Schizophrenia

MS. Garcha
Shape of the day Learning Intentions

- Activity - I will understand the

- Notes subtypes of schizophrenia
- Video clip - I will be able to explain the
- Notes possible causes of
- Video clip Crash Course schizophrenia
- I will be able to identify the
symptoms of schizophrenia
Activity ensure you all have a
sheet

Get into groups of 3 as there are 3 roles in this

activity. Each person will have a chance to be each
character. When Ms. Garcha says switch, you will
rotate to become the next character. Ex. If you were
the interviewer, you will then become the person
experiencing psychosis, and that person will become
the Voice and the person who was the voice will
then have their turn to be the interviewer.
 Schizophrenia

Different from other disorders in that there is no essential

feature.
Literally translated means split mind
Not a split personality but refers to a split from reality that
shows itself in disorganized thinking, disturbed
perceptions, and inappropriate emotions and actions

(schizen = split, phren = mind).

 Subtypes of Schizophrenia

Not a single disorder its a cluster of disorders

Subtypes share some common characteristics, but they also have
distinguishing symptoms
Symptoms are divided between positive symptoms and negative
symptoms
 DSM-5 diagnostic criteria

At least two characteristic symptoms:

+Delusions *
+Hallucinations *

+Disorganized speech
+Grossly disorganized or catatonic behavior
- Negative symptoms

* Only one symptom required if it is bizarre

delusions or continually commenting or
conversing auditory hallucinations
 Symptoms are classified as
Postive or Negative
Positive symptoms involve distorted or
excessive mental activity
Delusions, hallucinations, altered emotions,
erratic behaviors
Positive symptoms occur during acute episodes
Negative symptoms involve behavioral and
mental deficits
Flattened emotions, social withdrawal
Negative symptoms are chronic (long-term)
and may not respond well to drug treatment
 Positive Symptoms

Hallucinations are perceptions without sensations

Delusions are mistaken beliefs that are maintained despite
contrary evidence
Paranoid: others are talking about the person
Persecution: others are out to get the person
 Negative symptoms

Behavioral deficits:
Avolition
Lack of energy or interest in routine activities
Alogia
Poverty of speech
Poverty of speech content
Anhedonia
Inability to express pleasure
Flattened affect
Monotone; less facial expression of emotion
 Faces of schizophrenia

paranoia, disorganized, and/or catatonic,

undifferentiated, residual
Paranoid Schizophrenia looks like
Preoccupied with one or more delusions,
or
Frequent auditory hallucinations
Speech, behavior, and affect may or may
not be prominently impaired
John Nash Suffered paranoid
schizophrenia
A beautiful mind
https://www.youtube.com/watch?
v=YWwAOutgWBQ
 Faces of schizophrenia
Disorganized Schizophrenia

Behavior and speech are disorganized

Clang associations (words that rhyme)
and neologisms (made up words)
Complete neglect of appearance
Flat or rapidly changing inappropriate
emotion
 Catatonia

Used to be part of the schizophrenia diagnosis

the DSM 5 has now given it its own category
At least two of the following symptoms:
Motor immobility
Catalepsy - refers to an immobile stance that can be held
for hours (like a statue)
Waxy flexibility
Purposeless excess movement
Extreme negativism: motiveless resistance, rigidity,
mutism
Strange movements: posturing, stereotyped
movements, grimacing
Echolalia (repeat the words said to them like a parrot)
or echopraxia (repeating a movement)
 Still missing essays from:
- Addison
- David
- Franczesca
- Joanna
- Andersan
- Pourochista
- Erinn
- Gavin
- Charlotte
Shape of Learning
the Day Intentions
- Notes - I will be able to explain the different
- Crash course causes of schizophrenia
- I will be able to identify disorganized
schizophrenia
What causes it?

Genetics?
Excessive amounts of dopamine?
Enlarged ventricles in the brain?
Abnormal pattern of connections between
cortical cells?
Family relationships?
Birth difficulties?
 Etiology of Schizophrenia

In addition to genetic predisposition, experiences such has

prenatal trauma, infection, and stress may all be
susceptibility factors
Thus, individuals inherit a predisposition for
schizophrenia which may or may not be activated by
experience
 Etiologies of schizophrenia

The etiology may be complex, due to

Broad set of symptoms
Positive and negative symptoms
Genetic factors in etiology
1% of general population
10% in first-degree relatives of schizophrenics
45% in identical twins of schizophrenics
Etiological factors

Inherited susceptibility or several genes are

involved
Retrospective strangeness in childhood
behavior
A stress trigger is implicated.
Schizophrenia

Relationship between Positive and Negative

Symptoms: Role of the Prefrontal Cortex

The evidence reviewed in the previous subsection indicates

that schizophrenia is associated with abnormalities in many
parts of the brain, especially the prefrontal cortex.

Weinberger (1988) first suggested that the negative

symptoms of schizophrenia are caused primarily by
hypofrontality, decreased activity of the frontal lobes

Hypofrontality
decreased activity of the prefrontal cortex; believed to be
responsible for the negative symptoms of schizophrenia

20
21
 Environmental factors in
etiology (cause, set of causes, or manner of
causation of a disease or condition)

The negative symptoms may be due to

brain damage.
Some people with no family history of
schizophrenia or any related disorder
develop schizophrenia.
 Prenatal damage factors:
Epidemiology
Incidence of schizophrenia increases with:
season of birth: late winter/early spring
viral epidemics in second trimester (Tsuang, 2000)
malnutrition or refeeding after thiamine deficiency
prenatal stress: WW II widows offspring

Because vitamin D plays an important role in brain development, this

deficiency may be a risk factor for schizophrenia.

These considerations suggest that at least some of the increased incidence

of schizophrenia in city dwellers and those who live in cold climates may
be attributable to a vitamin D deficiency.
24
 Evidence of brain damage in
schizophrenia

Neurological symptoms
Catatonia and facial dyskinesias (involuntary
movement, similar to tics)
Unusual rates of blinking, staring
Avoidance of eye contact
No blink reflex to a tap on the forehead
Stopped speech w/ looking away, esp. to right
Jerky eye movements and poor visual tracking
Impaired reaction of pupils to light changes
Brain abnormality
 Magnetic Resonance Imaging (MRI)

MRI evidence suggest loss of gray matter in

temporal lobe
MRI show NO degenerative brain changes thus
suggesting the loss of gray matter is developmental
MRI studies support the viral infection hypothesis
(Infections during pregnancy activate dormant
viruses, disrupting brain development and
increasing the risk for schizophrenia)
 Positron Emission Tomography
(PET)
Observe live brain structure & function
Enlarged ventricles
Poor activation of frontal lobe during
cognitive tasks
Schizophrenics do less well on cognitive
tasks (decision-making, problem-solving,
memory, attention and judgement)
Enlarged ventricles detectable even
 And still more evidence

Abnormal cell pruning after puberty (Keshevan, Anderson &

Pettegrew, 1994)
Synaptic pruning or axon pruning is the process of synapse elimination
that occurs between early childhood and the onset of puberty in many
mammals, including humans. Pruning starts near the time of birth and is
completed by the time of sexual maturation in humans (google)
Excessive pruning in the prefrontal cortex (negative symptoms)
Failure of pruning in some subcortical structures (positive symptoms)
Higher incidence of schizophrenia in people who experienced
birth complications:
Oxygen deprivation, drugs, infections, endocrine disorders (Endocrine
disorders are diseases related to the endocrine glands of the body.
The endocrine system produces hormones, which are chemical signals
sent out, or secreted, through the bloodstream)
A variant dopamine hypothesis
 Is this an ex of disorganized
speech from a person with
schizophrenia?

Takes less place. Cat didnt know what Mouse did and
Mouse didnt know what Cat did Cat represented more
on the suspicious side than the mouse. Dumbo was a
good guy. He saw what the cat did, put himself with the
cat so people wouldnt look at them as comedians. Cat
and Dumbo are one and alike, but Cat didnt know what
Dumbo did and neither did the mouse.
Is this an ex of disorganized
speech from a person with
schizophrenia?
Everyone should have a good laugh. Dont cry
over it. Dont tell anyone -- they will tell
someone. Appreciate it without criticism. A
word like milk shouldnt be mentioned.
 Is this an ex of disorganized
speech from a person with
schizophrenia?

So to beseech you as full as for it. Exactly or as kings.

Shutters shut and open so do queens. Shutters shut and
shutters and so shutters shut and shutters and so and so
shutters and so shutters shut and so shutters shut and
shutters and. So and so shutters shut and so and also.
And also and so and so and also.
Disorganized speech credits

Disorganized speech 1 and 2 are from a person

with schizophrenia, quoted in Zimbardos
Instructors manual for Psychology and Life.
Disorganized speech 3 is from a poem by
Gertrude Stein.
Crash Course

https://www.youtube.com/watch?
v=uxktavpRdzU