Schizophrenia

1
Schizophrenia

• A Closer Look at Psychological Disorders

2
Schizophrenia

• The term schizophrenia comes from the Greek word
  schizein (to split) and phren (mind).
• The split represents a breaking away from
  reality, not a division of _____________.
• Schizophrenia occurs in about 1 of the
  population (1 in every 100 people).
• It affects both men and women at the same rate,
  and it occurs around the world at the same rate.
• It is perhaps the most frightening and
  misunderstood psychological disorder.

3
What is schizophrenia?

• Schizophrenia is not one disorder.
• It is a family of related disorders involving
• Disorganized and delusional thinking
• Disturbed perceptions
• Inappropriate emotions or behaviors.

4
What is schizophrenia?

• Disorganized thinking is fragmented and bizarre,
  and it is believed to come from a breakdown in
  selective attention
• Cannot filter out information
• The person has lost contact with reality to a
  considerable extent.
• Someone with depression or severe anxiety
  problems dreams in an unreal way about life.
• While a person with schizophrenia lives life as
  an unreal dream.

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Onset and Prognosis

• Schizophrenia tends to develop in adolescence or
  early adulthood.
• It strikes young people as they mature into
  adults.
• It affects men and women equally, but men suffer
  from it more severely than women.
• 1/3 of people diagnosed with schizophrenia
  improve with treatment and are able to function
  reasonably well
• 1/3 will continue to get worse
• 1/3 will be in and out of institutions for a long
  time, displaying symptoms that permanently impair
  their functioning.

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Onset and Prognosis

• Chronic vs. Acute Schizophrenia
• Chronic When schizophrenia is slow to develop
  (chronic/process) recovery is doubtful.
• Such schizophrenics usually display negative
  symptoms.
• Acute When schizophrenia rapidly develops
  (acute/reactive) recovery is better.
• Such schizophrenics usually show positive
  symptoms.
• Overall, a more favorable prognosis exists when
  the onset of the disorder is sudden and at a
  later age, the individuals social and work
  adjustment was good prior to onset, the
  proportion of negative symptoms is low, and the
  patient has a good social support system.

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Disorganized Delusional Thinking
This morning when I was at Hillside Hospital, I
was making a movie. I was surrounded by movie
stars Im Mary Poppins. Is this room painted
blue to get me upset? My grandmother died four
weeks after my eighteenth birthday.

• This monologue illustrates fragmented, bizarre
  thinking with distorted beliefs called delusions
  (Im Mary Poppins).

8
Symptoms of Schizophrenia

• Many sufferers experience delusions false
  beliefs maintained in the face of contrary
  evidence. There are several types of delusions
• Delusions of grandeur false beliefs that you
  are more important than you really are (may
  believe you are Jesus or Abraham Lincoln, for
  example)
• Delusions of persecution false beliefs that
  people are out to get you (may believe that you
  are being followed, CIA is after you, etc.)
• Delusions of sin or guilt false beliefs of
  being responsible for some misfortune (may
  believe you are responsible for a plane crash
  because you forgot to brush your teeth)
• Delusions of influence false beliefs of being
  controlled by outside forces (the devil made me
  do it)
• Delusion of reference false belief that random
  events, objects, behaviors of others, etc. have a
  particular and unusual significance to oneself
  (may believe that headlines or stories in
  newspapers are written especially for you, may
  believe that events (even world events) have been
  deliberately contrived for you, etc.)

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Symptoms of Schizophrenia (cont.)

• David Berkowitz (Son of Sam) killed
• six people and seriously wounded
• seven others in a one year long killing
• spree in New York.
• He was diagnosed as a potential
• paranoid schizophrenic when he
• claimed that his neighbor (Sam Carr,
• the Sam mentioned in the first letter
• Berkowitz sent to police) owned a dog that was
  possessed by an ancient demon.
• When the dog barked, it issued irresistible
  commands that Berkowitz must kill people.
  Berkowitz said he once tried to kill the dog,
  only to see his aim spoiled due to supernatural
  interference.
• This is an example of a delusion of ___________.

10
Symptoms of Schizophrenia (cont.)

• Many sufferers might also experience
  hallucinations perceptions in the absence of
  corresponding sensation. There are several kinds
  of hallucinations as well
• Auditory may hear voices, and sometimes the
  voices tell them what to do.
• Visual may see nonexistent objects, or
  distorted images of items or people.
• Tactile may feel skin stimulation, such as a
  tingling or burning or touch that is not real.
• Hallucinations can also distort taste and smell.
• Note the difference
• Delusions are beliefs with no logical basis
• Hallucinations are perceptions with no outside
  stimulation.
• However, hallucinations often provide evidence
  for delusions.

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Symptoms of Schizophrenia (cont.)

• Another symptom could be inappropriate emotions
  or behaviors
• Laughing uncontrollably when sadness is called
  for
• Very flat emotions, showing little or no
  emotional response
• Not speaking at all
• Waxy flexibility if you place them in a
  position, they might hold that position for hours
• Withdrawal from the affairs of the real world,
  which limits their knowledge of current events
  and their social skills
• Producing word salad nonsense talk

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Symptoms of Schizophrenia (cont.)

• Examples of word salad
• A woman was delighted to receive a letter from
  her son abroad, but distraught when she read it
  Dear mother I am writing on paper. The pen I
  am using is from a factory called Perry and Co.
  The factory is in England. The city of London is
  in England. I know this from my school days.
  Then I always liked geography. My last teacher
  in that subject was Professor August A. He was a
  man with black eyes. There are also blue and
  grey eyes and other sorts too. I have heard it
  said that snakes have green eyes. All people
  have eyes. There are some, too, who are blind.
• Emilio was hospitalized 12 times by the time he
  was 40. When interviewed, he just kept repeating
  that he had been eating wires and lightning
  fires.

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Symptoms of Schizophrenia Recap
Watch Janssens MINDSTORM http//www.youtube.com/
watch?vLWYwckFrksg
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Louis Wain Late Onset Schizophrenia

• An artist named Louis Wain experienced late onset
  schizophrenia (he was 57).
• Wain was famous
• for his drawings of cats,
• which began as very
• realistic portrayals or
• anthropomorphic scenes
• (cats in human clothing, situations, etc.).
• As the illness progressed, Wains symptoms can be
  seen in his paintings.

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Louis Wains art
 

• Wains pre-schizophrenic period featured cats
  dressed in human clothes or engaged in human
  activity

 
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Louis Wains art

• During the onset of his disease at 57, Wain
  continued to paint, draw and sketch cats, but the
  focus changed from fanciful situations, to focus
  on the cats themselves.

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Louis Wains art

• Characteristic changes in the art began to occur,
  changes common to schizophrenic artists.
• Jagged lines of bright color
• began emanating from his feline
• subjects. The outlines of the cats
• became sever and spiky, and their
• outlines persisted well throughout
• the sketches, as if they were throwing off
  energy.

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Louis Wains art

• Soon the cats became abstracted, seeming now to
  be made up of hundreds of small repetitive
  shapes, coming together in a clashing jangles of
  color that transform the cat into something
  resembling an Eastern diety.

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Louis Wains art

• The abstraction continued, the cats now being
  seen as made up by small repeating patterns,
  almost fractal in nature. Until finally they
  ceased to resemble cats at all, and became the
  ultimate abstraction, an indistinct form made up
  by near symmetrical repeating patterns.

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Types of Schizophrenia
John Nash (A Beautiful Mind)

• Paranoid schizophrenia characterized by
  delusions, particularly delusions of grandeur and
  persecution. Auditory and other hallucinations
  often support the delusions.
• Catatonic schizophrenia characterized largely
  by variations in voluntary movements.
• Sufferers alternate between two phases
  Catatonic excitement (rapid movement, delusions,
  and hallucinations)
• Catatonic stupor (very little activity or
  speech). Flat emotion and waxy flexibility are
  often part of the stupor phase. Parrot-like
  repeating of anothers speech and movements.
• Disorganized schizophrenia characterized by
  bizarre behavior, delusions, and hallucinations.
  Sufferers are visibly disturbed.
• In historical times they were thought to have
  gone mad. In disorganized schizophrenia, a
  particularly severe deterioration of adaptive
  behavior is seenincoherence, complete social
  withdrawal, delusions centering on bodily
  functions, etc.
• Undifferentiated schizophrenia characterized by
  symptoms that are disturbed but are not clearly
  consistent with the paranoid, catatonic, or
  disorganized types. Sufferers show clear
  evidence of the symptoms of schizophrenia.

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Criticisms of the Current Classification System
of Schizophrenia

• There are many critics of the current subtyping
  system for schizophrenia in the DSM.
• Some theorists argue that the disorder should be
  conceptualized along two categories
• Positive symptoms behavioral excesses or
  peculiarities, such as hallucinations, delusions,
  bizarre behavior, and wild flights of ideas
• Negative symptoms behavioral deficits, such as
  flattened emotions, social withdrawal, apathy,
  impaired attention, and poverty of speech.

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Examples of People Diagnosed with Schizophrenia
ABC 20/20 Part 1 (http//www.youtube.com/watch?v
74vTftboC_A )
ABC 20/20 Part 2 (http//www.youtube.com/watch?v
YXimT5CHCDE)
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Etiology of Schizophrenia

• Possible Causes

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Once again a bit nature, a bit nurture!

• Psychological and environmental factors can
  trigger schizophrenia if the individual is
  genetically predisposed (Nicol Gottesman, 1983).

• The genetically identical Genain sisters suffer
  from schizophrenia.
• However, two of the women have more severe cases
  than the others thus, there are contributing
  environmental factors.

Courtesy of Genain Family
Genain Sisters
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Biological Explanations Heredity

• Genetics the risk of schizophrenia increases
  substantially if relatives have the disorder
  (about a 10 chance).
• This risk is greater among closer relatives.
• Although environment also plays a role in the
  etiology of schizophrenia, the concordance rates
  shown to the right suggest that there must be a
  genetic vulnerability to the disorder. These
  concordance estimates are based on pooled data
  from 40 studies conducted between 1920 and 1987.
• The likelihood of an individual suffering from
  schizophrenia is 50 if their identical twin has
  the disease (Gottesman, 2001).

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Biological Explanations The Brain

• Brain structure the brain structure of people
  with schizophrenia differs markedly from normal
  brain structure.
• For example, they have smaller amounts of brain
  tissue, larger fluid-filled spaces around that
  tissue, and a smaller thalamus (responsible for
  routing incoming information).
• Brain function PET scans show that the frontal
  lobes (center of our most advanced thinking
  abilities) show less activity in schizophrenics.
  
• Also, there are as many as 6 times the normal
  number of receptive sites for the
  neurotransmitter dopamine. This may explain the
  delusions and hallucinations.

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Biological Explanations The Brain
Schizophrenia patients may exhibit morphological
changes in the brain like enlargement of
fluid-filled ventricles (15 larger).
Figure 14.19 Schizophrenia and the ventricles of
the brain. Cerebrospinal fluid (CSF) circulates
around the brain and spinal cord. The hollow
cavities in the brain filled with CSF are called
ventricles. The four ventricles in the human
brain are depicted here. Recent studies with CT
scans and MRI scans suggest that an association
exists between enlarged ventricles in the brain
and the occurrence of schizophrenic disturbance.
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Figure 14.18 The dopamine hypothesis as an
explanation for schizophrenia. Decades of
research have implicated overactivity at dopamine
synapses as a key cause of schizophrenic
disorders. However, the evidence on the exact
mechanisms underlying this overactivity, which is
summarized in this graphic, is complex and open
to debate. Recent hypotheses about the
neurochemical bases of schizophrenia go beyond
the simple assumption that dopamine activity is
increased. For example, one theory posits that
schizophrenia may be accompanied by decreased
dopamine activity in one area of the brain (the
prefrontal cortex) and increased activity or
dysregulation in other areas of the brain (Egan
Hyde, 2000). Moreover, abnormalities in other
neurotransmitter systems may also contribute to
schizophrenia.
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Environmental Factors

• Psychological factors
• Freud mistakenly thought that mothers who were
  cold, domineering, and selfish caused
  schizophrenia in their children.
• Stress may be a trigger that sets off the series
  of events that convert schizophrenia from a
  possibility into a reality.
• Disturbed family communications are also
  correlated with the development of the disorder,
  but its impossible to tell whether they are a
  cause of schizophrenia or a result of
  schizophrenia.

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Environmental Factors

• Sociocultural factors
• Poverty and other adverse living situations,
  maladaptive learning experiences, dysfunctional
  cognitive habit, and stressful family
  communication patterns may influence the onset of
  schizophrenia.
• Such stressors may actually increase the chances
  that disruptive or odd behaviors will persist or
  worsen.
• Patients who are helped to cope with these
  potentially damaging influences tend to have
  better long-term outcomes.

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Figure 14.23 The stress-vulnerability model of
schizophrenia. Multifactorial causation is
readily apparent in current theories about the
etiology of schizophrenic disorders. A variety of
biological factors and personal history factors
influence ones vulnerability to the disorder,
which interacts with the amount of stress one
experiences. Schizophrenic disorders appear to
result from an intersection of high stress and
high vulnerability.