Is schizophrenia a disorder ofIs schizophrenia a disorder ofmind or body?mind or body?

A mental disorder with changes A mental disorder with changes in perceptions, emotions, in perceptions, emotions, thoughts, and consciousnessthoughts, and consciousness

http://www.youtube.com/watch?v=bWaFqw8XnpA

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Axis I – Schizophrenia - Axis I – Schizophrenia - SymptomsSymptoms

symptoms of schizophrenia are symptoms of schizophrenia are positivepositive or or negativenegative

positive = additional behaviour/experiencepositive = additional behaviour/experience negative = absence of behaviour/experiencenegative = absence of behaviour/experience Positive SymptomsPositive Symptoms

hallucinations – false sensory experienceshallucinations – false sensory experiences bizarre delusions – false beliefsbizarre delusions – false beliefs incoherent speechincoherent speech inappropriate/disorganized behavioursinappropriate/disorganized behaviours

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Axis I – Schizophrenia – Axis I – Schizophrenia – Symptoms cont’dSymptoms cont’d

Negative SymptomsNegative Symptoms loss of motivationloss of motivation emotional flatnessemotional flatness social withdrawalsocial withdrawal slowed speech or no speechslowed speech or no speech loss of pleasure in activitiesloss of pleasure in activities loss of activityloss of activity

Delusions & associated Delusions & associated beliefsbeliefs

DSM-IV subtypes of DSM-IV subtypes of schizophreniaschizophrenia

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Theories of SchizophreniaTheories of Schizophrenia

Historically proposed causes: carbohydrate Historically proposed causes: carbohydrate metabolism, muscle fatigue, tooth decay, abnormality metabolism, muscle fatigue, tooth decay, abnormality of spinal fluid, blood vessel rigidity, iodine in the brain of spinal fluid, blood vessel rigidity, iodine in the brain – all seen in hospitalized schizophrenics– all seen in hospitalized schizophrenics

Current causal explanations:Current causal explanations: Genetic predispositionsGenetic predispositions Structural brain abnormalitiesStructural brain abnormalities Neurotransmitter abnormalitiesNeurotransmitter abnormalities Prenatal abnormalitiesPrenatal abnormalities Adolescent abnormalities in brain developmentAdolescent abnormalities in brain development

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Genetic Vulnerability to Genetic Vulnerability to SchizophreniaSchizophrenia

risk increases with risk increases with genetic relatedness genetic relatedness to diagnosed to diagnosed schizophrenicschizophrenic

but even identical but even identical twins are not 100% twins are not 100% concordantconcordant

genetics play a rolegenetics play a role

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Structural Brain AbnormalitiesStructural Brain Abnormalities

several abnormalities exist, especially several abnormalities exist, especially when schizophrenia characterized by when schizophrenia characterized by primarily negative symptoms:primarily negative symptoms: decreased brain weightdecreased brain weight decreased volume in temporal lobe or decreased volume in temporal lobe or

hippocampushippocampus enlargement of ventriclesenlargement of ventricles

but 25% do not have observable brain but 25% do not have observable brain abnormalitiesabnormalities

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Neurotransmitter Neurotransmitter AbnormalitiesAbnormalities

candidates: serotonin, glutamate, and dopaminecandidates: serotonin, glutamate, and dopamine many schizophrenics have high levels of brain many schizophrenics have high levels of brain

activity in dopaminergic areas and greater activity in dopaminergic areas and greater numbers of dopamine receptorsnumbers of dopamine receptors

schizophrenics have harder time filtering out schizophrenics have harder time filtering out external stimulationexternal stimulation

genetic – receptors genetic – receptors ““fooledfooled”” by nicotine by nicotine schizophrenics often heavy smokersschizophrenics often heavy smokers

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Prenatal or Birth ComplicationsPrenatal or Birth Complications

fetal brain damage increases chances of fetal brain damage increases chances of schizophrenia and other mental disordersschizophrenia and other mental disorders maternal malnutrition or illnessmaternal malnutrition or illness brain injury or oxygen deprivation at birthbrain injury or oxygen deprivation at birth maternal influenza during first 13 weeks maternal influenza during first 13 weeks

pregnancypregnancy schizophrenics have increased physical schizophrenics have increased physical

anomaliesanomalies more likely to be born in wintermore likely to be born in winter

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Adolescent Abnormalities in Adolescent Abnormalities in Brain DevelopmentBrain Development

normal pruning of excessive normal pruning of excessive synapses during adolescencesynapses during adolescence

schizophrenics show greater synaptic schizophrenics show greater synaptic pruningpruning first episode occurs in adolescence or first episode occurs in adolescence or

early adulthoodearly adulthood

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Axis II - Personality Axis II - Personality DisordersDisorders

Personality DisordersPersonality Disorders Rigid, maladaptive patterns of behaviour, emotions, and Rigid, maladaptive patterns of behaviour, emotions, and

thinking that cause personal distress or inability to get thinking that cause personal distress or inability to get along with othersalong with others

cannot adjust behaviour to situationcannot adjust behaviour to situation begins early in lifebegins early in life less likely to be happy, have a happy marriage, be a less likely to be happy, have a happy marriage, be a

good parentgood parent more likely to get into trouble with law, at work, in more likely to get into trouble with law, at work, in

relationships, substance abusing, depressed, self-relationships, substance abusing, depressed, self-harmingharming

comorbidity occurs frequentlycomorbidity occurs frequently

Axis II - Personality Disorders Axis II - Personality Disorders cont’dcont’d

Three clusters:Three clusters:1.1. Odd or EccentricOdd or Eccentric

2.2. Dramatic, Emotional, ErraticDramatic, Emotional, Erratic

3.3. Anxious or FearfulAnxious or Fearful

up to 15% of adults have one or moreup to 15% of adults have one or more

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Axis II – Personality Axis II – Personality Disorders – Odd or EccentricDisorders – Odd or Eccentric Paranoid Personality DisorderParanoid Personality Disorder

characterized by habitually unreasonable and characterized by habitually unreasonable and excessive suspiciousness and jealousyexcessive suspiciousness and jealousy

Schizoid Personality DisorderSchizoid Personality Disorder indifferent to and avoids relationships, lacks indifferent to and avoids relationships, lacks

empathy, flat affect, detachedempathy, flat affect, detached Schizotypal Personality DisorderSchizotypal Personality Disorder

perceptual dysfunction, magical thinking, perceptual dysfunction, magical thinking, eccentric dress and speech, indifferent to eccentric dress and speech, indifferent to othersothers

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Axis II – Personality Disorders – Axis II – Personality Disorders – Dramatic, Emotional, ErraticDramatic, Emotional, Erratic

Narcissistic Personality DisorderNarcissistic Personality Disorder exaggerated sense of self-importance, self-exaggerated sense of self-importance, self-

absorption, manipulative, excessive anger to absorption, manipulative, excessive anger to criticism, lacks empathycriticism, lacks empathy

http://www.youtube.com/watch?v=f9jRDHGabp8

Borderline Personality DisorderBorderline Personality Disorder stormy relationships, fear of abandonment, dramatic stormy relationships, fear of abandonment, dramatic

mood and opinion changes, feels empty inside, self-mood and opinion changes, feels empty inside, self-harmingharming

http://www.youtube.com/watch?v=_-nQ7qWO6Tshttp://www.youtube.com/watch?v=_-nQ7qWO6Ts

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Axis II – Personality Disorders – Axis II – Personality Disorders – Dramatic, Emotional, ErraticDramatic, Emotional, Erratic

Histrionic Personality DisorderHistrionic Personality Disorder overly dramatic, attention-seeking, temper tantrums, overly dramatic, attention-seeking, temper tantrums,

false sense of intimacy, demanding and manipulativefalse sense of intimacy, demanding and manipulative http://www.youtube.com/watch?v=ib5gqnNL_yshttp://www.youtube.com/watch?v=ib5gqnNL_ys

Anti-Social Personality DisorderAnti-Social Personality Disorder lying, stealing, manipulating others, and sometimes lying, stealing, manipulating others, and sometimes

violenceviolence lack of guilt, shame and empathylack of guilt, shame and empathy 3% of males and 1% of females3% of males and 1% of females more extreme form = more extreme form = psychopathypsychopathy http://www.youtube.com/watch?v=iPuxDYOWvj0http://www.youtube.com/watch?v=iPuxDYOWvj0

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Axis II – Personality Disorders – Axis II – Personality Disorders – Anxious and FearfulAnxious and Fearful

Obsessive-Compulsive Personality Disorder Obsessive-Compulsive Personality Disorder inflexible, perfectionist, controlling, detail-inflexible, perfectionist, controlling, detail-

focussed, unwilling to compromisefocussed, unwilling to compromise

Avoidant Personality DisorderAvoidant Personality Disorder inhibited and introverted, hypersensitive to inhibited and introverted, hypersensitive to

rejection, mistrustful, socially awkwardrejection, mistrustful, socially awkward Dependent Personality Disorder Dependent Personality Disorder

pervasive and excessive need to be taken care pervasive and excessive need to be taken care of, submissive, clingy, difficulty making of, submissive, clingy, difficulty making decisionsdecisions

Risk Factors for PDsRisk Factors for PDs

childhood history of abusechildhood history of abuse family history of schizophreniafamily history of schizophrenia family history of personality disorderfamily history of personality disorder childhood head injurychildhood head injury chaotic childhoodchaotic childhood

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Criticism #1Criticism #1 Too much overlap with Axis I disordersToo much overlap with Axis I disorders E.g., avoidant personality disorder E.g., avoidant personality disorder

sounds a lot like a social phobiasounds a lot like a social phobia Criticism #2Criticism #2

Only difference with a lot of personality Only difference with a lot of personality disorders from normal behavior is the disorders from normal behavior is the quantity of symptoms (i.e., symptoms in quantity of symptoms (i.e., symptoms in moderation are regarded as moderation are regarded as ‘‘normalnormal’’))

Clinical features of Clinical features of borderline borderline

personality disorderpersonality disorder