Schizophrenia
Chapter 12
Schizophrenia
• Broad spectrum of cognitive and
emotional dysfunctions that include
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Hallucinations
Delusions
Disorganized speech and behavior
Inappropriate emotions
• Affects about 1 in 100
• Complete recovery is rare
• Costs in 1991 estimated at $65 billion
Early figures
• Emil Kraepelin
– Dementia praecox
– Distinguished this from manicdepressive illness by emphasizing onset
and outcome
• Eugen Bleuler
– Schizophrenia. “split mind”
– “Breaking of associative threads”
– Recognized inability to keep constant
stream of thought
• Symptoms of heterogeneous: not all
people with schizophrenia share the
same symptoms
• Psychotic: delusions or hallucinations
• Person can display psychosis without
having schizophrenia
Positive symptoms
• Active manifestations of abnormal
behavior or an excess or distortion of
normal behavior
• Delusions
– Delusions of grandeur
– Delusions of persecution
Positive symptoms…
• Hallucinations
– The experience of sensory events
without input from the environment
– Auditory hallucinations are the most
common
– Broca’s area (speech) active not
Wernicke’s area (language
comprehension)
Negative symptoms
• Absence or insufficiency of normal
behavior
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Social withdrawal
Apathy
Impoverished speech or thought
Avoliton: apathy
Alogia: poverty of speech
Negative symptoms
• Anhedonia: lack of pleasure
• Flat affect: lack of emotional
expression
Disorganized symptoms
• Rambling speech, erratic behavior,
inappropriate affect
• Disorganized speech
– Cognitive slippage
– Tangentiality
– Loose associations
Disorganized symptoms….
• Inappropriate affect
– Laughing or crying at inappropriate
times
• Disorganized behavior
– Catatonia
Subtypes of Schizophrenia
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Paranoid
Disorganized
Catatonic
Undifferentiated
residual
Paranoid Schizophrenia
• Hallucinations and delusions
• Relatively intact cognitive skills and
affect
• Generally do not have disorganized
speech
• Best prognosis
• Delusions of grandeur and
persecution
Disorganized type (hebephrenia)
• Marked disruptions in speech and
behavior
• Flat or inappropriate affect
• Delusions tend to be fragmented
• Shows up early and tends to be
chronic
Catatonic type
• Unusual motor responses and odd
mannerism
• Echolalia
• Echopraxia: relatively rare
Undifferentiated type
• “catch all” category
• Some symptoms but do not meet full
criteria for paranoid, disorganized or
catatonic types
Residual type
• At least one episode but no longer
displaying major symptoms.
• Often have residual symptoms
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Negative beliefs
Unusual or bizarre ideas
Social withdrawal
Flat affect
Other psychotic disorders
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Schizophreniformn disorder
Schizoaffective disorder
Delusional disorder
Brief psychotic disorder
Shared psychotic disorder
Schizotypal personality disorder
Developmental research
• Early brain damage?
• Brain plasticity
– Compensation in early life more
difficult as person gets older
Genetic influence
• More severe the parent’s schizophrenia
greater likelihood child will develop
schizophrenia
• Genetic relatedness increases chances
• Monozygotic twins: 48%
• Fraternal: 17%
• Genes predispose person to schizophrenia
• Smooth movement eye tracking: genetic
marker?
Neurological considerations
• Dopamine
• Excess can cause psychotic
symptoms
• Antipsychotic drugs block dopamine
receptors
• Negative effects of drugs similar to
Parkinson's disease
Neurological considerations..
dopamine
• BUT
• Many with schizophrenia not helped
by dopamine antagonists
• Dopamine blocked quickly, but
symptoms remit long after
• More likely a dopamine/serotonin
interaction
• Virus?
Neurological damage…..
• Positive symptoms: dopamine?
• Negative symptoms: enlarged
ventricles?
• Can have these abnormalities w/o
schizophrenia
• Less activity in frontal lobes,
particularly dopamine pathway
• Finger tip ridge count: in 1/3 of of
discordant twins
Psychological and social influences
• Extreme stress can produce psychotic
symptoms
• May activate predisposition
• Family interactions:
– Schizophrenogenic mother and double
bind largely discounted
– Expressed emotion related to relapse
• Criticism, hostility and emotional overinvolvement
Treatment
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Institutionalization
Prefrontal lobotomy
ECT
Insulin therapy
Neuroleptic drugs
– Conventional drugs : unpleasant side
effects
• Atypical antipsychotics
New treatment?
• Transcranial magnetic stimulation
Psychosocial interventions
• Behavioral approaches
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Socialization
Self-care
Appropriate emotional responses
Token economies
Independent living skills
Behavioral family therapy
Vocational rehabilitation
Cultural factors
• Differences in family support
(Hispanics)
• China: meds and hospitalization
• Africa: prisons
prevention
• Genetic markers
• Early intervention