If depression is the common cold of psychological disorders, schizophrenia is
the cancer.
SCHIZOPHRENIA
1
Nearly 1 in a 100 suffer from schizophrenia.
Schizophrenia strikes young people as they mature into adults. It affects men
and women equally, but men suffer from it more severely than women.
The literal translation is “split mind.” A group of severe disorders characterized by
the following:
SYMPTOMS OF SCHIZOPHRENIA
2
1. Disorganized and delusional thinking.
2. Disturbed perceptions. 3. Inappropriate emotions
and actions.
DISORGANIZED & DELUSIONAL THINKING
3
Other forms of delusions include, delusions of persecution (“someone is following me”) or grandeur (“I am a
king”).
This morning when I was at Hillside [Hospital], I was making a movie. I was surrounded by movie stars … I’m Marry Poppins. Is this room painted blue to get me upset? My grandmother died four weeks after my eighteenth birthday.”
(Sheehan, 1982)
This monologue illustrates fragmented, bizarre thinking with distorted beliefs called delusions (“I’m Mary Poppins”).
Many psychologists believe disorganized thoughts occur because of selective attention failure (fragmented and
bizarre thoughts).
DISORGANIZED & DELUSIONAL THINKING
4
DISTURBED PERCEPTIONS
A schizophrenic person may perceive things that are not there
(hallucinations). Frequently such hallucinations are auditory and lesser
visual, somatosensory, olfactory, or gustatory.
5
L. B
erthold, Untitled. T
he Prinzhorn Collection, U
niversity of Heidelberg
August N
atter, Witches H
ead. The Prinzhorn C
ollection, University of H
eidelberg
Photos of paintings by K
rannert Museum
, University of Illinois at U
rbana-Cham
paign
INAPPROPRIATE EMOTIONS & ACTIONS
A schizophrenic person may laugh at the news of someone dying or show no
emotion at all (apathy).
6
Patients with schizophrenia may continually rub an arm, rock a chair, or remain motionless for hours (catatonia).
Schizophrenia is a cluster of disorders. These subtypes share some features, but
there are other symptoms that differentiate these subtypes.
SUBTYPES OF SCHIZOPHRENIA
7
Schizophrenics have inappropriate symptoms (hallucinations, disorganized
thinking, deluded ways) that are not present in normal individuals (positive
symptoms).
POSITIVE AND NEGATIVE SYMPTOMS
8
Schizophrenics also have an absence of appropriate symptoms (apathy,
expressionless faces, rigid bodies) that are present in normal individuals
(negative symptoms).
When schizophrenia is slow to develop (chronic/process) recovery is doubtful.
Such schizophrenics usually display negative symptoms.
CHRONIC AND ACUTE SCHIZOPHRENIA
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When schizophrenia rapidly develops (acute/reactive) recovery is better. Such
schizophrenics usually show positive symptoms.
EFFECTS OF SCHIZOPHRENIA
Disrupt social relationshipsMakes it difficult to hold a job
Often live in a private inner worldWith support, some may recover to enjoy a normal life or only experience bouts of
schizophrenia intermittently
TYPES OF SCHIZOPHRENIA
ParanoidDisorganized
CatatonicUndifferentiated
Share some common featuresAlso have some distinguishing symptoms
(see textbook)
SUBTYPES
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Schizophrenia is a disease of the brain exhibited by the symptoms of the mind.
UNDERSTANDING SCHIZOPHRENIA
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Dopamine Overactivity: Researchers found that schizophrenic patients express higher levels of dopamine D4 receptors in
the brain.
Brain Abnormalities
WHAT CAUSES SCHIZOPHRENI
A?
CAUSES: BRAIN ABNORMALITY
Excess of receptors for dopamine
May intensify brain signals, which would create the positive symptoms of hallucinations and paranoia
Drugs that block dopamine receptors often lessen positive symptoms
Drugs that increase dopamine activity (amphetamines and cocaine) can intensify them
But dopamine is also linked to Parkinson’s disease, so patients who take drugs to block dopamine develop Parkinson’s like
symptoms Dopamine blocking drugs have little effect on negative
symptoms Investigating the role of glutamate (excitatory
neurotransmitter)
Drugs that interfere with glutamate receptors can produce schizophrenia-like negative symptoms
CAUSE: BRAIN CONT.
People with schizophrenia have abnormal brain activity in several areas
NOT one isolated area
Low brain activity in frontal lobes
PET scans during hallucinations showed activity in the thalamus
Temporal lobe is activated during auditory hallucinations
People with paranoia showed increased activity in the amygdala
Brain size
Enlarged, fluid-filled areas in brains of patients
Smaller cerebral cortex
Smaller thalamus
Can show these BEFORE onset!
What causes these abnormalities? Famine during pregnancy
ABNORMAL BRAIN MORPHOLOGY
Schizophrenia patients may exhibit morphological changes in the brain like
enlargement of fluid-filled ventricles.
17
Both Photos: C
ourtesy of Daniel R
. Weinberger, M
.D., N
IH-N
IMH
/ NSC
ABNORMAL BRAIN ACTIVITY
Brain scans show abnormal activity in the frontal cortex, thalamus, and
amygdala of schizophrenic patients. Adolescent schizophrenic patients also
have brain lesions.
18
Paul T
hompson and A
rthur W. Toga, U
CL
A L
aboratory of Neuro
Imaging and Judith L
. Rapport, N
ational Institute of Mental H
ealth
GENETIC FACTORS
If your parent or siblings have schizophrenia, your odds of developing it are 1 in 10
If your identical twin has it, your odds are 1 in 2 (even when reared apart)
Those who share a placenta have an increased risk
Children adopted by someone who develops schizophrenia, seldom “catch” the disorder
Genes could affect dopamine levels or production of myelinIdentifying specific genes is difficult
Other factors (viruses, oxygen deprivation at birth, etc) may “turn off” or “turn on” the genes that predispose people to
the disease
GENETIC FACTORS
The likelihood of an individual suffering from schizophrenia is 50% if their
identical twin has the disease (Gottesman, 1991).
20
0 10 20 30 40 50Identical
Both parents
Fraternal
One parent
Sibling
Nephew or niece
Unrelated
GENETIC FACTORS
The following shows the prevalence of schizophrenia in identical twins as seen
in different countries.
21
PSYCHOLOGICAL FACTORS
Psychological and environmental factors can trigger schizophrenia if the
individual is genetically predisposed (Nicols & Gottesman, 1983).
22Genain Sisters
The genetically identical Genain
sisters suffer from schizophrenia. Two more
than others, thus there are contributing environmental
factors.
Courtesy of G
enain Fam
ily
PSYCHOLOGICAL FACTORS
“No environmental causes have been discovered that will invariably, or even
with moderate probability, produce schizophrenia in persons who are not
related to a person with schizophrenia”Susan Nicol and Irving Gottesman in 1983
VIRAL INFECTION
Schizophrenia has also been observed in individuals who contracted a viral
infection (flu) during the middle of their fetal development.
24
EARLY WARNING SIGNS
Study of “at risk” children/young adults who had relatives with schizophrenia
A mother whose schizophrenia was severe and long lasting
Birth complications, often involving oxygen deprivation and low birth weight
Separation from parentsShort attention span and poor muscle
coordinationDisruptive or withdrawn behavior
Emotional unpredictabilityPoor peer relations and solo play
PERSONALITY DISORDERS
Personality disorders are
characterized by inflexible and
enduring behavior patterns that impair social
functioning. They are usually without
anxiety, depression, or
delusions.26
ANTISOCIAL PERSONALITY DISORDER
A disorder in which the person (usually men) exhibits a lack of conscience for
wrongdoing, even toward friends and family members. Formerly, this person was called a
sociopath or psychopath.
27
UNDERSTANDING ANTISOCIAL PERSONALITY DISORDER
Like mood disorders and schizophrenia,
antisocial personality disorder has biological and
psychological reasons. Youngsters, before committing a crime, respond with lower levels of stress
hormones than others do at their
age. 28
UNDERSTANDING ANTISOCIAL PERSONALITY DISORDER
PET scans of 41 murderers revealed reduced activity in the frontal lobes. In a follow-up study repeat offenders had 11%
less frontal lobe activity compared to normals (Raine et al., 1999; 2000).
29
Normal Murderer
Courtesy of A
drian Raine,
University of Southern C
alifornia
UNDERSTANDING ANTISOCIAL PERSONALITY DISORDER
The likelihood that one will commit a crime doubles when childhood poverty is compounded
with obstetrical complications (Raine et al., 1999; 2000).
30
RATES OF PSYCHOLOGICAL DISORDERS
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RATES OF PSYCHOLOGICAL DISORDERS
32
The prevalence of psychological disorders during the previous year is shown below
(WHO, 2004).
RISK AND PROTECTIVE FACTORS
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Risk and protective factors for mental disorders (WHO, 2004).
RISK AND PROTECTIVE FACTORS
34