1. Psychopathology and the Brain

2. Schizophrenia Comes from Greek words meaning “split” and “mind” Comes from Greek words meaning “split” and “mind” People with schizophrenia do NOT have split personalities People with schizophrenia do NOT have split personalities “split mind” refers to the fact that people with schizophrenia are split off from reality and can’t distinguish what is real from what is not real “split mind” refers to the fact that people with schizophrenia are split off from reality and can’t distinguish what is real from what is not real

3. Demographics One of the most common mental illnesses One of the most common mental illnesses Affects 1 % of the population Affects 1 % of the population Men show first signs in early 20’s while women in late 20’s Men show first signs in early 20’s while women in late 20’s US spends $32.5 billion per year US spends $32.5 billion per year

4. Symptoms “psychosis” – psychotic element; state in which people cannot tell what is real and what is not “psychosis” – psychotic element; state in which people cannot tell what is real and what is not Delusions – bizarre, false beliefs; paranoia, grandiosity Delusions – bizarre, false beliefs; paranoia, grandiosity Hallucinations – unreal perceptions of environment; auditory, visual, olfactory, tactile Hallucinations – unreal perceptions of environment; auditory, visual, olfactory, tactile

5. More Symptoms Disorganized Thinking/Speech Disorganized Thinking/Speech Negative Symptoms – the absence of normal behavior Negative Symptoms – the absence of normal behavior Catatonia – immobility and “waxy flexibility” Catatonia – immobility and “waxy flexibility”

6. Types of Schizophrenia Disorganized Schizophrenia Disorganized Schizophrenia Catatonic Schizophrenia Catatonic Schizophrenia Paranoid Schizophrenia Paranoid Schizophrenia

7. Brain and Schizophrenia Larger than normal lateral ventricles – part of the ventricular system; contain cerebrospinal fluid Larger than normal lateral ventricles – part of the ventricular system; contain cerebrospinal fluid

8. Causes of Schizophrenia: Genetics Twin studies have shown that tendency for both monozygotic twins to develop schizophrenia is between 30 to 50%; the tendency for dizygotic twins and siblings to develop schizophrenia is 15% Twin studies have shown that tendency for both monozygotic twins to develop schizophrenia is between 30 to 50%; the tendency for dizygotic twins and siblings to develop schizophrenia is 15% Adoption Studies – 13% of biological relatives of adoptees with schizophrenia had the disease, but only 2% of biological relatives of normal adoptees had schizophrenia Adoption Studies – 13% of biological relatives of adoptees with schizophrenia had the disease, but only 2% of biological relatives of normal adoptees had schizophrenia

9. Causes of Schizophrenia: Environment Family Stress Family Stress Poor social interactions Poor social interactions Infections or viruses at an early age Infections or viruses at an early age Trauma at an early age Trauma at an early age Genetic makeup combines with non- genetic factors to cause schizophrenia Genetic makeup combines with non- genetic factors to cause schizophrenia

10. Causes of Schizophrenia: Neurotransmitters Dopamine Theory – schizophrenia caused by an overactive dopamine system in the brain; dopamine is a neurotransmitter that allows nerve cells in the brain to send messages to each other; dopamine imbalance may affect the way a person’s brain can react to stimuli Dopamine Theory – schizophrenia caused by an overactive dopamine system in the brain; dopamine is a neurotransmitter that allows nerve cells in the brain to send messages to each other; dopamine imbalance may affect the way a person’s brain can react to stimuli Many drugs for schizophrenia block dopamine receptors Many drugs for schizophrenia block dopamine receptors

11. Schizophrenia: Medication Antipsychotic medications – drugs do not cure disease, but reduce symptoms Antipsychotic medications – drugs do not cure disease, but reduce symptoms Some drugs have Parkinson’s Disease- like side effects Some drugs have Parkinson’s Disease- like side effects Counseling also helps Counseling also helps

12. Bipolar Disorder Characterized by changes in mood, behavior, and energy levels Characterized by changes in mood, behavior, and energy levels Affects approximately 1.2% of the population Affects approximately 1.2% of the population First episode often occurs in adolescence and can be triggered by a traumatic event; some people are symptom-free in between episodes First episode often occurs in adolescence and can be triggered by a traumatic event; some people are symptom-free in between episodes

13. Symptoms: Mania phase Abnormally elevated mood Abnormally elevated mood Inflated self-esteem Inflated self-esteem Reduced need for sleep Reduced need for sleep Excessive talkativeness Excessive talkativeness Racing thoughts Racing thoughts Distractibility Distractibility Activities done to excess Activities done to excess Pursuit of risky behavior or activities Pursuit of risky behavior or activities

14. Symptoms: Depression Phase Mania can quickly and without warning change to depression/sadness Mania can quickly and without warning change to depression/sadness Loss of interest Loss of interest Changes in appetite – weight gain/loss Changes in appetite – weight gain/loss Changes in sleep patterns Changes in sleep patterns Agitation Agitation Loss of energy Loss of energy Trouble concentrating/thinking Trouble concentrating/thinking Repeated thoughts of suicide/death Repeated thoughts of suicide/death

15. Accompanying Symptoms Psychosis Psychosis Delusions Delusions

16. Bipolar Disorder and the Brain Examination of brain tissue after people with BD have died Examination of brain tissue after people with BD have died Brain imaging Brain imaging New theory – mitochondrial malfunction New theory – mitochondrial malfunction Mitochondria – vital organelle for energy production Mitochondria – vital organelle for energy production 2000 – Kato, University of Tokyo – based on abnormal brain energy metabolism in bipolar patients measured by brain scans and mitochondrial depletion in autopsied bipolar brains; searched for mutant mitochondrial DNA – two suspect genes 2000 – Kato, University of Tokyo – based on abnormal brain energy metabolism in bipolar patients measured by brain scans and mitochondrial depletion in autopsied bipolar brains; searched for mutant mitochondrial DNA – two suspect genes March 2004, Archives of General Psychiatry, Christine Konradi - Harvard and McLean Hospital - studied brain tissue in hippocampus and found expression of genes that coded for mitochondrial proteins in bipolar patients decreased March 2004, Archives of General Psychiatry, Christine Konradi - Harvard and McLean Hospital - studied brain tissue in hippocampus and found expression of genes that coded for mitochondrial proteins in bipolar patients decreased

17. Famous People with BD Abraham Lincoln and Theodore Roosevelt Abraham Lincoln and Theodore Roosevelt George Handel, Robert Schumann, Ludwig van Beethoven George Handel, Robert Schumann, Ludwig van Beethoven Leo Tolstoy, Virginia Woolf, Ernest Hemingway, Charles Dickens Leo Tolstoy, Virginia Woolf, Ernest Hemingway, Charles Dickens Sir Isaac Newton Sir Isaac Newton Patty Duke, Linda Hamilton, Jean- Claude van Damme Patty Duke, Linda Hamilton, Jean- Claude van Damme

18. Multiple Personality Disorder Presence of two or more distinct identities, each with its own unique, and enduring way of relating to the world or self Presence of two or more distinct identities, each with its own unique, and enduring way of relating to the world or self At least two of these identities recurrently take control of the person’s behavior At least two of these identities recurrently take control of the person’s behavior An inability to recall important personal information to an extent that is more than ordinary forgetfulness An inability to recall important personal information to an extent that is more than ordinary forgetfulness

19. History of MPD Virtually unknown 30 years ago – became more common about 10 years ago Virtually unknown 30 years ago – became more common about 10 years ago Why? Why? W. S. Taylor and Mabel Martin in 1944 – fewer than 100 documented cases W. S. Taylor and Mabel Martin in 1944 – fewer than 100 documented cases 1985 to 1995 – abuot 40,000 new cases 1985 to 1995 – abuot 40,000 new cases

20. Why More Common? previously not diagnosed previously not diagnosed does mind choose pathology from options presented by culture? does mind choose pathology from options presented by culture? was called something different in the past – came in form of dead relative possession in 19 th century European culture was called something different in the past – came in form of dead relative possession in 19 th century European culture

21. Causes Childhood trauma – usually sexual abuse before age 5 Childhood trauma – usually sexual abuse before age 5 Experts believe alter arises to protect person from overwhelming memories and protect secrets from outsiders Experts believe alter arises to protect person from overwhelming memories and protect secrets from outsiders

22. Case Study: Eve Thigpen and Cleckley, 1953 Thigpen and Cleckley, 1953 Rooted from traumatic events witnessed growing up in South during Depression Rooted from traumatic events witnessed growing up in South during Depression Eve White – wife and mother; Eve Black – party girl; Jane – mature intellectual Eve White – wife and mother; Eve Black – party girl; Jane – mature intellectual Total of 22 personalities Total of 22 personalities

23. Case Study: Sybil True name – Shirley Mason True name – Shirley Mason Set the standard for MPD as a syndrome rooted in child abuse Set the standard for MPD as a syndrome rooted in child abuse 16 separate personalities all having unique talents and characteristics, such as piano playing or having British accent; some were male 16 separate personalities all having unique talents and characteristics, such as piano playing or having British accent; some were male Dr. Wilbur – Freudian psychologist Dr. Wilbur – Freudian psychologist 1998 – several publications exposed Sybil case as scam 1998 – several publications exposed Sybil case as scam Dr. Herbert Spiegel - only multiple personality in psychoanalytic setting; just extremely suggestible hysteric Dr. Herbert Spiegel - only multiple personality in psychoanalytic setting; just extremely suggestible hysteric To ensure the book deal, Sybil had to be multiple; Dr. Wilbur’s archives will be opened in 2005… To ensure the book deal, Sybil had to be multiple; Dr. Wilbur’s archives will be opened in 2005…

24. MPD in Court Billy Mulligan – accused of robberies and rapes at OSU; by the time faced trial, 10 of 23 personalities surfaced; one with British accent, one could write fluent in Arabic, one was 16, one was 8… Billy Mulligan – accused of robberies and rapes at OSU; by the time faced trial, 10 of 23 personalities surfaced; one with British accent, one could write fluent in Arabic, one was 16, one was 8… Juanita Maxwell – bludgeoned elderly woman to death with a lamp but had no memory of crime; went to trial and violent alter came out Juanita Maxwell – bludgeoned elderly woman to death with a lamp but had no memory of crime; went to trial and violent alter came out Critics say that vast majority of patients misdiagnosed, faked, or unconsciously created by clinician who makes diagnosis Critics say that vast majority of patients misdiagnosed, faked, or unconsciously created by clinician who makes diagnosis Problem: when evidence overwhelming against defendant, only way attorney can mitigate sentence is insanity defense Problem: when evidence overwhelming against defendant, only way attorney can mitigate sentence is insanity defense Often very hard to identify whether truly have disorder Often very hard to identify whether truly have disorder

25. Resources http://www.mcmanweb.com http://www.mcmanweb.com http://www.mcmanweb.com http://www.crimelibrary.com/criminal_ mind/psychology/multiples http://www.crimelibrary.com/criminal_ mind/psychology/multiples http://www.crimelibrary.com/criminal_ mind/psychology/multiples http://www.crimelibrary.com/criminal_ mind/psychology/multiples http://faculty.washington.edu/chudler/ neurok.html http://faculty.washington.edu/chudler/ neurok.html http://faculty.washington.edu/chudler/ neurok.html http://faculty.washington.edu/chudler/ neurok.html