This document provides information about schizophrenia, including its symptoms, diagnosis, course, and treatment. It discusses the range of psychotic symptoms involved in schizophrenia, such as hallucinations, delusions, and disorganized thinking. It notes that schizophrenia is a chronic condition defined by a deterioration of social and interpersonal relationships over at least six months. The document also summarizes research showing differences in brain structure and function in individuals with schizophrenia, such as enlarged ventricles and decreased blood flow to the frontal lobes. Finally, it discusses theories about the causes of schizophrenia, including genetic factors and prenatal infections.

1. Schizophrenia

2. The Brain
Gone Bad
Meshberger, JAMA 264:1837-1841

5. A disorder with a range of psychotic
symptoms involving disturbances in
content of thought, form of thought,
perception, affect, sense of self,
motivation, behavior, and interpersonal
functioning.
Schizophrenia

6. How Prevalent?
• About 1 in every 100 people are
diagnosed with schizophrenia.

7. Schizophrenia
• Individuals with schizophrenia have many different
symptoms
– Including
• hearing voices
• Unrealistic beliefs
• Disorganized communication
• Often need to be hospitalized
• Schizophrenia is a chronic condition
– Drugs or environmental toxins can cause acute psychosis
– Despite therapy about 30% of people with schizophrenia spend
a significant portion of their lives in mental hospitals
• About 1-1.5% of the population will suffer from
schizophrenia
– 2-3% will suffer from less severe symptoms that do not meet the
diagnostic criteria

8. Schizophrenia
• Schizophrenia is defined by
– a group of characteristic positive and negative
symptoms
– deterioration in social, occupational, or interpersonal
relationships
– continuous signs of the disturbance for at least 6
months

9. Positive v. Negative Symptoms
+
Positive Symptoms
• Presence of
inappropriate
symptoms
-
Negative Symptoms
• Absence of
appropriate ones.

11. Symptoms of Schizophrenia
• Disorganized thinking.
•Disturbed Perceptions
•Inappropriate Emotions and
Actions

12. Disorganized Thinking
• The thinking of a person with
Schizophrenia is fragmented and
bizarre and distorted with false beliefs.
•Disorganized thinking comes from a
breakdown in selective attention.-
they cannot filter out information.
Often causes………

13. Delusions (false beliefs)
• Delusions of
Persecution
• Delusions of
Grandeur

14. Delusions
• People with schizophrenia often have
delusions, firmly held, unshakable beliefs
with no basis in reality. Among the most
common delusions experienced by people
with schizophrenia are the beliefs that they
are being controlled by someone else, that
they are being persecuted by others, and
that their thoughts are being broadcast so
that others are able to know what they are
thinking.

15. Disturbed Perceptions
• hallucinations- sensory experiences
without sensory stimulation.

16. Hallucinations
• Sensory experiences in
the absence of any
stimulation from the
environment
• Any sensory modality
may be involved
– auditory (hearing);
– visual (seeing);
– olfactory (smelling);
– tactile (feeling);
– gustatory (tasting)
• Auditory hallucinations
are most common

17. Symptoms of schizophrenia
• Sometimes the voices can be familiar like a
parent or spouse
• Sometimes unrecognized
– Foreign agents
• Radio transmitter in head
• Voices of angels
• Often the voices are critical,
demanding, or accusatory
• Sometimes can direct the person
to perform destructive behaviors

18. Symptoms of schizophrenia
• Recently researchers have imaged the brain during
hallucinations
• Some consistent findings are
– Usually left cerebral hemisphere is more activated
• Typical language hemisphere
– Most active areas are in the audio linguistic association cortex
• Rather than primary cortex
– Consistent with the internally generated nature of the experience
– Some have hypothesized that auditory hallucinations are like
“inner speech”
• But Broca’s area is often not activated
• Wernicke’s area is usually activated
– Electrical stimulation of this area can cause hallucinations in a healthy
individual

19. Symptoms of schizophrenia

20. Perceptual disorders
• People with schizophrenia do not perceive
the world as most other people do. They
may see, hear, or smell things differently
from others and do not even have a sense of
their bodies in the way that others do. Some
reports suggest that individuals with
schizophrenia have difficulty determining
where their own bodies stop and the rest of
the world begins.

21. Emotional disturbances
• People with schizophrenia
sometimes show a bland lack
of emotion in which even the
most dramatic events produce
little or no emotional response.
Conversely, they may display
emotion that is inappropriate to
a situation.

22. Inappropriate Emotions and
Actions
• Laugh at
inappropriate times.
• Flat Effect
• Senseless,
compulsive acts.
• Catatonia-
motionless Waxy
Flexibility

23. Withdrawl
• People with schizophrenia tend to have
little interest in others. They tend not to
socialize or hold real conversations with
others, although they may talk at another
person. In the most extreme cases they do
not even acknowledge the presence of
other people, appearing to be in their own
isolated world.

24. etiology
• Schizophrenia is a familial disorder:
– incidence of schizophrenia higher among the relatives of
schizophrenics than in general population.
– Identical twins of schizophrenics are three times as likely
to be schizophrenic as the fraternal twins of
schizophrenics.
• The heritability for schizophrenia has been estimated at
between .60 and .90.
– This means that 10-40% of the variability is due to
environmental factors.

25. Etiology of Schizophrenia
• The etiology and pathogenesis of
schizophrenia is not known
• It is accepted, that schizophrenia is „the
group of schizophrenias“ which origin is
multifactorial:
– internal factors – genetic, inborn, biochemical
– external factors – trauma, infection of CNS,
stress

26. Causes of Schizophrenia
• There is no known cause of schizophrenia
• Theories include:
 Problems in pregnancy such as malnutrition or being
exposed to a virus
 The disease is passed down through family
 Brain growth problems causing neurotransmitter damage
(neurotransmitters communicate ideas around the brain
using chemicals)
• Current research into the disease being
passed down through family shows
promise

27. Why the damage?
• Some of the brain defects in schizophrenia apparently stem from
problems during pregnancy or at the time of birth.
• Prenatal problems include
– physical complications of mother and fetus
– emotional stresses on the mother.
• birth and pregnancy complications associated with
– brain deficits
– enlarged ventricles later in life.

28. Why the damage?
• Winter effect:
– patients are more often born during the winter and spring than during any other time of
the year.
• Infants born between January and May
– experienced second trimester of prenatal development in the fall or early winter:
– high incidence of infectious diseases.
– Strong evidence that the mother’s exposure to viral infections during the 4th-6th
months of pregnancy increases risk of schizophrenia.
• Prenatal starvation is another pathway to schizophrenia.
– Poor maternal diet
– Issues with metabolizing across placenta
• Bottom line:
– Schizophrenia may include predisposition of some kind
– May be related to autoimmune function
– May result in changes in axonal growth/brain development, particularly in ventricles

29. So what does a schizophrenia sufferers
brain look like?
This map reveals the 3-dimensional profile
of gray matter loss in the brains of
teenagers with early-onset schizophrenia,
with a region of greatest loss in the
temporal and frontal brain regions that
control memory, hearing, motor functions,
and attention
Source:
http://www.loni.ucla.edu/Research/Projects/S
chizophrenia.shtml

30. Source:
http://images.google.co.uk/imgres?imgurl=http://www.schizophrenia.com/images/schizophrenia_brain_large.gif&imgrefurl=http://www.schizophr
enia.com/schizpictures.html&usg=__n5FqNV6P0yjjAssAC6TbzC2Tn5c=&h=600&w=700&sz=86&hl=en&start=2&um=1&itbs=1&tbnid=B9S2Juc
-
v6DobM:&tbnh=120&tbnw=140&prev=/images%3Fq%3Dthe%2Bbrain%2Bin%2Bschizophrenia%26um%3D1%26hl%3Den%26lr%3D%26sa%3
DN%26rlz%3D1R2ACPW_enGB364%26tbs%3Disch:1

31. Early onset schizophrenia: Wave of gray matter loss -
begins in parietal cortex and spreads forward

32. Biochemical explanation.
Source:
http://images.google.co.uk/imgres?imgurl=http://www.schizophrenia.com/images/schizophrenia_brain_large.gif&imgrefurl=http://www.schizophrenia.com/
schizpictures.html&usg=__n5FqNV6P0yjjAssAC6TbzC2Tn5c=&h=600&w=700&sz=86&hl=en&start=2&um=1&itbs=1&tbnid=B9S2Juc-
v6DobM:&tbnh=120&tbnw=140&prev=/images%3Fq%3Dthe%2Bbrain%2Bin%2Bschizophrenia%26um%3D1%26hl%3Den%26lr%3D%26sa%3DN%26rlz%3D1R
2ACPW_enGB364%26tbs%3Disch:1

33. But we must remember there is
evidence to suggest otherwise!!

35. Underactive frontal lobes and overactive parietal lobes are thought to cause some of
schizophrenia’s associated symptoms. For example, when frontal lobes are underactive,
planning, organization, and volition are all impaired. Frontal lobe abnormalities are probably
related to schizophrenia’s negative symptoms.
Parietal lobes are involved in sensory perception, like voice recognition, the ability to
distinguish patterns, and spatial orientation. Overactive parietal lobes may cause distortion
of these senses, which is seen in many people with schizophrenia. Parietal lobe
abnormalities are probably more closely related to positive symptoms.
Abnormal brain structure is found consistently in people with schizophrenia. This includes
enlarged ventricles and asymmetrical hemispheres. Using imaging researchers have
discovered decreased blood flow to the frontal lobes of people with schizophrenia. These
types of brain abnormalities forecast certain symptoms, like loss of attention, difficulty with
abstract thinking, and the inability to solve problems.
Evidence??

36. • Some evidence suggests that infants who experience birth trauma or complications
while in the womb are at greater risk for schizophrenia. Maternal illness may play a
part as well. A mother who contracts a virus like the flu, especially during her second
trimester, may increase the risk for her child. It is not known, whether the virus itself
or the immune response to it increases the risk. (Chicken & egg scenario!)
• Some studies have shown that winter birth may be associated with schizophrenia,
especially during immune response and illness. Furthermore, viruses in the womb are
more common during the winter months. This has led some researchers to consider
intrauterine viral infection during the winter as a risk factor. The same link, however,
is found for major mood disorders, like bipolar disorder.
• Evidence??

37. How is the evidence investigated/gathered?
• Well...ethically you cannot perform lobotomy's as such or
prod and poke...so the information to support the
biological explanations as a whole are collected using a
variety of tests/procedures including blood tests and
brain scans.

38. Scanning.....
• MRI = Magnetic
resonance imaging
(MRI) is an imaging
technique used
primarily in medical
settings to produce
high quality images of
the inside of the human
body.
• It is a massive
breakthrough as it
shows clear pictures of
the living brain.

39. Scanning...
• PET/CT = PET stands for
Positron Emission
Tomography.
• PET scans measure
metabolic activity and
molecular function by using a
radioactive glucose injection.
• The F-18 FDG is injected into
the patient.
• The PET scanner detects the
radiation emitted from the
patient, and the computer
generates three-dimensional
images of tissue function or
cell activity in the tissues of
your body.

40. Could it be Genetic? Evidence is based
upon three specific areas: Family study.
1st degree relatives (parents, siblings and offspring) share an average of
50% of their genes
2nd degree relatives (half siblings, grandparents/children, aunts/uncles)
share approx 25% of their genes
To investigate genetic transmission of schizophrenia, studies compare
rates of schizophrenia in relatives of diagnosed cases compared to
controls Kendler et al (1985)

41. Genetics of Schizophrenia
• Many psychiatric disorders are multifactorial
(caused by the interaction of external and
genetic factors) and from the genetic point of
view very often polygenically determined.
• Relative risk for schizophrenia is around:
– 1% for normal population
– 5.6% for parents
– 10.1% for siblings
– 12.8% for children

42. • Most males usually develop
symptoms of schizophrenia in
their late teens and early
twenties, while females develop
symptoms during their late
twenties.

43. Diagnosis
• Diagnosis is not simple
– No two individuals show identical patterns
– Nor is there a single symptom that all people
with schizophrenia share
– Symptoms can increase and decrease over
time
• Some believe that schizophrenia
represents a cluster of disorders rather
than a single disorder

44. Course of Illness
• Course of schizophrenia:
– continuous without temporary improvement
– episodic with progressive or stable deficit
– episodic with complete or incomplete remission
• Typical stages of schizophrenia:
– prodromal phase
– active phase
– residual phase

45. PHASES OF SCHIZOPHRENIA
Residual
Prodromal
Active

46. • The development of schizophrenia occurs
in three major phases; acute, stabilization,
and maintenance phase.
– Acute: Development of Symptoms & Possible
Psychotic Episode
– Stabilization: Controlling & Treating the
Disease
– Maintenance: Medicating the Disease

47. Louis Wain
Progression of Schizophrenia

48. The Criteria of Diagnosis
For the diagnosis of schizophrenia is necessary
• presence of one very clear symptom - from point a) to d)
• or the presence of the symptoms from at least two groups - from point
e) to h)
for one month or more:
the hearing of own thoughts, the feelings of thought withdrawal, thought
insertion, or thought broadcasting
a) the delusions of control, outside manipulation and influence, or the
feelings of passivity, which are connected with the movements of the
body or extremities, specific thoughts, acting or feelings, delusional
perception
b) hallucinated voices, which are commenting permanently the behavior
of the patient or they talk about him between themselves, or the other
types of hallucinatory voices, coming from different parts of body
c) permanent delusions of different kind, which are inappropriate and
unacceptable in given culture

49. The Criteria of Diagnosis
e) the lasting hallucination of every form
f) blocks or intrusion of thoughts into the flow of thinking and resulting
incoherence and irrelevance of speach, or neologisms
g) catatonic behavior
h) „the negative symptoms”, for instance the expressed apathy, poor
speech, blunting and inappropriatness of emotional reactions
i) expressed and conspicuous qualitative changes in patient’s
behavior, the loss of interests, hobbies, aimlesness, inactivity, the
loss of relations to others and social withdrawal
• Diagnosis of acute schizophorm disorder (F23.2) – if the conditions
for diagnosis of schizophrenia are fulfilled, but lasting less than one
month
• Diagnosis of schizoaffective disorder (F25) - if the schizophrenic and
affective symptoms are developing together at the same time

50. Schizophrenia
• This term refers to the early idea that
there is a split (schism) between
affect (feelings) and cognition
(thoughts)
• Early physicians, Emil Kraepelin and
others, studied this disorder and term
and called it Dementia Praecox

51. Types of Schizophrenia

52. Characterized by at least two bodily
movement abnormalities:
• Motor immobility or stupor.
• Purposeless motor activity.
• Mutism or extreme negation.
• Peculiarities of movement or odd
mannerisms and grimacing.
• Echolalia or echopraxia.
TYPES OF SCHIZOPHRENIA

53. Characterized by a combination of
symptoms, including disorganized
speech and behavior and flat or
inappropriate affect.
Even delusions and hallucinations lack
a coherent theme.
TYPES OF SCHIZOPHRENIA

54. Characterized by preoccupation with
one or more bizarre delusions, or with
auditory hallucinations that are
related to a particular theme of being
persecuted or harassed.
Without disorganized speech or
disturbed behavior.
TYPES OF SCHIZOPHRENIA

55. Paranoid Schizophrenia
• preoccupation
with delusions
or
hallucinations.
• Somebody is out
to get me!!!!

56. Characterized by a complex of
schizophrenic symptoms that does
not meet the criteria for other types of
schizophrenia.
TYPES OF SCHIZOPHRENIA
Clip art copyright © 2002 www.arttoday.com. Used with permission.

57. Applies to people previously diagnosed
as schizophrenic if they no longer
show prominent psychotic symptoms
but still show lingering signs of the
disorder.
TYPES OF SCHIZOPHRENIA

58. F20.0 Paranoid Schizophrenia
• Paranoid schizophrenia is characterized mainly
by delusions of persecution, feelings of passive
or active control, feelings of intrusion, and often
by megalomanic tendencies also. The delusions
are not usually systemized too much, without
tight logical connections and are often combined
with hallucinations of different senses, mostly
with hearing voices.
• Disturbances of affect, volition and speech, and
catatonic symptoms, are either absent or
relatively inconspicuous.

59. F20.1 Hebephrenic Schizophrenia
• Hebephrenic schizophrenia is characterized by
disorganized thinking with blunted and inappropriate
emotions. It begins mostly in adolescent age, the behavior
is often bizarre. There could appear mannerisms,
grimacing, inappropriate laugh and joking,
pseudophilosophical brooding and sudden impulsive
reactions without external stimulation. There is a tendency
to social isolation.
• Usually the prognosis is poor because of the rapid
development of "negative" symptoms, particularly flattening
of affect and loss of volition. Hebephrenia should normally
be diagnosed only in adolescents or young adults.
• Denoted also as disorganized schizophrenia

60. F20.2 Catatonic Schizophrenia
• Catatonic schizophrenia is characterized mainly
by motoric activity, which might be strongly
increased (hypekinesis) or decreased (stupor), or
automatic obedience and negativism.
• We recognize two forms:
– productive form — which shows catatonic excitement,
extreme and often aggressive activity. Treatment by
neuroleptics or by electroconvulsive therapy.
– stuporose form — characterized by general inhibition of
patient’s behavior or at least by retardation and
slowness, followed often by mutism, negativism,
fexibilitas cerea or by stupor. The consciousness is not
absent.

61. F20.3 Undifferentiated
Schizophrenia
• Psychotic conditions meeting the general
diagnostic criteria for schizophrenia but not
conforming to any of the subtypes in F20.0-
F20.2, or exhibiting the features of more than
one of them without a clear predominance of a
particular set of diagnostic characteristics.
• This subgroup represents also the former
diagnosis of atypical schizophrenia.

62. F20.4 Postschizophrenic
Depression
• A depressive episode, which may be prolonged,
arising in the aftermath of a schizophrenic
illness. Some schizophrenic symptoms, either
„positive“ or „negative“, must still be present but
they no longer dominate the clinical picture.
• These depressive states are associated with an
increased risk of suicide.

63. F20.5 Residual Schizophrenia
• A chronic stage in the development of
schizophrenia with clear succession from the
initial stage with one or more episodes
characterized by general criteria of
schizophrenia to the late stage with long-lasting
negative symptoms and deterioration (not
necessarily irreversible).

64. F20.6 Simple Schizophrenia
• Simple schizophrenia is characterized by early
and slowly developing initial stage with growing
social isolation, withdrawal, small activity,
passivity, avolition and dependence on the
others.
• The patients are indifferent, without any initiative
and volition. There is not expressed the
presence of hallucinations and delusions.

65. How is The Disease
Diagnosed?
• There is no laboratory test for
Schizophrenia
• Tests are dependent on psychiatrist but
can take a few minutes to months to show
signs
• Most times a possible schizophrenic must
come in by themselves to be checked
many of these people never come for
check ups

66. Schizophrenia
A little bit more....

67. What sub type am I?
• Helen suffers from acute discomfort in close
relationships, cognitive & perceptual
distortion. She often displays odd, some may
say, eccentric behaviour, such as wearing
bright coloured clothes, and often organises
her clothes and food cupboards.
• She has little sense of humour and is vague
in conversation.

68. What sub type am I?
• Dave is a 19 year old student. He has been
unresponsive fro the whole duration of his
hospital stay (4 weeks). His body has been very
rigid and he has stared at the ceiling for long
periods of time and spends most of the day in a
trance like state.
• The only behaviour that can be investigated
happened prior to the hospitalisation when he
was ranting and raving that his psychology
teacher was a demon.

69. What sub type am I?
• Daisy is a unmarried woman who lives with
her elderly mother. She believes that the
world is filled with radio waves that are trying
to penetrate her brain and plant evil thoughts
into her brain. Because of this belief Daisy
rarely leaves the house. Her windows have
‘protection’ with foil, they deflect the radio
waves. The voices in her head comment on
the radio waves all the time.

70. Treatment of Schizophrenia
• The acute psychotic schizophrenic patients will respond
usually to antipsychotic medication.
• According to current consensus we use in the first line
therapy the newer atypical antipsychotics, because their
use is not complicated by appearance of extrapyramidal
side-effects, or these are much lower than with classical
antipsychotics.
conventional
antipsychotics
(classical
neuroleptics)
chlorpromazine, chlorprotixene, clopenthixole,
levopromazine, periciazine, thioridazine
droperidole, flupentixol, fluphenazine, fluspirilene,
haloperidol, melperone, oxyprothepine, penfluridol,
perphenazine, pimozide, prochlorperazine,
trifluoperazine
atypical
antipsychotics
amisulpiride, clozapine, olanzapine, quetiapine,
risperidone, sertindole, sulpiride

71. SCHIZOPHRENIA TREATMENT
Pharmacologic:
- traditional antipsychotics [dopamine2 (D2)-
receptor antagonists] first generation of
antipsychotic medication
- atypical antipsychotic agents –second
generation of antipsychotic medication
- Because of their better side-effect profiles,
the atypical agents are now first-line
treatments.

72. SCHIZOPHRENIA TREATMENT
Psychosocial treatments:
- Psychotherapy: individual, family, and
group
- Psychoeducation with activity of patients
or enhancing motivation to the treatment
- Social support

73. • Shock Treatments or Electroshock
Therapy
• Medications
• Rehabilitation Programs
Schizophrenia is a constant struggle
between reality and hallucinations for the
people suffering from this disease.

74. Factors Associated With More
Favorable Prognosis
• Good premorbid functioning
• Acute onset
• Later age at onset
• Good insight
• Being female
• Consistent in medication usage
• Brief active-phase symptoms
• Good functioning between episodes
• Absence of structural brain abnormalities
• Normal neurological functioning
• No family history of schizophrenia