Schizophrenia

Chapter 12

Schizophrenia

• Broad spectrum of cognitive and emotional dysfunctions that include– Hallucinations– Delusions– Disorganized speech and behavior– Inappropriate emotions

• Affects about 1 in 100

• Complete recovery is rare

• Costs in 1991 estimated at $65 billion

Early figures

• Emil Kraepelin– Dementia praecox– Distinguished this from manic-

depressive illness by emphasizing onset and outcome

• Eugen Bleuler– Schizophrenia. “split mind”– “Breaking of associative threads”– Recognized inability to keep constant

stream of thought

• Symptoms of heterogeneous: not all people with schizophrenia share the same symptoms

• Psychotic: delusions or hallucinations

• Person can display psychosis without having schizophrenia

Positive symptoms

• Active manifestations of abnormal behavior or an excess or distortion of normal behavior

• Delusions– Delusions of grandeur– Delusions of persecution

Positive symptoms…

• Hallucinations– The experience of sensory events

without input from the environment– Auditory hallucinations are the most

common– Broca’s area (speech) active not

Wernicke’s area (language comprehension)

Negative symptoms

• Absence or insufficiency of normal behavior– Social withdrawal– Apathy– Impoverished speech or thought– Avoliton: apathy– Alogia: poverty of speech

Negative symptoms

• Anhedonia: lack of pleasure

• Flat affect: lack of emotional expression

Disorganized symptoms

• Rambling speech, erratic behavior, inappropriate affect

• Disorganized speech– Cognitive slippage– Tangentiality– Loose associations

Disorganized symptoms….

• Inappropriate affect– Laughing or crying at inappropriate

times

• Disorganized behavior– Catatonia

Subtypes of Schizophrenia

• Paranoid

• Disorganized

• Catatonic

• Undifferentiated

• residual

Paranoid Schizophrenia

• Hallucinations and delusions

• Relatively intact cognitive skills and affect

• Generally do not have disorganized speech

• Best prognosis

• Delusions of grandeur and persecution

Disorganized type (hebephrenia)

• Marked disruptions in speech and behavior

• Flat or inappropriate affect

• Delusions tend to be fragmented

• Shows up early and tends to be chronic

Catatonic type

• Unusual motor responses and odd mannerism

• Echolalia

• Echopraxia: relatively rare

Undifferentiated type

• “catch all” category

• Some symptoms but do not meet full criteria for paranoid, disorganized or catatonic types

Residual type

• At least one episode but no longer displaying major symptoms.

• Often have residual symptoms– Negative beliefs– Unusual or bizarre ideas– Social withdrawal– Flat affect

Other psychotic disorders

• Schizophreniformn disorder

• Schizoaffective disorder

• Delusional disorder

• Brief psychotic disorder

• Shared psychotic disorder

• Schizotypal personality disorder

Developmental research

• Early brain damage?

• Brain plasticity– Compensation in early life more

difficult as person gets older

Genetic influence

• More severe the parent’s schizophrenia greater likelihood child will develop schizophrenia

• Genetic relatedness increases chances• Monozygotic twins: 48%• Fraternal: 17%• Genes predispose person to schizophrenia• Smooth movement eye tracking: genetic

marker?

Neurological considerations

• Dopamine

• Excess can cause psychotic symptoms

• Antipsychotic drugs block dopamine receptors

• Negative effects of drugs similar to Parkinson's disease

Neurological considerations..dopamine

• BUT

• Many with schizophrenia not helped by dopamine antagonists

• Dopamine blocked quickly, but symptoms remit long after

• More likely a dopamine/serotonin interaction

• Virus?

Neurological damage…..

• Positive symptoms: dopamine?• Negative symptoms: enlarged

ventricles?• Can have these abnormalities w/o

schizophrenia• Less activity in frontal lobes,

particularly dopamine pathway• Finger tip ridge count: in 1/3 of of

discordant twins

Psychological and social influences

• Extreme stress can produce psychotic symptoms

• May activate predisposition

• Family interactions:– Schizophrenogenic mother and double

bind largely discounted– Expressed emotion related to relapse

• Criticism, hostility and emotional over-involvement

Treatment

• Institutionalization

• Prefrontal lobotomy

• ECT

• Insulin therapy

• Neuroleptic drugs– Conventional drugs : unpleasant side

effects

• Atypical antipsychotics

New treatment?

• Transcranial magnetic stimulation

Psychosocial interventions

• Behavioral approaches– Socialization– Self-care– Appropriate emotional responses– Token economies– Independent living skills– Behavioral family therapy– Vocational rehabilitation

Cultural factors

• Differences in family support (Hispanics)

• China: meds and hospitalization

• Africa: prisons

prevention

• Genetic markers

• Early intervention