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Schizophrenia

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Definition
 Psychotic disorders characterised by loss of control of the
thought processes and inappropriate emotional responses.
 Most begin in the late teens and early twenties
 Right: Mathematician John Nash,
author Jack Kerouac,
Fleetwood Mac guitarist Peter Green,
and musician Syd Barrett (Pink Floyd).

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Symptoms
 Most distinctive: Disturbance of thought, perception and
language
 Often suffer from delusions (false beliefs despite evidence to
the contrary).
Delusion Associated Belief
Persecution Others are persecuting, spying or trying to harm them
Reference Objects, events or other people have particular significance to them
Grandeur They have great power, knowledge or talent
Identity They are someone else – Jesus Christ or PM
Guilt They have committed a terrible sin
Control Their thoughts and behaviours are being controlled by external forces

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Symptoms (cont’d)
 Hallucinations – perceptual experiences that distort or occur
without external stimulation. Auditory hallucinations are the
most common kind
 Loosening of association – tendency of conscious thought to
move along associative lines rather than to be controlled,
logical and purposeful. (e.g. “She came in last night from
Denver, in like a lion, she’s the king of beasts”)

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Positive and Negative symptoms
 Positive symptoms, such as delusions, hallucinations and loose
associations are most apparent in acute phases of the illness and
are often treatable by antipsychotic medications.
 Two kinds of positive:disorganised (inappropriate emotions,
disordered thought, bizarre behaviour) and psychotic (delusions
and hallucination)
 Negative symptoms include flat affect, lack of motivation, socially
inappropriate behaviour, withdrawal from relationships, intellectual
impairments.
 Positive and negative symptoms appear to involve different neural
circuits and to respond to different kinds of medications

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DSM-IV subtypes of schizophrenia
 1) Catatonic
 At least TWO of the following: extreme motor immobility;
purposeless excessive motor activity; extreme negativism
(motionless resistance to all instructions) or mutism (refusing to
speak); peculiar or bizarre voluntary movements; echolalia
 2) Disorganised:
 All of the following – disorganised speech,
disorganisedbehaviour, and inappropriate or flat affect – are
prominent in behaviour, but catatonic-type criteria are not met.
Delusions or hallucinations may be present, but only in
fragmentary or non-coherent form

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Subtypes (cont’d)
 3) Paranoid:
 Preoccupation with delusion/s or auditory hallucinations. Little
or no disorganised speech, disorganised or catatonic
behaviour, or inappropriate or flat affect
 4) Undifferentiated
 Does not fit any of the subtypes above, but meets the symptom
criteria for schizophrenia

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Subtypes (cont’d)
 5) Residual:
 Has experienced at least one episode of schizophrenia, but
currently does not have prominent positive symptoms
(delusions, hallucinations, disorganised speech or behaviour).
However, continues to show negative symptoms (inability to
experience pleasure, lack of motivation) and a milder variation
of positive symptoms (odd beliefs, eccentric behaviour)

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Theories of schizophrenia
 Most adopt a diathesis-stress model.
 Most of the time, this diathesis is genetic, but other cases
probably reflect early damage to the brain.
Threshold for Genetic
schizophrenia vulnerability
Threshold Environmental
cannot be component
crossed necessary
to cross
threshold
Genetically Genetically Genetically Not genetically
above near at risk predisposed
threshold

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Biology of Schizophrenia
 Genes undoubtedly play a primary role in the etiology (cause)
of schizophrenia
 The following table is based on data pooled across over 40
studies conducted over nearly 60 years
Relationship Degree of relatedness Risk (%)
Identical twin 1.0 48
Fraternal Twin .5 17
Sibling .5 9
Parent .5 6
Child .5 13
Second-degree relative .25 4

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Dopamine
 The dopamine hypothesis suggests that the brain produces too
much dopamine.
 Amphetamines (e.g. crystal meth, speed) increase dopamine
activity, and high doses induce psychotic-like symptoms such
as paranoia and hallucinations. An amphetamine-induced
psychosis is even more likely to occur in people with a
predisposition to schizophrenia.
 Also, many patients respond to antipsychotic medication that
block dopamine from binding with postsynaptic receptors. The
result is a reduction or elimination of positive symptoms

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Neural atrophy and dysfunction
Degeneration/wasting away of a body organ
 Neural atrophy: Enlargement of
fluid cavities in the brain called
ventricles.
 Indicates neural regions
surrounding them have
degenerated.
 Larger ventricles seen in patients
with chronic schizophrenia.
 Not exclusive to
schizophrenia, also observed in
other patients with psychotic
disorders and even in patients
with recurring depression and
anxiety disorders.

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Atrophy
 Most apparent in
temporal and frontal
lobes, and in the neural
tissue connecting the
frontal lobes to
emotion-processing
circuits in the limbic
system.

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 One study found severity of symptoms, especially auditory
hallucinations, correlated strongly with the degree of atrophy in
a region of the left temporal cortex specialised for auditory
processing of language.

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 The prefrontal cortex is another very likely site because one
section is involved in working memory and another in social
and emotional functioning.

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Prevalence
 In Australia, around 40,000 people (0.2% of population) have been
diagnosed with schizophrenia (Access Economics, 2002).
 Many studies find the rate is higher among economically impoverished
groups… effect on poverty OR difficulty holding employment?
 12 times more likely to die by suicide than the general population.
 In Australia, 60% of males with schizophrenia will attempt suicide at some
time in their lives.
 Agar, Argyle and Aderhold (2003) found that patients who had been
sexually and/or physically abused as a child were four times more likely to
experience hallucinations and 15 times more likely to hear voices than
patients who had not been abused.

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Treatment
 Individual, Group and Family Therapy
- can help patient and family understand the disease and symptom
triggers
- teaches families communication skills
- provides resources for dealing with emotional and practical
challenges
 Social skills training
- In hospital or community settings
- teaches social, self-care and vocational skills
 Medications
- antipsychotic medications to clarify thinking and perceptions of
reality and to reduce hallucinations and delusions
- drug treatment must be consistent to be effective. Inconsistent
dosage may aggravate existing symptoms or create new ones.

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Recovery
 Estimates vary: 10 to 20% ever fully recover.
 Less than half show even moderate improvement, and for
those who have shown improvement, almost half fall ill again
within a year
 People with good premorbid (prior to falling ill) social
functioning are least likely to relapse over time