Schizophreniaand

dementias

Do Now

• Word dump– Write down all words

(preconceptions) about “schizophrenia” that come to mind

A conversation between two people diagnosed with Schizophrenia

People with schizophrenia say and do things that other people can find difficult to understand.

A: Do you work at the air base?B: You know what I think of work. I’m 33 in June, do you mind?A: June?B: 33 years old in June. This stuff goes out the window after I leave this, uh -- leave this hospital.

So I can’t get my vocal cords back. So I lay off the cigarettes. I’m in a spatial condition, from outer space myself…

A: I’m a real spaceship from across.B: A lot of people talk that way, like crazy, but “Believe It or Not” by Ripley, take it or leave it -- alone

-- it’s in the Examiner, it’s in the comic section, “Believe It or Not” by Ripley, Robert E. Ripley, Believe it or not, but we don’t have to believe anything, unless I feel like it. Every little rosette -- too much alone.

A: Yeah, it could be possible.B: I’m a civilian seaman.A: Could be possible. I take my bath in the ocean.B: Bathing stinks. You know why? ‘Cause you can’t quit when you feel like it. You’re in the

service.

A Schizophrenic Soliloquy“How long have you been here?”

“I’ve been on this property on and off for a long time. I cannot say the exact time because we are absorbed by the air at night, and they bring back people. They kill everything; they can make you lie, talk through your throat”

“What is the name of this place?”

“This place is a star. At first it was a colony. They said it was heaven. These buildings were not solid at the time, and I am positive this is the same place. They have others just like it. People die and all the microbes talk over there, and prestigis you know is sending you from there to another world. I was sent by the government to the United States to Washington to some star and they had a pretty nice country there. Now you have a body like a young man who says he is of the prestigis”

“Who was this prestigis?”

“Why, you are yourself. You can be prestigitis. They make you say bad things, they can read you, they bring back Negroes from the dead”

What are the criteria for a Schizophrenia diagnosis?

• According to the DSM-IV, to be diagnosed with Schizophrenia, a person must:

– Show a long-term, serious decline in ability to work, care for himself/herself, and socially connect with others.

– Have two of the following Positive Symptoms:• Delusions• Hallucinations• Disorganized Speech• Grossly Disorganized (or catatonic) Behavior

– Negative Symptoms• Worsening cognitive abilities or physical behavior

Schizophrenia = “split mind”

Some General Facts• Approximately 1% of the US population suffers from

schizophrenia.• The proportion of men and women with schizophrenia is about

equal, but onset is much earlier for men (late teens vs. early twenties for women).

• Schizophrenia accounts for over 50% of the patients in mental hospitals in the USA, and 35-50% of the homeless population.

• Treatment and aid for people with Schizophrenia costs the federal government billions of dollars each year.

• Approximately 10% of people with schizophrenia commit suicide.

What are the symptoms of Schizophrenia?

Schizophrenia’s symptoms vary greatly among patients, but include some of the following:

• Delusions – beliefs that are held despite evidence to the contrary.

- Delusions of Persecution (Paranoid delusions) -- the belief that one is being cheated, harassed, or conspired against. (such as the belief that a doctor intends to poison the patient)

- Delusions of Reference – the belief that one’s behavior is controlled by an outside source, or that a neutral environmental stimulus is directed only towards oneself. (such as a TV announcer speaking directly to the patient)

- Delusions of Grandeur – the belief that one is a famous or important figure. (such as the president or Jesus)

What are the symptoms of Schizophrenia?

Hallucinations – perceptual experience without sensory stimulation.

In Schizophrenia, hallucinations are typically auditory. People with Schizophrenia often hear voices coming from their own minds. The voices can describe the patient’s activities, carry on a conversation, warn of impending dangers, or even issue orders.

What are the symptoms of Schizophrenia?

• Disorganized Speech

– Word Salad – A set of words and phrases that together have no meaning.• “I feel great… no sale… keep it up…new window…”

– Overinclusion – When a patient jumps from one idea to another illogically, often based on word associations. • “I wish you a happy, joyful…fruitful year, and many good wine-years…a

good apple year, and sauerkraut and cabbage, and squash and seed year…”

– Neologisms – Words that only have meaning to the speaker.• “I’m afraid to go there because the norks are looking for me.”

– Clang Associations – The meaningless rhyming of words.• “think pink ink ring sing”

– Glossolalia – mimicking and repeating another person’s words.• Nurse: “How are you feeling?” Patient: ”How are you feeling?”

What are the symptoms of Schizophrenia?

Grossly Disorganized Behavior – behaviors that are strikingly inappropriate for a situation, or very ineffective in achieving a goal.

Catatonic Behavior – periods of unresponsiveness to surroundings, which can be active resistance or a lack of movement and awareness.Inappropriate Emotionality – bizarre, inappropriate outbursts

What are the symptoms of Schizophrenia?

• Negative symptoms – A reduction in expected behaviors, thoughts, feelings, and drives.– slowing of body movements– apathy, social withdrawal (asociality)– inability to experience pleasure (anhedonia)– poverty of speech (slow, labored speech containing little

informational content)– flat affect ( absence of emotion in speech)– Decrease information processing

• Difficulty with attention and filtering out irrelevant information in a story

• Unable to remember sources of new information

What are the types of Schizophrenia?

• Disorganized– Symptoms: personality deterioration, speaking gibberish, dressing

and acting outrageously, performing ritualized movements, laughing oddly and inappropriately.

• Catatonic– Symptoms: unusual motor behavior, alternating between “catatonic

excitement” (frantic pacing, incoherent speech) and “catatonic stupor” (becoming mute, and “frozen”).

• Paranoid– Symptoms: hallucinations, delusions, suspiciousness,

argumentativeness• Undifferentiated

– Symptoms: A set of symptoms that does not fit any of the other categories.

What are the causes of Schizophrenia?

What do psychologists of different perspectives believe causes Schizophrenia?

Biological Psychodynamic Behavioral Cognitive Socio-cultural

-There are some genetic influences on schizophrenia, but nobody knows how much. -Dopamine hypothesis: overactivity in the synapses where dopamine is the neurotransmitter leads to schizophrenia- Atrophy of brain tissue creates enlarged cerebral ventricles.

- Failure to overcome dependence on the mother, leads people to become fixated at the oral stage and exhibit behavior associated with that stage.

- Assumes that people with schizophrenia have somehow been rewarded for behaving in bizarre ways.

-Schizophrenia is a failure of selective attention.

- There is a correlation between attention problems in childhood and schizophrenic behavior in adulthood.

- Children who grow up in homes where parents have disorganized or highly emotional behavior are at a higher risk for the illness if they have genetic predisposition

Schizophrenia, Genes and Environment• Genes

– Twin studies: 28% of diagnosis of other twin suffers from schizophrenia, but it is always difficult parsing out heredity and environment

• Environment– Stressors: trigger onset of those

preconditioned– Increased susceptibility if living in urban area– Family environments defined by

disorganized, emotional communication on the part of the parents had a higher incidence than family environments that did not (twins in separate environments that were already high risk)

• Critical prenatal period: Deprivation of food during critical period in development

Culture and Schizophrenia

• Symptoms– Feelings of guilt over delusions associated with Judeo-Christian cultures, as are religious hallucinations. These symptoms are rare in Islamic

and Buddhist societies. – Schizophrenics in Pakistan are more likely to have visual hallucinations– British schizophrenics are more likely to hear persecuting voices– South Asian schizophrenics report less delusions of grandeur, whereas patients in the United States have the highest incidents of such

symptoms.• Recovery

– 40% of patients remain “severely impaired” in western nations, only 24% do so in poorer countries.• Possible mechanisms:

– Expressed Emotions (EE): if people around are highly expressive in sharing emotions about person’s illness, it can cause stress and intensify the experience. EE varies by social group and culture (relapse rates are three to seven times as high in high EE families).

– Locus of Control: western countries value an internal locus of control so when people are sharing ideas/opinions about person suffering from schizophrenia, it tends to be in a way that indicates that the sufferer has some control or influence on the disease.

“In sum, what we know about culture and schizophrenia is… [that] culture is critical in nearly every aspect of schizophrenic illness experience; the identification, definition, and meaning of the illness during the primordial, acute and residual phases; the time and type of onset, symptom formation in terms of content, form and constellation; clinical diagnosis; gender and ethnic differences; the personal experience of schizophrenic illness; social response, support and stigma; and perhaps most important, the course and outcome with respect to symptomatology work and social functioning” (Jenkins & Barrett).

Dementias

Dementias• Degenerative

– Pathological processes of CNS

– Tend to affect single neural system

– Often hereditary

• Nondegenerative– Diverse– Extrinsic causes, such as

through exposure to toxic materials

Alzheimer’s Dementia

• Insidious cognitive decline over many years– Memory

• Recent and then remote

– Attention• Inability to focus

– Language• Semantics decline but not syntax remains

AD Pathology

• Clear damage and degeneration of neurons and tracts– Amyloid placques– Neurofibrillary tangles

Causes of AD

• Genetics– 3 genes (B-APP, presenilin1, presenilin2)

• Trace metals (Aluminum)

• Virus (Creutzfeldt-Jakob disease)

• Autoimmune reaction

Huntington’s Chorea• Progressive intellectual

deterioration (dementia)• Fatal• Genetic

– Degeneration of neurons in basal ganglia (caudate and putamen)

• Occurrence: 4-10 in 100,000

Parkinson’s Disease• Progressive motor and

cognitive decline

– Executive function

• Substantia nigra

– Unable to regulate movement

– Muscles and neurons governing them are no longer inhibited

– Loss of incoming dopamine neurotransmitter

• 0.1%-1% population

PD

• Positive symptoms– Resting tremor– Muscular rigidity– Involuntary movements

• Negative symptoms– Posture– Righting– Locomotion– Speech

Treatment of PD

• L-dopa– Dopamine (precursor) replacement

• Transplantation of fetal DA cells