybil

True name – Shirley MasonTrue name – Shirley Mason Set the standard for MPD as a Set the standard for MPD as a

syndrome rooted in child abusesyndrome rooted in child abuse 16 separate personalities all 16 separate personalities all

having unique talents and having unique talents and characteristics, such as piano characteristics, such as piano playing or having British accent; playing or having British accent; some were malesome were male

Dr. Wilbur – Freudian Dr. Wilbur – Freudian psychologistpsychologist

1998 – several publications 1998 – several publications exposed Sybil case as scamexposed Sybil case as scam

Dr. Herbert Spiegel - only Dr. Herbert Spiegel - only multiple personality in multiple personality in psychoanalytic setting; just psychoanalytic setting; just extremely suggestible hystericextremely suggestible hysteric

To ensure the book deal, Sybil To ensure the book deal, Sybil had to be multiple; Dr. Wilbur’s had to be multiple; Dr. Wilbur’s archives will be opened in archives will be opened in 2005…2005…

MPD in CourtMPD in Court

Billy Mulligan – accused of robberies and rapes at Billy Mulligan – accused of robberies and rapes at OSU; by the time faced trial, 10 of 23 personalities OSU; by the time faced trial, 10 of 23 personalities surfaced; one with British accent, one could write surfaced; one with British accent, one could write fluent in Arabic, one was 16, one was 8…fluent in Arabic, one was 16, one was 8…

Juanita Maxwell – bludgeoned elderly woman to Juanita Maxwell – bludgeoned elderly woman to death with a lamp but had no memory of crime; death with a lamp but had no memory of crime; went to trial and violent alter came outwent to trial and violent alter came out

Critics say that vast majority of patients Critics say that vast majority of patients misdiagnosed, faked, or unconsciously created by misdiagnosed, faked, or unconsciously created by clinician who makes diagnosisclinician who makes diagnosis

Problem: when evidence overwhelming against Problem: when evidence overwhelming against defendant, only way attorney can mitigate sentence defendant, only way attorney can mitigate sentence is insanity defenseis insanity defense

Often very hard to identify whether truly have Often very hard to identify whether truly have disorderdisorder

ResourcesResources

http://www.mcmanweb.comhttp://www.mcmanweb.com http://www.crimelibrary.com/crimihttp://www.crimelibrary.com/crimi

nal_mind/psychology/multiplesnal_mind/psychology/multiples http://faculty.washington.edu/chuhttp://faculty.washington.edu/chu

dler/neurok.htmldler/neurok.html