LESSON 1 A Brief Overview of Schizophrenia Southern Consortium A2 Psychology at Sydney Russell A. Lewis

Defining Schizophrenia Schizophrenia (formerly known as dementia praecox) is a severely debilitating neuro- psychiatric disorder that primarily includes disturbances of thought and behaviour, auditory hallucinations and multiple delusions. A2 Psychology: Schizophrenia

Defining Schizophrenia Science has been considering schizophrenia for over 100 years and there is still no clear aetiology for the disorder. Schizophrenia is best described as a clinical syndrome because its diagnosis requires the presence of a certain combination of symptoms. A2 Psychology: Schizophrenia

Defining Schizophrenia The diagnosis of schizophrenia is usually made with the help of a longitudinal view of the patient i.e. the form of the illness is as important as the content of the illness in making a diagnosis. A2 Psychology: Schizophrenia Louis Wain 1860-l939

Defining Schizophrenia The boundaries of schizophrenia are imprecise so it is essential to understand and recognise the degenerative and developmental symptoms of schizophrenia in order to define it correctly. A2 Psychology: Schizophrenia

Defining Schizophrenia Living with a psychotic illness and long-term mental health condition, people with schizophrenia may have an accurate view of reality and function well in daily life, and then at other times, lose touch with reality and become unable to care for themselves in the most basic ways. A2 Psychology: Schizophrenia

Classification of Schizophrenia Disorganised Schizophrenia: - Thought disturbances - Absence of expressed emotion - Loss of interest in life - Not goal directed A2 Psychology: Schizophrenia Interviewer: ‘How have you been feeling today?’ Patient: ‘Well, in myself I have been okay what with the prices in the shops being what they are and my flat is just round the corner. I keep a watch for the arbiters most of the time since it is just round the corner. There is not all that much to do otherwise.’

Classification of Schizophrenia Catatonic Schizophrenia: - Severe motor abnormalities - Unusual gestures of the body - Gesture repeatedly - Complex movements - Movements have meaning to patient A2 Psychology: Schizophrenia

Classification of Schizophrenia Paranoid Schizophrenia: - Delusional symptoms - More alert and verbal - Patient remains emotionally responsive Undifferentiated Schizophrenia - Shows signs of schizophrenia, but doesn’t fit into the above categories A2 Psychology: Schizophrenia

Symptoms of Schizophrenia Positive: - An addition of something - Rare in normal everyday experiences Negative: - Something taken away - Less dramatic Secondary: - Consequence of the disorder A2 Psychology: Schizophrenia

Positive Symptoms Hallucinations: - Hearing voices - Can hear own thinking - Thoughts are loud, others might hear – Thought Broadcasting. A2 Psychology: Schizophrenia

Positive Symptoms Delusions: - Unusual beliefs, without any supporting evidence - Believe that others are trying to harm them - Special meanings in ordinary events - Grandiose Delusions – exaggerated sense of power, knowledge and identity. A2 Psychology: Schizophrenia

Positive Symptoms Thought Disturbances: - Confused - Jump between topics - Lack of concentration - Can’t remember their thoughts A2 Psychology: Schizophrenia

Disorganised Thoughts – Heather A2 Psychology: Schizophrenia

Negative Symptoms - Lack of energy - Less dramatic - Loss of interest in life - May stop showing emotion, appear lifeless - Speak in flat toneless voice – flat effect - Tend to last longer than positive symptoms A2 Psychology: Schizophrenia

Secondary Symptoms - Consequences of having the disorder - Break down of relationships - Loss of employment - Depression A2 Psychology: Schizophrenia

Many Symptoms – Gerald A2 Psychology: Schizophrenia

Prevalence Rate Approximately 1.1% of the population over age 18. As many as 51 million people worldwide suffer from schizophrenia. A2 Psychology: Schizophrenia

Age of Onset Schizophrenia is a disease that typically begins in early adulthood; between the ages of 15 and 25. The average age of onset is 18 in men and 25 in women. Schizophrenia onset is quite rare for those under 10, or over 40. A2 Psychology: Schizophrenia

Onset & Impact – Gerald pt. 2 A2 Psychology: Schizophrenia

Case Study Jane was seen by a consultant on a domiciliary visit to the vicarage of St. Mary's church. Her father, the vicar, explained that Jane was a sixth form pupil at a local private school. She had always done well at school and had achieved high grades in her fifth form exams. She was hoping to go to University. Over the last few months though, her behaviour had changed. She had started refusing to go to school, but had declined to give any reason why. She spent her days writing in her room, and had not eaten for the last three days. She would not let her parents in to see her and had barricaded the door. There was no history of drug abuse. The consultant talked to her through the door, and finally persuaded her to trust him sufficiently to let him in to her room. He found that Jane was a tall, thin girl with a pale face. The room smelt of urine, and the walls had been covered in a fine, spidery writing. When the consultant tried to read what it said, she shouted at him. Jane looked at him suspiciously and, at times seemed to be conferring with an unseen person as to how trustworthy the doctor was. The doctor could see scratch marks on her neck where Jane had cut herself with the blade of a pair of scissors. She said that this was 'to let the bad blood out'. Jane appeared alert and knew the day and the time. When asked about her refusal to eat, Jane mumbled about her parents trying to poison her, because, she said, ' my mother offered me an Arrowroot Thin biscuit...that would make me thin...and she offered me some cabbage...that would turn me into a cabbage.' The doctor felt that Jane's health was at risk because she had been harming and starving herself, and that there was evidence of a mental disorder which warranted admission to hospital for further assessment. What are the diagnostic features of schizophrenia in this case? Why does schizophrenia often appear to begin in adolescence? A2 Psychology: Schizophrenia

Summary Defining Schizophrenia neuro-psychiatric disorder disturbances of thought and behaviour, auditory hallucinations and multiple delusions its diagnosis requires the presence of a certain combination of symptoms a longitudinal view of the patient positive, negative, and secondary symptoms A2 Psychology: Schizophrenia

Overview (Preview) Early Theories of Schizophrenia The views of Schizophrenia from the 1970s are erroneous and somewhat damaging, e.g. that inpatient facilities are not required or that schizophrenia does not exist (sociological phenomenon) or even that schizophrenia is attributable to parental malpractice (sometimes referred to as the double bind hypothesis). Bateson and Double Bind Hypothesis (receiving conflicting messages from care-giver) A2 Psychology: Schizophrenia

Lesson Plan for Current Revision LESSON 2 Biological explanations of causes of Schizophrenia, to include: – Genetic explanations (family studies and adoption studies) – Bio chemistry explanations (Dopamine hypothesis) – Evolutionary explanations LESSON 3 Biological therapies – Drug treatments – Other treatments LESSON 4 Contextual views of Schizophrenia – Over-arching knowledge regarding research methods – Review of major theories of aetiology – Evaluative view of causes and/or treatments A2 Psychology: Schizophrenia