Schizophrenia Brian J. Piper, Ph.D.
Goals Symptoms of Schizophrenia Causes Treatments
SchizophreniaThe Greek translation is schizein “split” and phren “mind” which refers to a split from    reality. A group o...
Symptoms of SchizophreniaPositive symptoms: the presence of inappropriatebehaviors      delusions      hallucinations: aud...
Disorganized & Delusional ThinkingThis morning when I was at Hillside [Hospital], I wasmaking a movie. I was surrounded by...
Example Patient  Haldol: classic antipsychotic drug  Delusions of grandeur: inappropriate beliefs about one’s self-worth o...
Auditory HallucinationsFor almost 7 years, except during sleep, I continue to hear voices. They accompany me to every plac...
Epidemiology of                Schizophrenia    Frequency: 0.7%    Onset: 18-20s    Sex: Males > Females in # and severity...
Vincent van Gogh1853-1890                                                Mary Todd Lincoln                                ...
DSM-IV Criteria for Diagnosis• Impaired social/occupational/self-care• 2 or more of the following:  – Delusions: delusions...
Subtypes (DSM-IV-TR only)• Catatonic: immobility• Disorganized: disorganized speech or  behavior, affective flattening• Pa...
Typical?The relationship between schizophrenia and aggression iscontroversial. Renfrew (1996). Aggression & Its Causes.
Typical? John Hinckley, Jr.                                                Jared Lee LoughnerThe relationship between schi...
Causes• Demonic possession  – Blood loss  – Damage to brain• “Refrigerator mothers”• Neurodevelopmental Disorder
Abnormal Brain Morphology  Schizophrenia patients may exhibitmorphological changes in the brain like enlargement of fluid-...
Meta-Analysis  • 58 studies                              Region (Left or Right)   % of                                    ...
Genetic Factors    The likelihood of an individual suffering from    schizophrenia is 50% if their identical twin has     ...
Genetic Factors  The following shows the prevalence ofschizophrenia in identical twins as seen in           different coun...
Genain Sisters“Genain”: Greek “dire birth”, born 1930, allhospitalized for schizophrenia by early 20s,          probabilit...
Neuropsych Testing of Genain            Sisters at age 68• Digit Span: working  memory• Trail Making Test: set  shifting• ...
Viral Infection  Schizophrenia has also been observed inindividuals who contracted a viral infection    (flu) during the m...
Natural Logarithm of Relative Risks (and 95% Confidence Intervals) for Subjects Included in Eight Ecological Studies from ...
Individual Differences in SCZ
Neurochemical Imbalance                         Typical     Origin              1952     Example             Chlorpromazin...
Drug TherapiesPsychopharmacology is the study of drug effects           on mind and behavior.  With the advent of drugs, h...
Neurochemical Imbalance                         Typical                   AtypicalOrigin                   1950s          ...
Concern• Adult monkeys  received typical                                        *  (haloperidol) or                       ...
Self-Medication?• Marijuana• Nicotine
Art During Disease Progression• A English artist, who was  fascinated by cats, painted  these pictures over a period of  t...
Summary• Symptoms ( + and - )• Current Biological Components  – Genetics  – Brain Structure  – Dopamine Receptors
Introductory Psychology: Schizophrenia
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Introductory Psychology: Schizophrenia

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lecture 15 from a college level introduction to psychology course taught Fall 2011 by Brian J. Piper, Ph.D. (psy391@gmail.com) at Willamette University, includes DSM-IV TR, positive symptoms, negative symptoms, hallucinations, epidemiology, famous patients, catatonic, disorganized, paranoid, genetics, neuroanatomy, Genain sisters, antipsychotics, dopamine

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  • Preview Question 1: What patterns of thinking, perceiving, feeling, and behaving characterize schizophrenia?
  • Natural Logarithm of Relative Risks (and 95% Confidence Intervals) for Subjects Included in Eight Ecological Studies from Europe, America, and Australia (Type A Studies) of Risk for Schizophrenia Associated with Exposure to 1957 Influenza Pandemic During Second Trimester of Prenatal Life. Studies are identified by first author and year of publication. Figure shows natural logarithm of all effect sizes and natural logarithm of grand mean.
  • Preview Question 1: What are the drug therapies? What criticisms have been leveled against drug therapies?
  • Introductory Psychology: Schizophrenia

    1. 1. Schizophrenia Brian J. Piper, Ph.D.
    2. 2. Goals Symptoms of Schizophrenia Causes Treatments
    3. 3. SchizophreniaThe Greek translation is schizein “split” and phren “mind” which refers to a split from reality. A group of severe disorders characterized by atypical: 1. Cognition 2. Behavior 3. Emotions
    4. 4. Symptoms of SchizophreniaPositive symptoms: the presence of inappropriatebehaviors delusions hallucinations: auditory >>> visual > other disorganized talking: “word salad” movementsNegative symptoms: the absence of appropriatebehaviors flat affect: joy, anger, disgust anhedonia catatonia: waxy flexibility
    5. 5. Disorganized & Delusional ThinkingThis morning when I was at Hillside [Hospital], I wasmaking a movie. I was surrounded by movie stars …I’m Mary Poppins. Is this room painted blue to get meupset? My grandmother died four weeks after myeighteenth birthday.” (Sheehan, 1982)Other forms of delusions include, delusions ofThis monologue illustrates fragmented, bizarrethinking with (“someone is following delusions persecution distorted beliefs called me”) or grandeur (“I am a king”). (“I’m Mary Poppins”).
    6. 6. Example Patient Haldol: classic antipsychotic drug Delusions of grandeur: inappropriate beliefs about one’s self-worth or special powersGerald (upto 2:30): http://www.youtube.com/watch?v=gGnl8dqEoPQ
    7. 7. Auditory HallucinationsFor almost 7 years, except during sleep, I continue to hear voices. They accompany me to every place and at all times, when I’m in conservations with other people, they persist,undeterred, even when I concentrate on other things, for instance, read a book, play thepiano, etc. Only when I’m talking aloud to other people or to myself are they drowned by the stronger sound of the spoken word and therefore inaudible to me. Recounted by Ann M. Kring, Ph.D. Pros & Cons Behavioral strategies (& family discord) Command Hallucinations
    8. 8. Epidemiology of Schizophrenia Frequency: 0.7% Onset: 18-20s Sex: Males > Females in # and severity Low SES/African-Americans Rule of thirdsSources: Anna K. Kring, Brad Olson, & Peter Gray
    9. 9. Vincent van Gogh1853-1890 Mary Todd Lincoln 1818-1882 Brian Wilson 1942- Schizophrenia & Artists? Jack Kerouac John Nash 1922-1969 1928-
    10. 10. DSM-IV Criteria for Diagnosis• Impaired social/occupational/self-care• 2 or more of the following: – Delusions: delusions of grandeur or persecution – Hallucinations – Disorganized speech – Disorganized behavior: mannerisms – Negative symptoms
    11. 11. Subtypes (DSM-IV-TR only)• Catatonic: immobility• Disorganized: disorganized speech or behavior, affective flattening• Paranoid: – Present: delusions & auditory hallucinations, possible religiosity – Absent: disorganized behavior & affective flattening
    12. 12. Typical?The relationship between schizophrenia and aggression iscontroversial. Renfrew (1996). Aggression & Its Causes.
    13. 13. Typical? John Hinckley, Jr. Jared Lee LoughnerThe relationship between schizophrenia and aggression iscontroversial.Disorganized: Increased risk of victimizationParanoid: small increase Renfrew (1996). Aggression & Its Causes.
    14. 14. Causes• Demonic possession – Blood loss – Damage to brain• “Refrigerator mothers”• Neurodevelopmental Disorder
    15. 15. Abnormal Brain Morphology Schizophrenia patients may exhibitmorphological changes in the brain like enlargement of fluid-filled ventricles. Both Photos: Courtesy of Daniel R. Weinberger, M.D., NIH-NIMH/ NSC
    16. 16. Meta-Analysis • 58 studies Region (Left or Right) % of Control • 1,588 SCZ patients L Lateral Ventricle 130 R Lateral Ventricle 120 Gray Matter 96 White Matter 98 L Frontal Lobe 95 L Hippocampus 95 L Amygdala 91 L Thalamus 96 R Thalamus 96Wright et al. (2000). Am J Psychiatry, 157, 16-25.
    17. 17. Genetic Factors The likelihood of an individual suffering from schizophrenia is 50% if their identical twin has the disease (Gottesman, 2001). 0 10 20 30 40 50 Identical Both parents Fraternal One parent SiblingNephew or niece Unrelated
    18. 18. Genetic Factors The following shows the prevalence ofschizophrenia in identical twins as seen in different countries.
    19. 19. Genain Sisters“Genain”: Greek “dire birth”, born 1930, allhospitalized for schizophrenia by early 20s, probability = 1.5 billion Nora: intermediate (jobs, no family) Iris: intermediate (jobs, no family) Myra: secretary, married, 2 sons Hester: showed signs at age 11, institutionalized Genetics: identical Environment: identical (schizophrenic mom) Prenatal: ?
    20. 20. Neuropsych Testing of Genain Sisters at age 68• Digit Span: working memory• Trail Making Test: set shifting• Continuous Performance Test: attention Mirsky et al. (2000). Schizophrenia Bulletin, 26, 699-708.
    21. 21. Viral Infection Schizophrenia has also been observed inindividuals who contracted a viral infection (flu) during the middle of their fetal development.
    22. 22. Natural Logarithm of Relative Risks (and 95% Confidence Intervals) for Subjects Included in Eight Ecological Studies from Europe, America, and Australia (Type A Studies) of Risk for Schizophrenia Associated with Exposure to 1957 Influenza Pandemic During Second Trimester of Prenatal Life. http://en.wikipedia.org/wiki/Natural_logarithm Selten J et al. Schizophr Bull 2009;36:219-228
    23. 23. Individual Differences in SCZ
    24. 24. Neurochemical Imbalance Typical Origin 1952 Example Chlorpromazine Haloperidol Mechanism D2 antagonist Treats + symptoms Side-Effects Tardive dyskinesiaTD (20 sec): http://www.youtube.com/watch?v=fLwZQBJs8fI
    25. 25. Drug TherapiesPsychopharmacology is the study of drug effects on mind and behavior. With the advent of drugs, hospitalization in mental institutions has rapidly declined.
    26. 26. Neurochemical Imbalance Typical AtypicalOrigin 1950s 1970Example Chlorpromazine Clozapine HaloperidolMechanism D2 antagonist D2 & 5-HT2A antagonistTreats + symptoms + symptomsSide-Effects Tardive dyskinesia Weight gain TD (20 sec): http://www.youtube.com/watch?v=fLwZQBJs8fI
    27. 27. Concern• Adult monkeys received typical * (haloperidol) or * atypical (olanzapine) antipsychotics for 2 years at doses similar to schizophrenics.• Gray matter in parietal cortex was examined.Konopaske et al. (2007). Neuropsychobiol 32, 1216-1223.
    28. 28. Self-Medication?• Marijuana• Nicotine
    29. 29. Art During Disease Progression• A English artist, who was fascinated by cats, painted these pictures over a period of time in which he became mentally ill.• Pro – Paranoia – Disorganization• Con Louis Wain (1860-1939) – Schizophrenia – Order
    30. 30. Summary• Symptoms ( + and - )• Current Biological Components – Genetics – Brain Structure – Dopamine Receptors
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