Schizophrenia A Closer Look at Psychological Disorders.

Schizophrenia

A Closer Look at Psychological Disorders

SchizophreniaSchizophrenia 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.

What is schizophrenia?What is schizophrenia? Schizophrenia is not one disorder. It is a family of related disorders

involving:Disorganized and delusional thinkingDisturbed perceptions Inappropriate emotions or behaviors.

What is schizophrenia?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.

Onset and PrognosisOnset 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.

Onset and PrognosisOnset 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 individual’s 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.

Disorganized & Delusional ThinkingThis morning when I was at Hillside [Hospital], I was making a movie. I was surrounded by movie stars … I’m 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 (“I’m Mary Poppins”).

Symptoms of SchizophreniaSymptoms 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.)

Symptoms of Schizophrenia (cont.)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 ___________.

Symptoms of Symptoms of Schizophrenia (cont.)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.

Symptoms of Schizophrenia (cont.)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

Symptoms of Schizophrenia (cont.)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.”

Symptoms of Schizophrenia: RecapSymptoms of Schizophrenia: Recap

Symptoms of Schizophrenia

Delusions HallucinationsInappropriate

EmotionInappropriate

Behavior

Watch Janssen’s MINDSTORM: http://www.youtube.com/watch?v=LWYwckFrksg

Louis Wain: Late Onset SchizophreniaLouis 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, Wain’s symptoms can be seen in his paintings.

Louis Wain’s artLouis Wain’s art Wain’s pre-schizophrenic period featured cats dressed in

human clothes or engaged in human activity:

Louis Wain’s artLouis Wain’s 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.

Louis Wain’s artLouis Wain’s 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.

Louis Wain’s artLouis Wain’s 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.

Louis Wain’s artLouis Wain’s 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.

Types of Types of SchizophreniaSchizophrenia

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 another’s 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 seen…incoherence, 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.

John Nash (A Beautiful Mind)

Criticisms of the Current Classification Criticisms of the Current Classification System of SchizophreniaSystem 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.

Examples of People Diagnosed with Examples of People Diagnosed with SchizophreniaSchizophrenia

ABC 20/20 – Part 2 (http://www.youtube.com/watch?

v=YXimT5CHCDE)

ABC 20/20 – Part 1

(http://www.youtube.com/watch?v=74vTftboC_A )

Etiology of Schizophrenia

Possible Causes

Once again… a bit nature, a bit Once again… a bit nature, a bit nurture!nurture!

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

Genain Sisters

• 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 G

enain Fam

ily

Biological Explanations – HeredityBiological 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).

Biological Explanations – The BrainBiological 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.

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.

Biological Explanations – The BrainBiological Explanations – The Brain

Schizophrenia patients may exhibit morphological changes in the brain like enlargement of fluid-filled ventricles (15%

larger).

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.

Environmental FactorsEnvironmental 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 it’s impossible to tell whether they are a cause of schizophrenia or a result of schizophrenia.

Environmental FactorsEnvironmental 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.

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 one’s 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.