What is Schizophrenia? Comes from Greek meaning “split” and “mind” ‘split’ refers to loss of touch with reality not dissociative state not ‘split personality’ Equally common among men and women but men have earlier onset 18 to 25 for men 26 to 45 for women Sample videos 1 Symptoms of Schizophrenia Positive symptoms: hallucinations Delusions Disordered thinking and speech Heightened or distorted perceptions Inappropriate affect Negative symptoms absence of normal cognition or affect (e.g., flat affect, poverty of speech, social withdrawal, loss of motivation) Psychomotor Symptoms Awkward movement, grimaces, posturing, gestures 2 Examples from “Rose Garden” Positive symptoms: Hallucinations in Yr a voice shrieked out of the deep Pit: Innocent! Innocent! after a while the smell of people in the heavy ether-andchloroform stench of the Pit made her think that she should try to see them. Delusions – the construction of Yr & Midworld, her Yr name (Januce), her Yr name for Dr. Fried, others? 3 Examples from “Rose Garden” Disordered thinking/loose associations Deborah sat down, while the Censor said in Yri: Listen Bird-one … The tables have no defense against your clumsiness. ‘Do you know why you are here?’ the doctor asked. ‘Clumsiness. Clumsiness is first and then we have a list: lazy, wayward, headstrong, self-centered, fat, ugly, mean, tactless, and cruel … Deborah looked at the Nose. “Obstacle,” she said. Disordered perceptions Deborah had looked about and found that she could not see except in outlines, gray against gray, and with no depth, but flatly, like a picture. She could only see in gray now, and she could barely hear. Her sense of touch was also leaving … 4 Examples from “Rose Garden” Psychomotor Symptoms - Catatonic that day and the next she spent on Yr’s plains, simple long sweeps of land where the eye was soothed by the depth of space. A few days later, Deborah returned to the Midworld looking down on Earth. 5 DSM-IV Criteria Criteria A – Two or during “significant portion of the time” during a 1-month period: Delusions Hallucinations Disorganized speech Disorganized/catatonic behavior Negative symptoms B - Social/occupational dysfunction C - Continuous disturbance for at least 6 months D - Not Schizoaffective or Mood disorder E - Not due to substance use/medical condition F - Can have a co-occuring pervasive developmental disorder if hallucinations/delusions > 1 month 6 Symptoms of Schizophrenia Delusions of persecution ‘they’re out to get me’ paranoia Delusions of grandeur Delusions of being controlled the CIA is controlling my brain with a radio signal 7 Symptoms of Schizophrenia Hallucinations hearing or seeing things that aren’t there contributes to delusions command hallucinations: voices giving orders Disorganized speech overinclusion - jumping from idea to idea without the benefit of logical association paralogic - on the surface, seems logical, but seriously flawed e.g., Jesus was a man with a beard, I am a man with a beard, therefore I am Jesus 8 Symptoms of Schizophrenia Disorganized behavior and affect behavior is inappropriate for the situation e.g., wearing sweaters and overcoats on hot days Affect(emotion) is inappropriately expressed flat affect - no emotion at all in face or speech inappropriate affect - laughing at very serious things, crying at funny things catatonic behavior unresponsiveness to environment, usually marked by immobility for extended periods 9 DSM-IV Criteria 5 subtypes: Disorganized –confusion, incoherence, and flat or inappropriate affect Catatonic –psychomotor disturbance of some sort Paranoid –an organized system of delusions and auditory hallucinations Undifferentiated –symptoms cross subtypes Residual – symptoms have lessened in strength and number 10 Subtypes of Schizophrenia Paranoid type delusions of persecution believes others are spying and plotting delusions of grandeur believes others are jealous, inferior, subservient Catatonic type - unresponsive to surroundings, purposeless movement, parrotlike speech Disorganized type delusions and hallucinations with little meaning disorganized speech, behavior, and flat affect 11 Other Psychotic Disorders Schizophreniform Disorder – Criteria A, D, E from Schizophrenia met Lasts between 1 and 6 months Schizoaffective Disorder Major Depressive, Manic, or Mixed episode at the same time Criteria A from Schizophrenia met At least 2 weeks with hallucinations/delusions without significant mood symptoms 12 Other Psychotic Disorders Delusional Disorder – “Non Bizarre” Delusions lasting at least 1 month Erotomanic, Grandiose, Jealous, Persecutory, Somatic Types Schizophrenia criteria A never met Aside from delusions, functioning not impaired Brief Psychotic Disorder - Lasts between 1 day and 1 month 13 Schizophrenia and Genetics Sz risk increases with genetic similarity 50 Lifetime risk of developing schizophrenia for relatives of a schizophrenic 40 30 20 10 0 0 General Siblings Children Fraternal Children Identical population of two twin twin schizophrenia victims 14 Cultural Differences in Schizophrenia Prevalence of Sz symptoms is similar no matter what the culture (1-2%) Less industrialized countries have better rates of recovery than industrialized countries families tend to be more accepting and less critical of the Sz patients (humanistic) less use of antipsychotic medications, which may impair full recovery think of Sz as transient, rather than chronic and lasting disorder: see it as a temporary exaggeration of normal feelings 15