1 Schizophrenia Module 39

2 Psychological Disorders Schizophrenia overview  Symptoms of Schizophrenia  Onset and Development of Schizophrenia  Understanding Schizophrenia

3 Schizophrenia The literal translation is “split mind” which refers to a split from reality. A group of severe disorders characterized by the following: 1.Disorganized and delusional thinking. 2.Disturbed perceptions. 3.Inappropriate emotions and actions. LinkLink 58:42

4 Symptoms of Schizophrenia Positive symptoms: the presence of inappropriate behaviors (hallucinations, disorganized or delusional talking) Negative symptoms: the absence of appropriate behaviors (expressionless faces, rigid bodies) Schizophrenia vid: Schizophrenics 9:23

5 Other forms of delusions include, delusions of persecution (“someone is following me”) or grandeur (“I am a king”). 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.” (Sheehan, 1982) This monologue illustrates fragmented, bizarre thinking with distorted beliefs called delusions (“I’m Mary Poppins”). Link GeraldLink Gerald 8:12 Part 2Part 2 7:11 Female Schizophrenic

6 3 Jesuses walk into a bar… …this is not a joke. I must not be Jesus You guys are crazy, I am Jesus Huh?

The proverb test Proverbs like "birds of a feather flock together" or "a rolling stone gathers no moss" will be explained in a literal fashion by a schizophrenic i.e. a stone that is rolling can't get moss on it because it's moving. 7

8 Disorganized & Delusional Thinking Many psychologists believe disorganized thoughts occur because of selective attention failure (fragmented and bizarre thoughts).

Great book about a girl whose friend “turns schizophrenic” while they are backpacking in China. 9

10 Disturbed Perceptions A schizophrenic person may perceive things that are not there (hallucinations). Most such hallucinations are auditory and lesser visual, somatosensory, olfactory, or gustatory. L. Berthold, Untitled. The Prinzhorn Collection, University of Heidelberg August Natter, Witches Head. The Prinzhorn Collection, University of Heidelberg Photos of paintings by Krannert Museum, University of Illinois at Urbana-Champaign

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12 …schizophrenics can tickle themselves because of a problem with their timing that does not allow their motor actions and resulting sensations to be correctly sequenced.

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16 A 20th-century artist, Louis Wain, who was fascinated by cats, painted these pictures over a period of time in which he developed schizophrenia. The pictures mark progressive stages in the illness and exemplify what it does to the victim's perception.

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19 Inappropriate Emotions & Actions A schizophrenic person may laugh at the news of someone dying or show no emotion at all (flat affect). Patients with schizophrenia may continually rub an arm, rock a chair, or remain motionless for hours (catatonia). Childhood schizophrenia at 20/20Childhood schizophrenia at 20/20 9:18

20 Onset and Development of Schizophrenia Nearly 1 in a 100 suffer from schizophrenia, and throughout the world over 24 million people suffer from this disease (WHO, 2002). Schizophrenia strikes young people as they mature into adults. It affects men and women, but men suffer from it more severely than women.

Schizophrenia: Course Group 3 30% have repeated episodes of illness with some impairment between episodes Group 2 25% have repeated episodes of illness with no impairment between episodes Group 1 15% have only a single episode of illness with no subsequent impairment Group 4 30% have repeated episodes of illness with gradually declining impairment between episodes

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23 Chronic and Acute Schizophrenia When schizophrenia is slow to develop (chronic/process) recovery is doubtful. Such schizophrenics usually display negative symptoms. When schizophrenia rapidly develops (acute/reactive) recovery is better. Such schizophrenics usually show positive symptoms.

24 Understanding Schizophrenia Schizophrenia is a disease of the brain exhibited by the symptoms of the mind. Dopamine Overactivity: Researchers found that schizophrenic patients express higher levels of dopamine D4 receptors in the brain. Drugs that block these sites help schizophrenic patients. Brain Abnormalities

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26 Antipsychotic Drugs Generic NameTrade NameComments AripiprazoleAbilify New antipsychotic medication that may work on dopamine and serotonin systems. ChlorpromazineThorazineThe first antipsychotic medication developed ChlorprothixeneTaractan ClozapineClozaril Does not have "tardive dyskinesia" (see below, side effects) as a side effect, but there is a 1-2% chance of developing a low white blood cell count FluphenazineProlixinA phenothiazine type drug HaloperidolHaldol LoxapineLoxantaneNOT a phenothiazine type drug MesoridazineSerentil MolindoneMoban OlanzapineZyprexaBlocks serotonin and dopamine receptors PerphenazineTrilafon QuetiapineSeroquelBlocks some serotonin and dopamine receptors; Introduced in 1997 RisperidoneRisperdalBlocks some serotonin and dopamine receptors ThioridazineMellarilAlso used as a tranquilizer ThiothixeneNavane TrifluoperazineStelazineAlso used to control anxiety and nausea

27 Abnormal Brain Activity Brain scans show abnormal activity in the frontal cortex, thalamus, and amygdala of schizophrenic patients. Paul Thompson and Arthur W. Toga, UCLA Laboratory of Neuro Imaging and Judith L. Rapport, National Institute of Mental Health

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31 Abnormal Brain Morphology Schizophrenia patients may exhibit morphological changes in the brain like enlargement of fluid-filled ventricles. Both Photos: Courtesy of Daniel R. Weinberger, M.D., NIH-NIMH/ NSC

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33 Viral Infection Schizophrenia has also been observed in individuals whose mothers contracted a viral infection (flu) during the middle of their fetal development.

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35 Genetic Factors The likelihood of an individual suffering from schizophrenia is 50% if their identical twin has the disease (Gottesman, 2001) Identical Both parents Fraternal One parent Sibling Nephew or niece Unrelated

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37 Genetic Factors The following shows the prevalence of schizophrenia in identical twins as seen in different countries.

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41 Psychological Factors Psychological and environmental factors can trigger schizophrenia if the individual is genetically predisposed (Nicol & Gottesman, 1983). Genain Sisters The genetically identical Genain sisters suffer from schizophrenia. Courtesy of Genain Family

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