Upload
brian-piper
View
760
Download
0
Tags:
Embed Size (px)
DESCRIPTION
lecture 15 from a college level introduction to psychology course taught Fall 2011 by Brian J. Piper, Ph.D. ([email protected]) at Willamette University, includes DSM-IV TR, positive symptoms, negative symptoms, hallucinations, epidemiology, famous patients, catatonic, disorganized, paranoid, genetics, neuroanatomy, Genain sisters, antipsychotics, dopamine
Citation preview
Schizophrenia
Brian J. Piper, Ph.D.
Goals Symptoms of Schizophrenia
Causes
Treatments
Schizophrenia
The Greek translation is schizein “split” and phren “mind” which refers to a split from
reality. A group of severe disorders characterized by atypical:
1. Cognition2. Behavior 3. Emotions
Symptoms of Schizophrenia
Positive symptoms: the presence of inappropriate behaviors
delusions
hallucinations: auditory >>> visual > other
disorganized talking: “word salad”
movements
Negative symptoms: the absence of appropriate behaviors
flat affect: joy, anger, disgust
anhedonia
catatonia: waxy flexibility
Other forms of delusions include, delusions of persecution (“someone is following me”) or grandeur (“I am a
king”).
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.”
(Sheehan, 1982)
This monologue illustrates fragmented, bizarre thinking with distorted beliefs called delusions (“I’m Mary Poppins”).
Example Patient
Gerald (upto 2:30): http://www.youtube.com/watch?v=gGnl8dqEoPQ
Haldol: classic antipsychotic drug
Delusions of grandeur: inappropriate beliefs about one’s self-worth or specialpowers
Auditory Hallucinations
For almost 7 years, except during sleep, I continue to hear voices. They accompany me to every place and at all times, when I’m in conservations with other people, they persist, undeterred, even when I concentrate on other things, for instance, read a book, play the piano, etc. Only when I’m talking aloud to other people or to myself are they drowned by the stronger sound of the spoken word and therefore inaudible to me.
Recounted by Ann M. Kring, Ph.D.
Pros & Cons
Behavioral strategies (& family discord)
Command Hallucinations
Epidemiology of Schizophrenia
Frequency: 0.7%Onset: 18-20sSex: Males > Females in # and severityLow SES/African-AmericansRule of thirds
Sources: Anna K. Kring, Brad Olson, & Peter Gray
Vincent van Gogh1853-1890
Brian Wilson1942-
John Nash1928-
Jack Kerouac1922-1969
Mary Todd Lincoln1818-1882
Schizophrenia & Artists?
DSM-IV Criteria for Diagnosis
• Impaired social/occupational/self-care
• 2 or more of the following:– Delusions: delusions of grandeur or
persecution– Hallucinations– Disorganized speech– Disorganized behavior: mannerisms– Negative symptoms
Subtypes (DSM-IV-TR only)
• Catatonic: immobility
• Disorganized: disorganized speech or behavior, affective flattening
• Paranoid: – Present: delusions & auditory hallucinations,
possible religiosity– Absent: disorganized behavior & affective
flattening
Typical?
The relationship between schizophrenia and aggression is controversial.
Renfrew (1996). Aggression & Its Causes.
Typical?
The relationship between schizophrenia and aggression is controversial.
Disorganized: Increased risk of victimizationParanoid: small increase
Renfrew (1996). Aggression & Its Causes.
John Hinckley, Jr.
Jared Lee Loughner
Causes
• Demonic possession– Blood loss– Damage to brain
• “Refrigerator mothers”
• Neurodevelopmental Disorder
Abnormal Brain MorphologySchizophrenia patients may exhibit
morphological changes in the brain like enlargement of fluid-filled ventricles.
Both Photos: C
ourtesy of Daniel R
. Weinberger, M
.D., N
IH-N
IMH
/ NSC
Meta-Analysis
• 58 studies
• 1,588 SCZ patients
Region (Left or Right) % of Control
L Lateral Ventricle 130
R Lateral Ventricle 120
Gray Matter 96
White Matter 98
L Frontal Lobe 95
L Hippocampus 95
L Amygdala 91
L Thalamus 96
R Thalamus 96
Wright et al. (2000). Am J Psychiatry, 157, 16-25.
Genetic Factors
The likelihood of an individual suffering from schizophrenia is 50% if their identical
twin has the disease (Gottesman, 2001).
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.
Genain Sisters“Genain”: Greek “dire birth”, born 1930, all hospitalized for schizophrenia by early 20s,
probability = 1.5 billion
Nora: intermediate (jobs, no family)Iris: intermediate (jobs, no family)Myra: secretary, married, 2 sonsHester: showed signs at age 11, institutionalized
Genetics: identicalEnvironment: identical (schizophrenic mom)Prenatal: ?
Neuropsych Testing of Genain Sisters at age 68
• Digit Span: working memory
• Trail Making Test: set shifting
• Continuous Performance Test: attention
Mirsky et al. (2000). Schizophrenia Bulletin, 26, 699-708.
Viral Infection
Schizophrenia has also been observed in individuals who contracted a viral
infection (flu) during the middle of their fetal development.
Natural Logarithm of Relative Risks (and 95% Confidence Intervals) for Subjects Included in Eight Ecological Studies from Europe, America, and Australia (Type A Studies) of Risk for
Schizophrenia Associated with Exposure to 1957 Influenza Pandemic During Second Trimester of Prenatal Life.
Selten J et al. Schizophr Bull 2009;36:219-228http://en.wikipedia.org/wiki/Natural_logarithm
Individual Differences in SCZ
Neurochemical ImbalanceTypical
Origin 1952
Example ChlorpromazineHaloperidol
Mechanism D2 antagonist
Treats + symptoms
Side-Effects Tardive dyskinesia
TD (20 sec): http://www.youtube.com/watch?v=fLwZQBJs8fI
Drug Therapies
Psychopharmacology is the study of drug effects on mind and behavior.
With the advent of drugs, hospitalization in mental institutions has rapidly declined.
Neurochemical ImbalanceTypical Atypical
Origin 1950s 1970
Example ChlorpromazineHaloperidol
Clozapine
Mechanism D2 antagonist D2 & 5-HT2A antagonist
Treats + symptoms + symptoms
Side-Effects Tardive dyskinesia Weight gain
TD (20 sec): http://www.youtube.com/watch?v=fLwZQBJs8fI
Concern
• Adult monkeys received typical (haloperidol) or atypical (olanzapine) antipsychotics for 2 years at doses similar to schizophrenics.
• Gray matter in parietal cortex was examined.
Konopaske et al. (2007). Neuropsychobiol 32, 1216-1223.
**
Self-Medication?
• Marijuana• Nicotine
Art During Disease Progression
• A English artist, who was fascinated by cats, painted these pictures over a period of time in which he became mentally ill.
• Pro– Paranoia– Disorganization
• Con– Schizophrenia– Order
Louis Wain (1860-1939)
Summary
• Symptoms ( + and - )• Current Biological Components
– Genetics– Brain Structure– Dopamine Receptors