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Schizophrenia Outline
Carolyn R. Fallahi, Ph. D.
What is Schizophrenia?
Who does it affect?
Age of onset younger in males (21) versus females (27).
Prevalence = 1%. 2 million affected by the disorder; 200,000 new cases/yr.
1/100 individual = SX.
Huge costs.
1988 Kaplan & Sadock.
History: ancient Egypt & Europe in the middle ages; homeless; need to
understand pathophysiology.
History: Emil Kraepelin & dementia praecox different from euphoria &
depression. Viewed as a physiological disease.
Eugene Bleuler: added simple SX for patients who did not display deteriorative
course.
What does Schizophrenia mean?
Bleuler adopted a more “psychological” view.
Contemporary clinical views.
 Heterogeneous mix of disorders
 Issues with classification
 Positive versus negative symptoms (Hughlings-Jackson, 1931) & Bartko
(1974)
 Crow (1980) – type I versus type II
 Types of delusions: delusions of grandeur; delusions of persecution;
Capgras Syndrome; Cotard’s syndrome.
 Hallucinations & study using single photo emission tomography (SPECT)
 Negative symptoms: affective blunting, anhedonia, avolition-apathy,
alogia, affective flattening.
 Some issues surrounding flat affect
 Disorganized symptoms
 Disorganized speech: cognitive slippage, tangentiality, loose associations,
derailment.
 Miller & Flaum (1995): positive symptoms subdivide into 2 dimensions –
psychotic factor & disorganization factor.
 Research into negative symptoms or “deficit” symptoms. These include
flattened or restricted affect, anhedonia, poverty of speech, lack of a
sense of purpose, and diminished social drive. Secondary symptoms due
to meds?
 Hallucinations & delusions.
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Types of delusions: persecutory, grandiose, somatic.
Type I versus Type II symptoms.
Schizophrenia subtypes: paranoid type; catatonic type (echolalia,
echopraxia); disorganized type (hebephrenia); undifferentiated type;
residual type.
Schizophreniform disorder.
Schizoaffective disorder.
Delusional disorder: the erotomanic type; grandiose type; persecutory
type; somatic type.
Brief psychotic disorder.
Shared psychotic disorder (folie a deux).
Schizotypal P. D.
Etiology of Schizophrenia: a disease of the brain.
 History: the psychoanalytic tradition, e.g. schizophrenogenic mother
(Fromm-Reichmann, 1948).
 Prenatal environmental risk factors: viral infection.
 Mednick & Colleagues (1988)
 Studies of starvation using the Dutch Hunger Winter between Oct 1944 &
May 1945.
 Genetic Factors: “trigger”; diathesis-stress theory of illness.
 Family Studies: 40 family studies between 1920 & 1987. Risk for the
general population = 1%; risk for spouses 2%; second degree relatives 2
to 6%; first degree relatives 9 to 40%; MZ twins 50%. But….risk for MZ
rate is below 100% which means…..
 The issue of schizotypal & paranoid P.D.
 Twin Studies: Gottesman (1991) concordance rate of 48% for MZ twins &
17% for DZ twins.
 Adoption studies: Heston (1966) 10.4%.
 Model of transmission? Single gene model versus Multifactorial/polygenic
model.
 Gottesman (1991) 6 criteria that distinguish polygenic from Mendelian
illnesses.
 Linkage & association studies focus on chromosomes 6 and 11.
 Clinical neuropsychology or brain pathology.
 Neurochemical studies: DA hypothesis based on the effects of drugs that
are either agonists or antagonists.
 Support for the DA hypothesis.
 Multiple subtypes of DA receptors, specifically D1 and D2.
 PET technology show elevated D2 receptor densities; but inconsistent
finding.
 Ratio of DA receptor subtypes?
 DA and its link to attention and memory.
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Neurological damage theories. Positive symptoms; negative symptoms;
frontal lobes, e.g. hypofrontality & deficits that are in the dorsolateral
prefrontal cortex of the frontal lobes.
Psychological & social influences.
Family interactions.