1. Copyright © 2007 by The McGraw-Hill Companies, Inc. All rights reserved. Schizophrenia

2. Copyright © 2007 by The McGraw-Hill Companies, Inc. All rights reserved. Chapter 11 A beautiful mind 1 st half of movie Interview with John Nash and his family

3. Copyright © 2007 by The McGraw-Hill Companies, Inc. All rights reserved. Chapter 11 DSM-IV Criteria for Schizophrenia A. Two or more core symptoms (next slide) B. Significant impairment in work, academic performance, interpersonal relationships, and/or self-care C. Continuous signs of the disturbance for at least 6 months

4. Copyright © 2007 by The McGraw-Hill Companies, Inc. All rights reserved. Chapter 11 Core Symptoms (Positive) 1. Delusions -- 1. Persecutory 2. Delusions of Reference 3. Grandiose Delusions 4. Delusions of Thought Insertion 2. Hallucinations 3. Disorganized Thought and Speech 4. Disorganized or Catatonic Behavior

5. Copyright © 2007 by The McGraw-Hill Companies, Inc. All rights reserved. Chapter 11 Core symptoms (negative) 5. Negative Symptoms – Affective Flattening (or Blunted Affect) –Alogia: Severe reduction or complete absence of speech –Avolition: Inability to persist at common, goal- oriented tasks Video clips to demonstrate some of these symptoms

6. Copyright © 2007 by The McGraw-Hill Companies, Inc. All rights reserved. Chapter 11 Biological Aspects of Schizophrenia OVERVIEW Neuroanatomy -- brain changes / tissue loss Genetics Viral theories Neurotransmitters

7. Copyright © 2007 by The McGraw-Hill Companies, Inc. All rights reserved. Chapter 11 Biological Aspects of Schizophrenia Secret Life of the Brain (episode 3) Loss of brain tissue (NYTimes video clip)

8. Copyright © 2007 by The McGraw-Hill Companies, Inc. All rights reserved. Chapter 11 Biological Aspects of Schizophrenia Structural Brain Abnormalities (tissue loss – excessive pruning) – Parietal cortex deficits (sensory experience) – Frontal lobe deficits: Reduced volume and neuron density in frontal cortex cause cognitive and emotional deficits (perhaps especially negative symptoms) – Loss of myelin sheath?

9. Copyright © 2007 by The McGraw-Hill Companies, Inc. All rights reserved. Chapter 11 Biological Aspects of Schizophrenia, continued Genetic Theories – Polygenetic influence – May be inheriting a general risk for psychosis – Epigenetics – environment + gene interaction (e.g., Finnish study of children adopted away at birth; Tienari et al., 2004): “Disordered” home environment increases risk

10. Copyright © 2007 by The McGraw-Hill Companies, Inc. All rights reserved. Chapter 11 Biological Aspects of Schizophrenia, continued Birth Complications & Prenatal Viral Exposure – Podcast from “All in the mind” 11/2/07 on viruses and immune system (4’’ – 14.30’’) Neurotransmitter Theories – Imbalances in levels of or receptors for dopamine cause symptoms; serotonin, GABA, and glutamate may also play roles

11. Copyright © 2007 by The McGraw-Hill Companies, Inc. All rights reserved. Chapter 11 Psychosocial Perspectives on Schizophrenia Social drift Stress and relapse

12. Copyright © 2007 by The McGraw-Hill Companies, Inc. All rights reserved. Chapter 11 Treatments for Schizophrenia Biological Treatments: Antipsychotic drugs (next slide)

13. Copyright © 2007 by The McGraw-Hill Companies, Inc. All rights reserved. Chapter 11  Most are dopamine receptor antagonists  Older neuroleptics: Haldol & Thorazine  Newer (“atypical”): Clozaril, Seroquel, Risperdal, Zyprexa  Somewhat of Trial and Error approach  Most are dopamine receptor antagonists  Older neuroleptics: Haldol & Thorazine  Newer (“atypical”): Clozaril, Seroquel, Risperdal, Zyprexa  Somewhat of Trial and Error approach  Antipsychotics

14. Copyright © 2007 by The McGraw-Hill Companies, Inc. All rights reserved. Chapter 11  Side Effects: Neuroleptics and Atypicals can cause  Sedation, weight gain  “Extrapyramidal” (Parkinsonian) side effects, like tremor, akinesia (e.g., shuffling of feet)  Tardive Dyskinesia (long-term, irreversible -- irregular/involuntary muscle movements)  Anticholinergic (dry mouth/eyes, blurred vision, etc.)  Orthostatic hypotension  Side Effects: Neuroleptics and Atypicals can cause  Sedation, weight gain  “Extrapyramidal” (Parkinsonian) side effects, like tremor, akinesia (e.g., shuffling of feet)  Tardive Dyskinesia (long-term, irreversible -- irregular/involuntary muscle movements)  Anticholinergic (dry mouth/eyes, blurred vision, etc.)  Orthostatic hypotension Side Effects

15. Copyright © 2007 by The McGraw-Hill Companies, Inc. All rights reserved. Chapter 11 Treatments for Schizophrenia Behavioral, Cognitive, and Social Interventions: Recognition of demoralizing attitudes they may have toward their illness, operant conditioning, modeling, family therapy, token economies, self-help groups, assertive community treatment programs.