SCHIZOPHRENIA

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SCHIZOPHRENIA

• Rachel Criddle
• Beth Smith
• Elizabeth Downs
• Sara Miller
• Lara Kim

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Schizophrenia

• Definition Serious brain disorder that distorts
  the way a person thinks, acts, and perceives
  reality.
• S/S
• Beliefs not based in reality (delusions)
• Hallucinations
• Incoherent speech
• Lack of emotions
• Catatonic behavior
• Angry outbursts
• Trouble functioning at school and work

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Schizophrenia

• Dx
• Presence of at least two of these
• delusions, hallucinations, disorganized speech,
  disorganized or catatonic behavior, or presence
  of negative symptoms
• Significant impairment in the ability to work,
  attend school or perform normal daily tasks
• Signs last for at least six months
• Other mental health disorders have been ruled out

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Types of Schizophrenia

• Paranoid-type schizophrenia - delusions
  and auditory hallucinations but relatively normal
  intellectual functioning and expression of
  affect.
• Disorganized-type schizophrenia - speech and
  behavior are disorganized or difficult to
  understand, and flattening or inappropriate
  emotions.
• Catatonic-type schizophrenia - disturbances of
  movement, may keep themselves completely immobile
  or move all over the place.
• Undifferentiated-type schizophrenia is
  characterized by some symptoms seen in all of the
  above types but not enough of any one of them to
  define it as another particular type of
  schizophrenia.
• Residual-type schizophrenia - a past history of
  at least one episode of schizophrenia, but the
  person currently has no positive symptoms.

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The Schizophrenic Brain

• Cortical (mildly impaired)
• Subcortical (heavily impaired)
• Relatively Unimpaired

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Neurotransmitters

• GABA
• Dopamine
• glutamate

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Treatment

• No cure for schizophrenia
• Antipsychotic medication
• Thorazine, Haldol, Etrafon, Prolixin
• Clorazil
• Risperdal, Zyprexa, Seroquel, Serdolect, Geodon

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Important Info

• Common Adverse Effects
• Drowsiness, dizziness, blurred vision, rapid
  heart beat, menstrual problems, photosensitivity,
  and skin rashes
• Take medications regularly, and do not stop cold
  turkey
• Relapse
• Implication of smoking

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What Causes Schizophrenia? Nature vs.
Nurture

• Combination of influences
• Biological
• Physiological
• Psychological
• Environmental factors.

Source Presentation by Dr. Ira Glick,"New
Schizophrenia Treatments" - Stanford University
Schizophrenia and Bipolar Education Day, July 2005
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Biological Influences

• Biochemical
• Dopamine Hypothesis
• Disease is caused by excess of dopamine-dependent
  neuronal activity in the brain.
• Abnormalities in other neurotransmitters
  suggested.
• Genetics
• Genes increase chance of becoming ill they DO
  NOT cause the illness
• Scientist suspect over 20 genes linked to
  schizophrenia

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Genetics and Schizophrenia
(Image Source Debby Tsuang, M.D., M.Sc.,
University of Washington, www.schizophrenia.com)
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Physiological Influences

• Viral Infections
• High incidence of schizophrenia after prenatal
  exposure to influenza.
• Possible association between viral infections of
  CNS during childhood and adult-onset
  schizophrenia
• Anatomical Abnormalities
• Brain abnormalities Ventricular and sulci
  enlargement and cerebellar atrophy.
• Histological Changes
• Disarray of pyramidal cells in the hippocampus.
• Possibly dues to prenatal influenza encounter
  during 2nd Trimester

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Psychological Influences

• Early theories focused on family relationship
  factors as the major influences on development of
  the illness
• Poor parent-child relationships
• Dysfunctional family systems
• Researchers are now focusing studies more in
  terms of schizophrenia as a brain disorder.

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Environmental Influences

• Social Cultural Factors
• Studies have attempted to like schizophrenia to
  social classes.
• Stressful Life Event
• Stress may contribute to the severity and course
  of the illness
• Extreme stress can precipitate psychotic episodes
  and can precipitate symptoms in individuals who
  have a genetic vulnerability to schizophrenia.

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Coping Mechanisms

• Non-pharmaceutical approaches

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Cognitive Behavior Therapy

• To prevent relapse and reduce symptoms
• Helps patients cope with residual or medication
  resistant symptoms
• Decreases distress

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CBT

• Hallucinations Auditory
• Result of an individual misattributing inner
  speech
• Distraction, normalizing rationale, focusing,
  rational responding
• Delusions and Unusual beliefs
• Belief modification, rational responding,
  normalizing
• Relapse Prevention
• Schema-focused intervention, developing a
  blueprint, prodromal monitoring

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Family

• Realizing schizophrenia is a
• disease, not someones fault
• Support from other family members and friends
• Mutual support groups in the community
• Professional help
• Education and role clarity
• Symptom control
• Direct services for the ill-sibling
• Long-term planning, monitoring symptoms and
  medications, alternative living arrangements,
  community resources

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Quality of Life factors

• Social support
• Attachment close personal relationships
• Reassurance of worth
• Coping
• Strategies
• Changing the situation
• Appraisal
• Sociodemographics
• Education
• Clinical
• Lifetime length of hospitalizations

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Prevalence of Schizophrenia

• Schizophrenia affects 1 to 2 of the population
  in the United States.
• Equally prevalent in both sexes.
• Schizophrenia often first appears in men in their
  late teens or early twenties
• In contrast, women are generally affected in
  their twenties or early thirties

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Famous People with Schizophrenia

• John NashMathematics, Nobel Prize in Economics
• Jack Kerouac American Novelist
• Brian Wilson Lead songwriter for The Beach Boys
• Mary Todd Lincoln wife of Abraham Lincoln

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New Research on Schizophrenia
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Rare Chromosomal Deletions and Duplications Found
to Increase Risk

• Long standing consensus genetic factors
• account for 73-90 of schizophrenia
• First large-scale genome-wide survey -
• tripled the number of areas in the human
• genome definitely linked to schizophrenia
• Support for old findings
• Deletions found on chromosome 22
• New findings
• Associations with schizophrenia were also found
  for large deletions on chromosomes 1 and 15
• Significance provides insight into rare
  structural genetic variation which may result in
  improved Dx, Tx, and prevention

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Immature Brain Linked to Schizophrenia

• Japanese researchers found that the dentate gyrus
  remained immature in an animal model of
  schizophrenia
• Located in the hippocampus, the dentate gyrus is
  thought to be responsible for working memory and
  mood regulation
• Significance
• Biomarkers that characterize a single
  subpopulation of a specific psychiatric disorder
  are essential for increasing the understanding of
  the pathogenesis/pathophysiology of such
  disorders
• Immature dentate gyrus a biomarker that may
  help produce new Dx Tx for schizophrenia
  patients

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Stress During Pregnancy May Predispose
Schizophrenia

• Pregnant women who endure the psychological
  stress of being in a war zone are more likely to
  give birth to a child who develops schizophrenia
• Evidence suggests human vulnerability may be
  greatest in the 1st trimester
• Evidence suggests the pattern is gender-specific
• affecting females more than males
• Theory Placenta is very sensitive to the
• mothers stress hormones, which were
• probably amplified during war time

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Exercise May Improve
Schizophrenia

• Findings mental and physical exercises can
  improve behaviors associated with schizophrenia
• Lab mice demonstrated significant improvements
  with enhanced mental and physical exercise
• Wait a minute! How can a mouse have
  schizophrenia?!?
• An anti-psychotic drug used by humans also
  improved the mouses condition, indicating that
  this mouse is a valid model
• for schizophrenia in humans
• Significance
• This discovery could pave the way for the
• development of better treatments for
  schizophrenia

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Resources

• BioMedCentral.com
• ScienceDaily.com
• MayoClinic.com
• Nature.com
• WebMD.com
• Schizophrenia

• PsychCentral.com Immature Brain
• PsychCentral.com - Pregnancy
• PsychCentral.com - Exercise
• Wikipedia- Famous Individuals
• National Institute of Mental Health
• Signs of Schizophrenia

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References

• Caron, J., Lecomte, Y., Stip, E., Renaud, S.
  (2005). Predictors of quality of life in
  schizophrenia. Community Mental Health Journal,
  41, 399-417.
• Chien, W. T., Chan, S., Morrissey, J.,
  Thompson, D. (2004). Effectiveness of a mutual
  support group for families of patients with
  schizophrenia. Journal of Advanced Nursing, 51,
  595-608.
• Friedrich, R. M., Lively, S., Rubenstein, L. M.
  (2008). Siblings coping strategies and mental
  health services A national study of siblings of
  persons with schizophrenia. Psychiatric
  Services, 59, 261- 267.
• James, A. (2008, September). Schizophrenia A
  case of nature or nurture?. Mental Health
  Today, Retrieved October 15, 2008, from CINAHL
  with Full Text database.
• Townsend, M.C. (2008). Essentials of Psychiatric
  mental health nursing Concepts of care in
  evidence-based practice (4th ed.). Philadelphia
  F.A. Davis.
• Townsend, M.C. (2008). Nursing diagnoses in
  psychiatric nursing Care plans and psychotropic
  medications (7th ed.). Philadelphia F.A. Davis.
• Wilson, M. (2007). Cognitive behavioral therapy
  for risk management in schizophrenia. Nursing
  Standard, 21, 35-40.