Psychological
Disorders
PowerPoint®
Presentation
by Jim Foley
© 2013 Worth Publishers
Module 50:
Schizophrenia
Mr. James believes that people are
constantly laughing at him and that FBI
agents are trying to steal his life savings.
Mr. James is most clearly suffering
from:
A.
B.
C.
D.
compulsions.
catatonia.
delusions.
hallucinations.
Schizophrenia:
Psychosis refers
to a mental split
from reality and
rationality.
the mind is split from reality, e.g.
a split from one’s own thoughts
so that they appear as
hallucinations.
Schizophrenia
symptoms include:
 disorganized
and/or
delusional
thinking.
 disturbed
perceptions.
 inappropriate
emotions and
actions.
Positive and Negative Symptoms of
Schizophrenia
Positive +
presence of
problematic
behaviors




Hallucinations (illusory
perceptions), especially
auditory
Delusions (illusory
beliefs), especially
persecutory
Disorganized thought and
nonsensical speech
Bizarre behaviors
Negative absence of
healthy
behaviors






Flat affect (no emotion
showing in the face)
Reduced social interaction
Anhedonia (no feeling of
enjoyment)
Avolition (less motivation,
initiative, focus on tasks)
Alogia (speaking less)
Catatonia (moving less)
Schizophrenia Symptoms:
Problems in Thinking and Speaking
 Disorganized speech,
including the “word salad”
of loosely associated
phrases
 Delusions (illusory beliefs),
often bizarre and not just
mistaken; most common
are delusions of grandeur
and of persecution
 Problems with selective
attention, difficulty
filtering thoughts and
choosing which thoughts to
believe and to say out loud
?!?!
?!?!
Schizophrenia Symptoms:
Disturbed Perceptions
 People with schizophrenia often
experience hallucinations, that is,
perceptual experiences not
shared by others.
 The most common form of
hallucination is hearing voices
that no one else hears, often with
upsetting (e.g. shaming) content.
 Hallucinations can also be visual,
olfactory/smells, tactile/touch, or
gustatory/taste.
Am I evil?
You’re evil!
Schizophrenia Symptoms:
Inappropriate Emotions
 Odd and socially inappropriate
responses such as looking bored
or amused while hearing of a
death
 Flat affect: facial/body
expression is “flat” with no
visible emotional content
 Impaired perception of
emotions, including not
“reading” others’ intentions and
feelings
Schizophrenia Symptoms:
Inappropriate Actions/Behavior
Odd and socially inappropriate
behavior can be caused by symptoms
such as:
 errors in social perception.
 disorganized, unfiltered thinking.
 delusions and hallucinations.
The schizophrenic body exhibits
symptoms such as:
 repetitive behaviors such as
rocking and rubbing.
 catatonia, such as sitting
motionless and unresponsive for
hours.
Onset and
Development of
Schizophrenia
 Onset: Typically,
schizophrenic symptoms
appear at the end of
adolescence and in early
adulthood, later for women
than for men.
 Prevalence: Nearly 1 in 100
people develop
schizophrenia, slightly
more men than women.
 Development: The course
of schizophrenia can be
acute/reactive or chronic.
Course of
Schizophrenia
Acute/Reactive Schizophrenia
In reaction to stress, some
people develop positive
symptoms such as
hallucinations.
– Recovery is likely.
Chronic/Process Schizophrenia
develops slowly, with more
negative symptoms such as flat
affect and social withdrawal.
– With treatment and
support, there may be
periods of a normal life,
but not a cure.
– Without treatment, this
type of schizophrenia
often leads to poverty and
social problems.
Subtypes of Schizophrenia
Paranoid
• Plagued by hallucinations, often with negative
messages, and delusions, both grandiose and
persecutory
Disorganized
• Primary symptoms are flat affect, incoherent speech,
and random behavior
Catatonic
• Rarely initiating or controlling movement; copies
others’ speech and actions
Undifferentiated
• Many varied symptoms
Residual
• Withdrawal continues after positive symptoms have
disappeared
Understanding Schizophrenia
What’s going on in
the brain in
schizophrenia?
Abnormal brain
structure and
activity
 Too many dopamine/D4 receptors
help to explain paranoia and
hallucinations; it’s like taking
amphetamine overdoses all the time.
 Poor coordination of neural firing in
the frontal lobes impairs judgment
and self-control.
 The thalamus fires during
hallucinations as if real sensations
were being received.
 There is general shrinking of many
brain areas and connections between
them.
Understanding Schizophrenia
Are there biological risk factors
affecting early development?
Biological Risk Factors
Schizophrenia is somewhat more
likely to develop when one or more of
these factors is present:
 low birth weight
 maternal diabetes
 older paternal age
 famine
 oxygen deprivation during delivery
 maternal virus during mid-pregnancy
impairing brain development
Schizophrenia is more
likely to develop in
babies born:
 during and after flu
epidemics.
 in densely
populated areas.
 a few months after
flu season.
 after mothers had
the flu during the
second trimester, or
had antibodies
showing viral
infection.
 The lesson is to:
get flu shots
with early fall
pregnancies.
Understanding Schizophrenia
Are there genetic risk factors?
If so, we would see more
similar schizophrenia risk
shared between identical twins
than fraternal twins (graph
below). Do we?
Genetic Factors
If one twin has
schizophrenia, the
chance of the other
one also having it are
much greater if the
twins are identical.
Having adoptive
siblings (or parents)
with schizophrenia
does not increase the
likelihood of
developing
schizophrenia.
Understanding Schizophrenia
Genetic and Prenatal Causes
if maternal flu
 Even in identical twins, genetics do  Even
during the second
not fully predict schizophrenia.
trimester doubles the
risk of schizophrenia,
 This could be because of
this means only 2
environmental differences.
percent of these
 First difference: twins in separate
babies develop the
placentas.
disorder.
Only one of two twins has the enlarged
ventricles seen in schizophrenia.
 Genetics may
differentiate these 2
percent.
 Research shows many
genes linked to
schizophrenia, but it
may take
environmental factors
to turn on these
genes.
Understanding Schizophrenia
Are there
psychological
causes?
SocialPsychological
Factors
 Research does not support the idea
that social or psychological factors
(such as parenting) alone can cause
schizophrenia.
 However, there may be factors such
as stress that affect the onset of
schizophrenia.
 Until we find a mechanism of
causation, all we may have is a list of
factors which correlate with
increased risk.
Predicting Schizophrenia:
Early Warning Signs
Social/psychological
factors which tend to
appear before the
onset of
schizophrenia:
 early separation from
parents
 short attention span
 disruptive OR withdrawn
behavior
 emotional unpredictability
 poor peer relations and/or
solitary play
Biological factors
which tend to appear
before the onset of
schizophrenia:
 having a mother with
severe chronic
schizophrenia
 birth complications,
including oxygen
deprivation and low
birth weight
 poor muscle
coordination
You have a patient who has been suffering
from schizophrenia. He has had the
symptoms for several years after they slowly
appeared over a period of time. In addition,
you know that one of his grandparents
suffered from similar symptoms. Your
patient seems generally withdrawn and
emotionless. In fact, he rarely moves from
his chair during the day.
Continued on next slide
Continued from previous slide
He rarely exhibits the bizarre delusions and
hallucinations. What prognosis can you give his
family?
A. The prognosis is good because the symptoms are
not very bizarre.
B. The prognosis is good because new medications
have been shown to alleviate these symptoms
completely.
C. The prognosis is poor because of the chronic nature
of the disorder.
D. The prognosis is poor because very few people with
schizophrenia ever have remissions.