Schizophrenia
A Closer Look at Psychological
Disorders
Schizophrenia

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?

Schizophrenia is not one disorder.

It is a family of related disorders
involving:
 Disorganized and delusional thinking
 Disturbed perceptions
 Inappropriate emotions or behaviors.
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 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 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 Thinking
This 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 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.)


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
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.)

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.)

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: Recap
Symptoms of
Schizophrenia
Delusions
Hallucinations
Inappropriate
Emotion
Inappropriate
Behavior
Watch Janssen’s MINDSTORM: http://www.youtube.com/watch?v=LWYwckFrksg
Louis 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 art

Wain’s pre-schizophrenic period featured cats dressed in
human clothes or engaged in human activity:
Louis 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 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 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 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
Schizophrenia


John Nash (A
Beautiful
Mind)
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.
Criticisms of the Current Classification
System 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:
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.
 Positive
Examples of People Diagnosed with
Schizophrenia
ABC 20/20 – Part 1
(http://www.youtube.com/watch?v=74vTftboC_A )
ABC 20/20 – Part 2
(http://www.youtube.com/watch?v=YXimT5CHCDE)
Etiology of
Schizophrenia
Possible Causes
Once again… a bit nature, a bit
nurture!

Psychological and environmental factors can
trigger schizophrenia if the individual is
genetically predisposed (Nicol & Gottesman,
1983).
Courtesy of Genain Family
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.
Biological 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 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.
Biological Explanations – The Brain
Schizophrenia patients may exhibit
morphological changes in the brain
like enlargement of fluid-filled
ventricles (15% larger).
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.
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 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 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.