Schizophrenia

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Schizophrenia

• A little bit more....

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Fact 1There are different types.

• Paranoid Schizophrenia- Delusions/or
  hallucinations
• Hebephrenic Schizophrenia- Aimless behaviour
  disorganised.
• Catatonic schizophrenia-Motor abnormality
• Undifferentiated Schizophrenia-Insufficient no.
  of symptoms from other subtypes.
• Post- Schizophrenia-Within last 12mths but not
  present.
• Residual Schizophrenia-Criteria currently,
  although not in past.
• Simple Schizophrenia- Slow progressive decline
  (over 12 mths) of e.g. sociability occupation
  etc.

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2 Criteria needs to be met for diagnosis

• In all cases the general criteria for a diagnosis
  must be met as well as the specific criteria for
  each subtype.
• The only exception being simple schizophrenia.
• Within Britain schizophrenia is usually diagnosed
  using Schizophrenia as a overarching
  illness/label. However Crow (1985) proposed
  additional categories Type I or Type II.
• Type I Acute disorder with positive symptoms
• Type II Chronic disorder with negative
  symptoms.

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3 The subtypes are not without their problems!!

• There can be a blurred distinction between the
  two. Certain individuals are diagnosed with one
  type and develop the symptoms from another, thus
  invalidating the reliability the of the original
  diagnosis.
• These individuals do not therefore fit any
  specific category. The distinction may be useful
  but is not a 100 reliable.

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What sub type am I?

• Helen suffers from acute discomfort in close
  relationships, cognitive perceptual distortion.
  She often displays odd, some may say, eccentric
  behaviour, such as wearing bright coloured
  clothes, and often organises her clothes and food
  cupboards.
• She has little sense of humour and is vague in
  conversation.

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What sub type am I?

• Dave is a 19 year old student. He has been
  unresponsive fro the whole duration of his
  hospital stay (4 weeks). His body has been very
  rigid and he has stared at the ceiling for long
  periods of time and spends most of the day in a
  trance like state.
• The only behaviour that can be investigated
  happened prior to the hospitalisation when he was
  ranting and raving that his psychology teacher
  was a demon.

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What sub type am I?

• Daisy is a unmarried woman who lives with her
  elderly mother. She believes that the world is
  filled with radio waves that are trying to
  penetrate her brain and plant evil thoughts into
  her brain. Because of this belief Daisy rarely
  leaves the house. Her windows have protection
  with foil, they deflect the radio waves. The
  voices in her head comment on the radio waves all
  the time.

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So what does a schizophrenia sufferers brain look
like?
This map reveals the 3-dimensional profile of
gray matter loss in the brains of teenagers with
early-onset schizophrenia, with a region of
greatest loss in the temporal and frontal brain
regions that control memory, hearing, motor
functions, and attention
Source http//www.loni.ucla.edu/Research/Projects
/Schizophrenia.shtml
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Source http//images.google.co.uk/imgres?imgurlh
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Biochemical explanation.
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Dopamine is a neurotransmitter that transports
signals between nerve endings in the brain. It is
thought that the brains of people with
schizophrenia and other psychotic disorders
produce too much dopamine. There is evidence that
supports and counters the dopamine hypothesis.
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Dopamine hypothesis

• The main support for the theory that too much
  dopamine causes schizophrenia is the fact that
  antipsychotic medications, which are used to
  treat schizophrenia, block dopamine receptors.
  The medications are designed to bind to dopamine
  receptors in the brain, and their effects have
  helped many people cope with symptoms. Secondly,
  drugs that increase levels of dopamine, like
  amphetamines, often cause psychotic symptoms and
  a schizophrenic-like paranoid state.

• However, several factors challenge the dopamine
  hypothesis. E.G. dopamine-related psychosis
  occurs in many disorders, not exclusively in
  schizophrenia.
• People with schizophrenia are not the only ones
  who respond to antipsychotic medication.
• Antipsychotic medication may not significantly
  affect the negative symptoms of schizophrenia,
  which suggests that there is more involved than
  abnormal dopamine levels alone.
• Moreover, dopamine levels might actually be lower
  rather than higher in the frontal lobes of the
  brain. At any rate, antipsychotic medication only
  treats the symptoms of schizophrenia it does not
  eliminate its underlying causes.

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But we must remember there is evidence to suggest
otherwise!!
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Underactive frontal lobes and overactive parietal
lobes are thought to cause some of
schizophrenias associated symptoms. For example,
when frontal lobes are underactive, planning,
organization, and volition are all impaired.
Frontal lobe abnormalities are probably related
to schizophrenias negative symptoms. Parietal
lobes are involved in sensory perception, like
voice recognition, the ability to distinguish
patterns, and spatial orientation. Overactive
parietal lobes may cause distortion of these
senses, which is seen in many people with
schizophrenia. Parietal lobe abnormalities are
probably more closely related to positive
symptoms. Abnormal brain structure is found
consistently in people with schizophrenia. This
includes enlarged ventricles and asymmetrical
hemispheres. Using imaging researchers have
discovered decreased blood flow to the frontal
lobes of people with schizophrenia. These types
of brain abnormalities forecast certain symptoms,
like loss of attention, difficulty with abstract
thinking, and the inability to solve problems.
Evidence??
Brown et al (1986) Buschbaum (1990) Woodruff et
al (1997) Wood et al (2005)
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• Some evidence suggests that infants who
  experience birth trauma or complications while in
  the womb are at greater risk for schizophrenia.
  Maternal illness may play a part as well. A
  mother who contracts a virus like the flu,
  especially during her second trimester, may
  increase the risk for her child. It is not known,
  whether the virus itself or the immune response
  to it increases the risk. (Chicken egg
  scenario!)
• Some studies have shown that winter birth may be
  associated with schizophrenia, especially during
  immune response and illness. Furthermore, viruses
  in the womb are more common during the winter
  months. This has led some researchers to consider
  intrauterine viral infection during the winter as
  a risk factor. The same link, however, is found
  for major mood disorders, like bipolar disorder.
• Evidence??

Hope-Simpson (1981) Bradbury Miller
(1985) Jones cannon (1998) Torrey et al (1988)

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How is the evidence investigated/gathered?

• Well...ethically you cannot perform lobotomy's as
  such or prod and poke...so the information to
  support the biological explanations as a whole
  are collected using a variety of tests/procedures
  including blood tests and brain scans.

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Scanning.....

• MRI Magnetic resonance imaging (MRI) is an
  imaging technique used primarily in medical
  settings to produce high quality images of the
  inside of the human body.
• It is a massive breakthrough as it shows clear
  pictures of the living brain.

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Scanning...

• PET/CT PET stands for Positron Emission
  Tomography.
• PET scans measure metabolic activity and
  molecular function by using a radioactive glucose
  injection.
• The F-18 FDG is injected into the patient.
• The PET scanner detects the radiation emitted
  from the patient, and the computer generates
  three-dimensional images of tissue function or
  cell activity in the tissues of your body.

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Could it be Genetic? Evidence is based upon three
specific areas

• Twin studies

• Concordance rates are investigated,(Maudsley twin
  register 58 were concordant)
• Fischer (1971) 9.4 of offspring developed
  schizophrenia.
• Cardno et el (1999) 40 concordance in MZ twins
  compared with 5.3 in DZ twins.

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Could it be Genetic? Evidence is based upon three
specific areas Adoption study.

• Finnish adoption study (Tienari 1969) adopted off
  spring of biological mothers with schizophrenia
  vs. Matched pairs group found 7 of adoptees in
  index group developed schizophrenia vs. 1.5 in
  control group.
• Aged 5-7yrs at start of study, all sep from mum
  before the age of 4).
• Danish study also supports findings Kety et al
  (1994)

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Could it be Genetic? Evidence is based upon three
specific areas Family study.
1st degree relatives (parents, siblings and
offspring) share an average of 50 of their
genes 2nd degree relatives (half siblings,
grandparents/children, aunts/uncles) share approx
25 of their genes To investigate genetic
transmission of schizophrenia, studies compare
rates of schizophrenia in relatives of diagnosed
cases compared to controls

Kendler et al (1985)
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AO2/AO3 should be made up of the following
point/issues.

• What does ?? suggest about schizophrenia?
• Problems with family studies?
• Twins often reared in same environment so cant
  separate genetic and environmental factors
• Data provided by prospective studies suggest a
  strong genetic link for schizophrenia
• No twin study has yet shown 100 concordance in
  MZ twins
• Twin, adoption and family studies continues to
  provide reliable evidence that the degree of risk
  increases with degree of genetic relatedness

• Even twins reared apart shared the same
  environment in the womb before birth
  environmental factors cant be discounted
• Longitudinal studies are hampered as diagnostic
  criteria for schizophrenia is constantly being
  updated and changed
• More effective in separating effects of genetic
  and environmental factors
• Studies conducted so far dont tell us which
  genes might be important for the transmission of
  schizophrenia.
• Individual differences.
• Role of other neurotransmitters (Clozapine).
• Role of Dopamine in other disorders.

• Dont forget!!! APPROACHES ISSUES DEBATES