Schizophrenia

July 20, 2012 by Dr. Tangen Leave a Comment

The schizophrenias

It’s difficult to tell if the voices I hear are inside or outside of me.

The schizophrenias are a group of mental disorders that greatly impact individuals. They are unique from other disorders because of the difficulties in perception, thinking and emotional stability. With schizophrenia, it is hard to tell what is real and what isn’t. Characterized by hallucinations and delusions, schizophrenia is chronic, severe and disabling condition. There is no clear cause and no known cure. Here’s what is included in this lesson:

types of schizophrenia
causes of schizophrenia
symptoms & treatments

Read chapter 15 of Kalat’s Biological Psychology

Here are the resources you need:

cluster
slides
terms
notes
quiz
video

SLIDES

TERMS

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abnormalities of perception
adopted children
aggravaters
agitated movements
agranulocytosis = loss of white blood cells
aliens
amino acid
amphetamine
antipsychotic drugs
Aripiprazole (Abilify)
atypical antipsychotics
brain abnormalities
brain development
catatonic
childhood infections
Chlorpromazine (Thorazine)
Clozapine (Clozaril)
cocaine
cognitive symptoms
DA agonists
DA antagonists
DA receptor blockers
delusions
dementia praecox
dendritic spines
DISC1 gene
disorganized schizophrenia
disorganized speech
disorganized thinking
distorted thinking
disturbed emotions
dopamine hypothesis
dorsolateral prefrontal cortex
environmental causes
environmental trigger
episodes
equator
false sensory experiences
flat affect
flu (or other viral illness)
fluid speech
Fluphenazine (Prolixin)
foreground-background
fraternal twins
genetic hypothesis
glutamate hypothesis
hallucinations
Haloperidol (Haldol)
hebephrenic schizophrenia
hippocampus
hyperemotional
identical twin
incidence
infection hypothesis
lack of persistence
lack of pleasure
long-term drug treatment
low birth weight
LSD
marijuana
monozygote
movement disorders
negative symptoms
neologisms = new words
neurodevelopmental hypothesis
new drugs
nicotine
nonsense words
nutrition
obsessed
Olanzapine (Zyprexa)
old egg-sperm theory
Paliperidone (Invega)
paranoid delusions
paranoid schizophrenia
Perphenazine (Etrafon)
Phencyclidine (PCP)
Phenothiazines
positive symptoms
poverty of speech
prodromal = pre-symptoms
Quetiapine (Seroquel)
relapse
Rh factor
Risperidone (Risperdal)
schizophrenic art
season-of-birth effect
self medication
self-diagnosis as bipolar
self-isolation
side effects
spontaneous movement
suicide risk
tardive dyskinesia
The Schizophrenias
thiamine deficienc
thought blocking
thought disorders
thought insertion
Three-Factor Model
tremors
undifferentiated schizophrenia
unusual thoughts
ventricles
Ziprasidone (Geodon)

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NOTES

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Psychotic disorders
“The Schizophrenias”
1% incidence
More likely in US & Europe
- 10 to 100 times
Slightly more common in men
Earlier onset, more severe
Originally: dementia praecox
- Eugen Bleuler called it schizophrenia in 1911
Starts as teens or early adult
- Typical onset 16 to 30
- Uncommon onset over 45
Symptoms vary
- Seem OK until share thoughts
- Sit without moving…for hours
Episodes
- Typical: not more than 6 weeks
- Symptoms come & go
- Hallucinations
  - Lasts a few days
  - Feel agitated
- Delusions
  - Lasts a few months
Range of severity
- Hospitalized
- Meaningful lives in communities
3-Factor Model
- Disorganized thinking
- Distorted thinking
  - Delusions & hallucinations
- Disconnected mind-motor
  - Spontaneous movement
  - Fluid speech
  - Self control
Positive symptoms
- Unique to schizophrenia
  - Not schiz without them
- Delusions
  - Unusual false beliefs
    - Martians are controlling me
  - Reading my mind
  - Thought insertion
    - “I killed someone”
  - Behavior controlled by
    - People on TV or movies
    - Special messages
    - Magnetic waves
    - Aliens
  - Believe you are someone else
    - Often historical person
  - Someone out to get you
    - Paranoid delusions
    - Spying, plotting, cheating
- Hallucinations
  - False sensory experiences
    - See things not there
      - See invisible objects or people
    - Hear voices not there
      - Voices are most common
      - Hear multiple voices
      - Talk to invisible person
      - Voices talk to each other
    - Feel invisible fingers touching
    - Smells
- Thought disorders
  - 1. Disorganized thinking
    - organizing thoughts
    - connecting thoughts
    - garbled talk
  - 2. Thought blocking
    - Stop in middle of thought
    - Feel thought taken out head
  - 3. Nonsense words
    - Neologisms = new words
    - Disorganized speech
      - Rambling sentences
      - Incoherent patterns
- Movement disorders
  - Agitated movements
  - Repeat motions over and over
  - Catatonic = immobility
  - Rare—treated with drugs
Negative symptoms
- Occur in other disorders
- Flat affect
  - face immobile
  - monotonous voice
- Similar to brain damage
  - poor control of eye movements
  - unusual facial expressions
- Negative = lack of
  - Lack of pleasure
  - Lack initiative & planning
  - Poor hygiene
  - Lack of persistence
  - Social withdrawal
  - Poverty of speech
    - Lacks fluidity of speech
    - Words don’t flow
  - Don’t talk much
    - Even when forced
Cognitive symptoms
- Difficult to notice
- Executive functioning
- Trouble switching tasks
- Trouble paying attention
- Trouble with working memory
- Disturbed emotions
  - Hyperemotional
  - Depressed
  - Flat affect (no emotion)
Abnormalities of perception
- Schizophrenic Art
  - No foreground-background diff
  - Obsessed with certain objects (skulls)
  - Emotionally distant
  - Dark silhouettes
  - Watchful eyes
  - Fragments
  - Characteristic of LSD
Types of Schizophrenia
- 1. Disorganized
  - “Hebephrenic schizophrenia”
  - Inappropriate thoughts & behavior
  - Don’t make sense
  - Severe
  - Can’t do routine daily activities
    - bathing & meal prep
  - Hard to understand what say
  - Frustration, agitation, anger
- 2. Catatonic
  - Extremes
  - Coma-like daze
  - or
  - Talk in bizarre-hyperactive way
  - May last month+
  - Easily treated with drugs
  - Can be caused by non-schiz
- 3. Paranoid
  - Delusions
    - Someone trying to harm you
    - Hear voices plotting
  - Not as many memory problems
  - Okay concentration
  - Handle daily life okay
  - Suicide risk
- 4. Undifferentiated
  - Not meet all criteria
  - Miscellaneous
  - Junk term
Causes of Schizophrenia
- Genetics
  - Heritability
    - Runs in families
  - Environmental trigger?
  - Old egg-sperm theory
    - Older parents more schiz children
  - Children of schiz patients
    - Less than ½ become schiz
  - Inherit susceptibility to environmental factors?
    - People without family history can develop schizophrenia
Why likely genetic component
- Men & women about equal
  - Men slightly more
  - Men have earlier onset
  - Men have more severity
- About 1% worldwide
Runs in families
- 1% in general population
- 10% when parent or sibling
- 15% in fraternal twin
- 50% when identical twin
Pure genetic effect = 100%
- greatest environmental similarity
- monozygote
Adopted Children
- 12.5% siblings in same environ.
- None adopted had schiz
Correlated factors
- Women with schizophrenia
- drink & smoke during preg?
Not one single gene
- 10+ genes are more common in schizophrenics
- DISC1 gene
  - (disrupted in schizophrenia 1)
  - Controls production of dendritic spines
  - Controls generation of new neurons in hippocampus
- Other genes linked to
  - brain development
  - glutamate synapses
  - hippocampus & prefrontal cortex connections
- Combo
Dopamine hypothesis
- Over-activity of DA synapses
- In mesolimbic pathway?
- DA agonists-antagonist effects
- All treatment drugs block DA receptors
- Chlorpromazine
  - Originally used to prevent surgical shock
  - Dramatically effective
  - Reduces symptoms of schizophrenia
- DA agonists cause schiz sympts
  - Cocaine
  - Amphetamine
  - L-DOPA
  - Elation, euphoria
  - Similar to start schiz. episode
- Paranoid delusions
  - Maybe caused by increased DA input to amygdala
    - involved with emotional responses for aversive events
  - Clozapine
    - atypical antipsychotic drug
    - blocks D4 receptors
    - in nucleus accumbens
      - Part of the reward circuit
- Caused by excess activity at some dopamine synapses
  - Evidenced by
    - Drugs that help
    - Drugs that aggravate
  - Aggravaters
    - Cocaine
    - Amphetamine
    - LSD
    - Dopamine not cleaned up?
    - Schiz have twice as many D2 receptors occupied by dopamine as normal
- Dopamine not sole cause
  - Drugs that block dopamine receptors
    - do so immediately
  - but effects on behavior build up
    - gradually over 2 or 3 weeks
Glutamate Hypothesis
- Caused by poor glutamate functioning
  - dopamine inhibits glutamate
- Mixed evidence
  - Release less glutamate
    - in prefrontal cortex & hippocampus
    - have fewer glutamate receptors
  - Phencyclidine (PCP)
    - blocks NMDA glutamate receptors
    - produces symptoms similar to schiz
    - induces both negative and positive symptoms
  - Doesn’t produce psychosis in preadolescents
    - produces more severe symptoms than schiz
- Risky to increase glutamate
  - Too widely used
  - Don’t stimulate directly
  - Working on glycine
    - amino acid
    - enhances NMDA effects
    - not effective antipsychotic
    - increases antipsychotics effects
Brain Abnormalities
- MRI & CT studies
  - Found loss of brain tissue in patients with schizophrenia
- Ventricles
  - Relative size of lateral ventricles
  - 2+ size of control subjects
- Mild Brain Abnormalities
  - Less than average gray matter
  - Larger than average ventricles
  - Smaller thalamus
  - Left hemisphere slightly larger
- Worst in
  - Left temporal lobe & frontal lobe
    - Immature or poorly developed
    - dorsolateral prefrontal cortex
  - Deficits in memory & attention
  - Smaller cell bodies
    - in frontal cortex & hippocampus
  - Environmental Causes
    - Famine during pregnancy
      - (especially thiamine deficiency)
Predictors
- More likely if mother underweight
- More likely if low birth-weight
- More likely if Rh incompatible
Nneurodevelopmental hypothesis
- Schiz caused by abnormalities to nervous system during prenatal or neonatal periods
- Prenatal and Neonatal
  - Mother’s nutrition
  - Premature birth
  - Low birth weight
  - Complications during delivery
  - Rh-negative & baby Rh-positive
    - may trigger immunological rejection by mother
    - hearing deficits
    - mental retardation
    - twice usual probability of schiz
    - 2%
Season-of-birth effect
- Winter, slightly greater
- Nutrition
- viral infections
  - fever and influenza
Infections
- Flu (or other viral illness)
- More likely if born during late winter and early spring
- More likely in cities than countryside
- More likely far from equator
- Decreased winter temp?
- Childhood infections
  - Such as toxoplasma gondii
    - memory disorders, hallucinations, and delusions
    - bacteria only reproduces in cats
    - more likely to have a pet cat
Diagnosis of Schizophrenia
- Confused with drug abuse
- Can’t show abuse causes schiz
- More likely to abuse drugs
  - Self medication
  - Makes treatment less effective
Prodromal = pre-symptoms
- Self-isolation
- Increased unusual thoughts
- Increased suspicions
- Family history of schiz
Self-diagnosis as bipolar
- Or something “less sever”
Drugs can help-hurt
- Some drugs make it worse
- Marijuana
- Amphetamines
- Cocaine
- Smoking
  - 3x likely addicted to nicotine
  - 90% in schiz
  - Schiz worse during withdrawal
Some drugs make it better
- Chlorpromazine (Thorazine)
  - 1st drug successful
  - Antipsychotic drugs
  - Primarily work by blocking dopamine receptors
- Phenothiazines
  - class of neuroleptic drugs
  - includes chlorpromazine
- Try several medications
  - Not all work the same for all
  - Best combination, right dose
Relapse
- Stop taking meds
- Feel better, think don’t need
- Interact with other drugs
- Interact with alcohol
Antipsychotic medications
- Available since mid-1950’s
  - Chlorpromazine (Thorazine)
  - Haloperidol (Haldol)
  - Perphenazine (Etrafon)
  - Fluphenazine (Prolixin)
- Available since mid-1990’s
  - “atypical” antipsychotics
  - Clozapine (Clozaril)
    - psychotic symptoms
    - Hallucinations; breaks with reality
    - Side effect for clozapine
  - Agranulocytosis = loss of white blood cells
  - Risperidone (Risperdal)
  - Olanzapine (Zyprexa)
  - Quetiapine (Seroquel)
  - Ziprasidone (Geodon)
  - Aripiprazole (Abilify)
  - Paliperidone (Invega)
Old & new ones about equally effective
Side effects
- Worse when start
- Last few days for most
- Dizzy when changing positions
- Blurred vision
- Drowsiness
- Rapid heartbeat
- Sensitivity to the sun
- Skin rashes
- Major weight gain
- Rigidity of joints
- Muscle spasms
- Restlessness
- Tremors
- Tardive dyskinesia
  - Caused by long term use
  - Can’t control mouth muscles
- Tremors & involuntary move
  - Caused by prolonged blocking of dopamine receptors in basal ganglia
Antipsychotic medications
- Usually in pill or liquid form
- Some are shots given monthly
New Drugs
- Atypical medications
- Mesolimbocortical system
- Where antipsychotics impact?
  - Set of neurons
  - Project from midbrain tegmentum to limbic system
  - Don’t cause movement problems
  - Less intense effects on dopamine type D2 receptors
  - Stronger effects at D4 and serotonin 5-HT2 receptors
- More effective?
  - Better with positive symptom
  - Not so much with negative
  - Don’t improve overall quality of life any better
Long-term drug treatment
- Antipsychotic drugs not cure
- Don’t fully treat condition
- Don’t work for 1/3 of patients
- Serious side effects
  - Similar symptoms to Parkinson’s disease
  - Slow movement, lack of facial expression, general weakness

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QUIZ

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Schizophrenia

It’s difficult to tell if the voices I hear are inside or outside of me.

SLIDES

TERMS

NOTES

QUIZ

VIDEO

DISCUSSION ITEM

It’s difficult to tell if the voices I hear are inside or outside of me.

SLIDES

TERMS

NOTES

QUIZ

VIDEO

DISCUSSION ITEM

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