Understanding Schizophrenia: Symptoms, Types, Treatment, and Social Influence

1. Schizophrenia Chapter 12

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

3. Affects about 1 in 100 • Complete recovery is rare • Costs in 1991 estimated at $65 billion

4. 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

5. Symptoms of heterogeneous: not all people with schizophrenia share the same symptoms • Psychotic: delusions or hallucinations • Person can display psychosis without having schizophrenia

6. Positive symptoms • Active manifestations of abnormal behavior or an excess or distortion of normal behavior • Delusions • Delusions of grandeur • Delusions of persecution

7. 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)

8. Negative symptoms • Absence or insufficiency of normal behavior • Social withdrawal • Apathy • Impoverished speech or thought • Avoliton: apathy • Alogia: poverty of speech

9. Negative symptoms • Anhedonia: lack of pleasure • Flat affect: lack of emotional expression

10. Disorganized symptoms • Rambling speech, erratic behavior, inappropriate affect • Disorganized speech • Cognitive slippage • Tangentiality • Loose associations

11. Disorganized symptoms…. • Inappropriate affect • Laughing or crying at inappropriate times • Disorganized behavior • Catatonia

12. Subtypes of Schizophrenia • Paranoid • Disorganized • Catatonic • Undifferentiated • residual

13. Paranoid Schizophrenia • Hallucinations and delusions • Relatively intact cognitive skills and affect • Generally do not have disorganized speech • Best prognosis • Delusions of grandeur and persecution

14. 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

15. Catatonic type • Unusual motor responses and odd mannerism • Echolalia • Echopraxia: relatively rare

16. Undifferentiated type • “catch all” category • Some symptoms but do not meet full criteria for paranoid, disorganized or catatonic types

17. 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

18. Other psychotic disorders • Schizophreniformn disorder • Schizoaffective disorder • Delusional disorder • Brief psychotic disorder • Shared psychotic disorder • Schizotypal personality disorder

19. Developmental research • Early brain damage? • Brain plasticity • Compensation in early life more difficult as person gets older

20. 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?

21. Neurological considerations • Dopamine • Excess can cause psychotic symptoms • Antipsychotic drugs block dopamine receptors • Negative effects of drugs similar to Parkinson's disease

22. 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?

23. 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

24. 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

25. Treatment • Institutionalization • Prefrontal lobotomy • ECT • Insulin therapy • Neuroleptic drugs • Conventional drugs : unpleasant side effects • Atypical antipsychotics

26. New treatment? • Transcranial magnetic stimulation

27. Psychosocial interventions • Behavioral approaches • Socialization • Self-care • Appropriate emotional responses • Token economies • Independent living skills • Behavioral family therapy • Vocational rehabilitation

28. Cultural factors • Differences in family support (Hispanics) • China: meds and hospitalization • Africa: prisons

29. prevention • Genetic markers • Early intervention