REVOLUTION: 1980 - PRESENT FROM PSYCHOLOGICAL PERSONALITY EARLY LIFE PSYCHOTHERAPY TO BIOLOGICAL DISEASE BRAIN MEDICATION.

REVOLUTION: 1980 - PRESENT

• FROM • PSYCHOLOGICAL• PERSONALITY• EARLY LIFE• PSYCHOTHERAPY

• TO • BIOLOGICAL• DISEASE• BRAIN• MEDICATION

HISTORY

• DOMINANT IN 19TH CENTURY - DISEASE OF BRAIN

• RISE AND DOMINANCE OF PSYCHODYNAMIC THEORY

• LITTLE KNOWLEDGE ABOUT BRAIN

• DISCREDITING OF GENETIC THOUGHT WITH NAZIS

EMERGENCE OF BIOLOGY

• SCIENTIFIC REVOLUTION BEGAN ABOUT 1980

• MORE KNOWLEDGE ABOUT BRAIN – HUMAN GENOME PROJECT NOW

• NEW TECHNOLOGY FOR THE STUDY OF THE BRAIN (CAT; MRI; PET)

EMERGENCE OF BIOLOGY

• PSYCHOPHARMACOLOGICAL DEVELOPMENTS

• INSURANCE AND MANAGED CARE

• DRUGS CHEAPER AND MORE EFFICIENT THAN THERAPY

• CAN TREAT SERIOUSLY ILL

DSM-III (1980)

• REJECTED DYNAMIC MODEL OF DSM-I AND DSM-II

• ADOPTED DIAGNOSTIC MODEL

DIAGNOSTIC MODEL

• PARTICULAR DIAGNOSIS VERY IMPORTANT

• NOT CONTINUOUS, BUT CATEGORICAL

• SYMPTOMS INDICATE UNDERLYING DISEASES

• BUT, NO “GOLD STANDARD” OTHER THAN SYMPTOMS

CAUSES

• BRAIN DISORDERS

• OFTEN GENETIC VULNERABILITIES

• EARLY CHILDHOOD ILLNESSES OR TRAUMAS

• CURRENT TRAUMAS CAN CHANGE BRAIN

EVIDENCE FOR GENETIC

• PROBABILITY OF SCHIZOPHRENIA

• NO SCHIZ RELATIVES 1%

• UNCLES/AUNTS/COUSINS 2-4%

• ONE PARENT 6%

• FULL SIBLING 10%

• DZ 6-15%

• MZ 30-40%

BASIC PROBLEM

• FAMILIES TRANSMIT GENES AND BEHAVIORS, VALUES, CULTURE, ETC.

• HOW SEPARATE GENETIC FROM ENVIRONMENTAL INFLUENCES?

• TWO MAJOR WAYS

ADOPTION STUDIES

• GET GENES FROM ONE SET OF PARENTS AND ENVIRONMENT FROM ANOTHER SET

• NATURAL CHILDREN OF M.I. PARENTS RAISED BY NON-M.I. FOSTER PARENTS

• COMPARE TO ADOPTED CONTROL GROUP

HESTON STUDY

• 47 CHILDREN BORN TO SCHIZ. MOTHER IN OREGON M.H. 1915-45 AND TAKEN AWAY AT BIRTH

• CONTROL GROUP OF 47 CHILDREN OF NON-M.I. MOTHERS ADOPTED AT BIRTH

HESTON (CONT.)

• 17% OF CHILDREN BORN OF SCHIZ. MOTHERS BECAME SCHIZ.

• 0% OF CONTROL GROUP

• OTHER STUDIES OF SCHIZOPHRENIA ALSO SUPPORT GENETIC INFLUENCE (ALTHOUGH NOT AS STRONGLY)

OTHER ILLNESSES

• DEPRESSION AND ALCOHOLISM

• RATES IN ADOPTEES SOMETIMES RESEMBLE FOSTER PARENTS MORE THAN NATURAL PARENTS

• INDICATES ENVIRONMENTAL AS WELL AS GENETIC INFLUENCES

COMPARE MZ - DZ TWINS

• MONOZYGOTIC TWINS (MZ) - SHARE 100% GENES

• DYZYGOTIC TWINS (DZ) - SHARE 50% GENES

• RAISED IN SAME FAMILY, ETC.

• CONTROL ENVIRONMENT, VARY GENES

DIFFERENCES IN SCHIZ.

• SIBLINGS 10%

• DZ 6-15%

• MZ 30-40%

• OTHER DISORDERS LESS DIFFERENCE BUT ALWAYS MORE MZ THAN DZ

LIMITS OF TWIN STUDIES

• MZ CONCORDANCE FAR FROM 100%

• ARE TWINS REPRESENTATIVE?

• EXTENT GREATER CONCORDANCE FOR MZ IS SOCIAL NOT GENETIC

• PHYSICAL SIMILARITY, MORE INTERACTION, SAME FRIENDS

• CAN’T LOCATE PARTICULAR GENES