If depression is the common cold of psychological disorders, schizophrenia is

the cancer.

SCHIZOPHRENIA

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Nearly 1 in a 100 suffer from schizophrenia.

Schizophrenia strikes young people as they mature into adults. It affects men

and women equally, but men suffer from it more severely than women.

The literal translation is “split mind.” A group of severe disorders characterized by

the following:

SYMPTOMS OF SCHIZOPHRENIA

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1. Disorganized and delusional thinking.

2. Disturbed perceptions. 3. Inappropriate emotions

and actions.

DISORGANIZED & DELUSIONAL THINKING

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Other forms of delusions include, delusions of persecution (“someone is following me”) or grandeur (“I am a

king”).

This morning when I was at Hillside [Hospital], I was making a movie. I was surrounded by movie stars … I’m Marry 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”).

Many psychologists believe disorganized thoughts occur because of selective attention failure (fragmented and

bizarre thoughts).

DISORGANIZED & DELUSIONAL THINKING

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DISTURBED PERCEPTIONS

A schizophrenic person may perceive things that are not there

(hallucinations). Frequently such hallucinations are auditory and lesser

visual, somatosensory, olfactory, or gustatory.

5

L. B

erthold, Untitled. T

he Prinzhorn Collection, U

niversity of Heidelberg

August N

atter, Witches H

ead. The Prinzhorn C

ollection, University of H

eidelberg

Photos of paintings by K

rannert Museum

, University of Illinois at U

rbana-Cham

paign

INAPPROPRIATE EMOTIONS & ACTIONS

A schizophrenic person may laugh at the news of someone dying or show no

emotion at all (apathy).

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Patients with schizophrenia may continually rub an arm, rock a chair, or remain motionless for hours (catatonia).

Schizophrenia is a cluster of disorders. These subtypes share some features, but

there are other symptoms that differentiate these subtypes.

SUBTYPES OF SCHIZOPHRENIA

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Schizophrenics have inappropriate symptoms (hallucinations, disorganized

thinking, deluded ways) that are not present in normal individuals (positive

symptoms).

POSITIVE AND NEGATIVE SYMPTOMS

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Schizophrenics also have an absence of appropriate symptoms (apathy,

expressionless faces, rigid bodies) that are present in normal individuals

(negative symptoms).

When schizophrenia is slow to develop (chronic/process) recovery is doubtful.

Such schizophrenics usually display negative symptoms.

CHRONIC AND ACUTE SCHIZOPHRENIA

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When schizophrenia rapidly develops (acute/reactive) recovery is better. Such

schizophrenics usually show positive symptoms.

EFFECTS OF SCHIZOPHRENIA

Disrupt social relationshipsMakes it difficult to hold a job

Often live in a private inner worldWith support, some may recover to enjoy a normal life or only experience bouts of

schizophrenia intermittently

TYPES OF SCHIZOPHRENIA

ParanoidDisorganized

CatatonicUndifferentiated

Share some common featuresAlso have some distinguishing symptoms

(see textbook)

SUBTYPES

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Schizophrenia is a disease of the brain exhibited by the symptoms of the mind.

UNDERSTANDING SCHIZOPHRENIA

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Dopamine Overactivity: Researchers found that schizophrenic patients express higher levels of dopamine D4 receptors in

the brain.

Brain Abnormalities

WHAT CAUSES SCHIZOPHRENI

A?

CAUSES: BRAIN ABNORMALITY

Excess of receptors for dopamine

May intensify brain signals, which would create the positive symptoms of hallucinations and paranoia

Drugs that block dopamine receptors often lessen positive symptoms

Drugs that increase dopamine activity (amphetamines and cocaine) can intensify them

But dopamine is also linked to Parkinson’s disease, so patients who take drugs to block dopamine develop Parkinson’s like

symptoms Dopamine blocking drugs have little effect on negative

symptoms Investigating the role of glutamate (excitatory

neurotransmitter)

Drugs that interfere with glutamate receptors can produce schizophrenia-like negative symptoms

CAUSE: BRAIN CONT.

People with schizophrenia have abnormal brain activity in several areas

NOT one isolated area

Low brain activity in frontal lobes

PET scans during hallucinations showed activity in the thalamus

Temporal lobe is activated during auditory hallucinations

People with paranoia showed increased activity in the amygdala

Brain size

Enlarged, fluid-filled areas in brains of patients

Smaller cerebral cortex

Smaller thalamus

Can show these BEFORE onset!

What causes these abnormalities? Famine during pregnancy

ABNORMAL BRAIN MORPHOLOGY

Schizophrenia patients may exhibit morphological changes in the brain like

enlargement of fluid-filled ventricles.

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Both Photos: C

ourtesy of Daniel R

. Weinberger, M

.D., N

IH-N

IMH

/ NSC

ABNORMAL BRAIN ACTIVITY

Brain scans show abnormal activity in the frontal cortex, thalamus, and

amygdala of schizophrenic patients. Adolescent schizophrenic patients also

have brain lesions.

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Paul T

hompson and A

rthur W. Toga, U

CL

A L

aboratory of Neuro

Imaging and Judith L

. Rapport, N

ational Institute of Mental H

ealth

GENETIC FACTORS

If your parent or siblings have schizophrenia, your odds of developing it are 1 in 10

If your identical twin has it, your odds are 1 in 2 (even when reared apart)

Those who share a placenta have an increased risk

Children adopted by someone who develops schizophrenia, seldom “catch” the disorder

Genes could affect dopamine levels or production of myelinIdentifying specific genes is difficult

Other factors (viruses, oxygen deprivation at birth, etc) may “turn off” or “turn on” the genes that predispose people to

the disease

GENETIC FACTORS

The likelihood of an individual suffering from schizophrenia is 50% if their

identical twin has the disease (Gottesman, 1991).

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0 10 20 30 40 50Identical

Both parents

Fraternal

One parent

Sibling

Nephew or niece

Unrelated

GENETIC FACTORS

The following shows the prevalence of schizophrenia in identical twins as seen

in different countries.

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PSYCHOLOGICAL FACTORS

Psychological and environmental factors can trigger schizophrenia if the

individual is genetically predisposed (Nicols & Gottesman, 1983).

22Genain Sisters

The genetically identical Genain

sisters suffer from schizophrenia. Two more

than others, thus there are contributing environmental

factors.

Courtesy of G

enain Fam

ily

PSYCHOLOGICAL FACTORS

“No environmental causes have been discovered that will invariably, or even

with moderate probability, produce schizophrenia in persons who are not

related to a person with schizophrenia”Susan Nicol and Irving Gottesman in 1983

VIRAL INFECTION

Schizophrenia has also been observed in individuals who contracted a viral

infection (flu) during the middle of their fetal development.

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EARLY WARNING SIGNS

Study of “at risk” children/young adults who had relatives with schizophrenia

A mother whose schizophrenia was severe and long lasting

Birth complications, often involving oxygen deprivation and low birth weight

Separation from parentsShort attention span and poor muscle

coordinationDisruptive or withdrawn behavior

Emotional unpredictabilityPoor peer relations and solo play

PERSONALITY DISORDERS

Personality disorders are

characterized by inflexible and

enduring behavior patterns that impair social

functioning. They are usually without

anxiety, depression, or

delusions.26

ANTISOCIAL PERSONALITY DISORDER

A disorder in which the person (usually men) exhibits a lack of conscience for

wrongdoing, even toward friends and family members. Formerly, this person was called a

sociopath or psychopath.

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UNDERSTANDING ANTISOCIAL PERSONALITY DISORDER

Like mood disorders and schizophrenia,

antisocial personality disorder has biological and

psychological reasons. Youngsters, before committing a crime, respond with lower levels of stress

hormones than others do at their

age. 28

UNDERSTANDING ANTISOCIAL PERSONALITY DISORDER

PET scans of 41 murderers revealed reduced activity in the frontal lobes. In a follow-up study repeat offenders had 11%

less frontal lobe activity compared to normals (Raine et al., 1999; 2000).

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Normal Murderer

Courtesy of A

drian Raine,

University of Southern C

alifornia

UNDERSTANDING ANTISOCIAL PERSONALITY DISORDER

The likelihood that one will commit a crime doubles when childhood poverty is compounded

with obstetrical complications (Raine et al., 1999; 2000).

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RATES OF PSYCHOLOGICAL DISORDERS

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RATES OF PSYCHOLOGICAL DISORDERS

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The prevalence of psychological disorders during the previous year is shown below

(WHO, 2004).

RISK AND PROTECTIVE FACTORS

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Risk and protective factors for mental disorders (WHO, 2004).

RISK AND PROTECTIVE FACTORS

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