History

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History

• The word schizophrenia is less than 100 years
  old, but the illness has probably accompanied
  mankind through its history.
• Schizophrenia can be traced in written documents
  to the old Pharaonic Egypt, as far back as the
  second millennium before Christ
• Depression, dementia, as well as thought
  disturbances found in schizophrenia are described
  in detail in the Book of Hearts.
• The psychical illnesses were regarded as symptoms
  of the heart and the uterus and originating from
  the blood vessels or from purulence, fecal
  matter, a poison or demons. In most cases the
  Egyptians apparently looked upon the mental
  diseases as physical illnesses.
• The treatment comprised temple sleep, also called
  incubation. The ill persons spent the night in a
  holy place.

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The History of Schizophrenia

• Characterized by distortions perception,
  thought, language, emotions
• Greece Hippocrates had knowledge of the basic
  symptoms.
• Eugen Bleuler Swiss psychiatrist coined
  schizophrenia
• Greek words for split mind - separation of
  cognitive and emotional functions mental
  confusion, inappropriate or absent emotional
  expression.
• Not the same as multiple personality disorder
• Heinz Leshmann chlorpromazine, first modern
  anti-psychotic drug made positive symptoms
  disappear.

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Symptoms

• Familiar things like colors, sounds, or tastes
  may appear altered in a strange way.
• At first, symptoms may include mild feelings of
  tension, inability to sleep or concentrate, and a
  loss of interest in school, work, or friends.
• The symptoms of schizophrenia vary from one
  person to another, and they can appear either
  gradually or suddenly
• As the illness progresses, people with
  schizophrenia experience symptoms that include
  psychosis. The person incorrectly evaluates the
  accuracy of his or her perceptions and thoughts
  and makes incorrect conclusions about reality.

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Symptoms

• Positive symptoms common schizophrenia behaviors
  
• Delusions false beliefs kept despite contrary
  evidence. (believing you are the Virgin Mary)
• Hallucinations false perceptions (usually
  hearing voices)
• mental disturbance illogical thought, incoherent
  speech, word usage shifts.
• Negative Symptoms absence of expected behavior
• Physical immobility
• No emotional expression
• Little speech
• Withdrawal from social world

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What are the symptons associated with the
different types of schizophrenia?

• Paranoid Schizophrenia
• Delusions, hallucinations, misinterpretation of
  facts
• Violent, suicidal behavior - high risk
• Ex patient images that he is someone else or
  someone is trying to harm him.
• Imaginary voices

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Disorganized Schizophrenia

• Confused functions
• Incoherent speech/thought
• Improper emotional expression
• Act silly/bizarre
• Withdrawal from world

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Catatonic Schizophrenia

• Negative Symptoms
• Abnormal posture/movements
• Repeated motions
• Motionlessness
• Inactivity/Excitement periods
• Impulsiveness

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• Residual Schizophrenia
• Moderate symptoms which occur after partial
  recovery of an acute episode of schizophrenia
• Less severe symptoms flat affect, Absence of
  emotion, limited speech

• Undifferentiated Schizophrenia
• Decrease in outside interests/relationships
• Absence of mental activity
• Lack of emotion
• Mixture of symptoms
• Does not fit any of the categories

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Etiology of Schizophrenia
What exactly might be the cause of Schizophrenia?
Is there a concrete explanation? The biological,
cognitive, and behaviorist approaches all have
their different theories to resolve a cure for
this disorder. Research is revealing that
schizophrenia is indeed a environmental impact
during the the development of the brain during
pregnancy and childhood. Another prediction is
that is a result of the interaction of certain
variations of genes. These would be the damaged
portions of genes.
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The Cause of Schizophrenia Behaviourist Approach
The Behaviourist Approach interprets abnormal
behavior as simply maladaptive learning. From
this, the behaviourist approach would then say
that Schizophrenia is not regarded at all
differently to other forms of abnormal behaviour.
In other words, the behaviourist approach would
actually see the term Schizophrenia as having no
etiological value. Although the behaviourist
approach does not believe that there seems to be
an etiology for this disorder, it does have a
number of different treatments for it, such as
token economy.
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Risk of developing schizophrenia
It seems that Identical Twins hold the highest
risk percentage to obtain this disordermight
this have a biological connection?
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The Cause of Schizophrenia Biological Approach
The biological approach closely looks at the
interaction between the environment and genetics.
Some might say that the biological perspective is
too radical, and reductionist, but it seems that
genetics due play a major role in the involvement
of this disorder. Research nowadays proposes the
idea that schizophrenia is caused by a genetic
vulnerability which is coupled with the
environmental and psychological stressors. This
is also known as the diathesis-stress model. The
idea basically says that whether the person
develops the disorder or not, for the most part
it is determined by the vulnerability. In
overall, as said beforethe biological approach
closely looks at the genetic factors, and how
they apply to the disorder. In this case, if
there is a genetic vulnerability, it is more
likely for the person to develop Schizophrenia.
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Biological Perspective
The Medical Model

• Explanations of schizophrenia
• Genetic predisposition
• Structural brain abnormalities
• (smaller frontal cortex)
• Neurotransmitter abnormalities
• (the dopamine hypothesis)
• Prenatal abnormalities
• The vulnerability (Stress Approach)

• Explains Schizophrenia in terms of genetic and
  psychological processes
• Emphasizes environmental influences
• Try to identify individuals who are defined as
  being at risk, and observe whether they in fact
  develop schizophrenia
• In that case the results are correlational

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Genetic Predisposition
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Risk of developing schizophrenia
It seems that Identical Twins hold the highest
risk percentage to obtain this disordermight
this have a biological connection?
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Biological Perspective

• Dopamine hypothesis theory that schizophrenia
  is related to over activity in neural pathways
  which depend on dopamine as a neurotransmitter.
• Not all patients respond to chlorpromazine.
• Even though drugs reach brain after ingestion, it
  takes days or weeks before improvement. If excess
  dopamine alone was the problem, behavior should
  change as soon as dopamine levels drop.
• Clozapine better than chlorpromazine, affects
  more non-dopamine than dopamine pathways.
• Glutamate and serotonin may be involved.
• Brain scans have showed less frontal lobe
  activity in Schizophrenic patients. Also
  differences in brain structures.
• Heredity factor
• Identical twins raised together, 50 concordance
  rate not purely hereditary.
• two hit model Mednick model proposes that
  first hit occurs during second trimester of
  pregnancy. Genetic defect possibly
• i.e. Mother contracting the flu during this stage
  of pregnancy.
• Second hit - environmental stress, trauma
  during birth, negative rearing conditions.
• Diathesis-stress model of abnormal behavior
  abnormal behavior arises as a result of the
  combination of a predisposition and a stressful
  environment.
• No stressor, predisposition is not manifested.

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The Cause of Schizophrenia Biological Approach
The biological approach closely looks at the
interaction between the environment and genetics.
Some might say that the biological perspective is
too radical, and reductionist, but it seems that
genetics due play a major role in the involvement
of this disorder. Research nowadays proposes the
idea that schizophrenia is caused by a genetic
vulnerability which is coupled with the
environmental and psychological stressors. This
is also known as the diathesis-stress model. The
idea basically says that whether the person
develops the disorder or not, for the most part
it is determined by the vulnerability. In
overall, as said beforethe biological approach
closely looks at the genetic factors, and how
they apply to the disorder. In this case, if
there is a genetic vulnerability, it is more
likely for the person to develop Schizophrenia.
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Therapies Technique application effectiveness Appropriateness
PSYCHO-SURGERY Traditionally crude lobotomy precise bundles of nerve fibers are destroyed, Traditionally for schizophrenia mainly as a last resort for severe depression It can be effective for certain disorders, e.g. severe depression. Side effects profound changes in personality, motivation, 1-4 likelihood of death.
ELECTRO-CONVULSIVE Electro shock of approx. 100 volts to induce a seizure At least six times repeated over 3-4 weeks. Traditionally for schizophrenia Today to treat severe depression (drugs having failed) 60-80 relief cases in depression destroy neurons responsible for emotions, affect the balance of neurotransmitters involved in emotions, act as punishment, produce memory loss and restructuring of thoughts. Side effects Memory loss, 3 / 10,000 mortality risk, ethical problem, matter of control, it can save lives.
DRUG THERAPY Anti-psychotics Block dopamine or serotonin Anti-anxiety drugs (minor tranquillisers, e.g. valium) reduce anxiety and panic attacks. Reduced the need for institutionalization Anti-anxiety drugs (e.g. valium) effective against generalised anxiety Best studies with placebo groups and double blind assessment techniques. Side-effects Dryness of mouth, Drowsiness, Weight gain or loss, body spasm, involuntary mouth / tongue movements, Dangerous blood conditions, Psychphysical addiction, pharmacological strait-jackets (based on symptom control, does not cure causes)
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Biological Treatment Medication

• Antipsychotic drugs do not cure schizophrenia,
  they just treat it.
• Are very effective in treating hallucinations and
  delusions.
• Work differently from individual to individual.
• Examples Clozaril, Risperdal, Zyprexa, Haldol,
  Thorazine, Seroquel.
• Long-acting injectable forms. No need to take
  pills. Eg Haldol, Prolixin, Trilafon.
• Side effects Drowsiness, restlessness, muscle
  spasms, tremor, dry mouth, blurring of vision,
  Tardive dyskinesia, weight gain, social
  withdrawal and symptoms resembling Parkinson's
  Disease.

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The Learning Perspective

• Behaviorists interpret abnormal behavior in terms
  of faulty learning.
• Focus on behavior rather than mental processes
• Reinforcement (Encouraging or gradually shaping
  desirable responses. )
• Positive reinforcement socially rewarding
  stimuli (e.g. attention and prize), educational
  feedback (good grades), token systems (merit
  points, star charts), liked activities
• Not Regarded as any different from other forms of
  abnormal behavior
• Social and environmental stressors can make the
  disorder worse
• Although learning by reinforcement is a well
  demonstrated general principal there is no direct
  evidence for the acquisition of Schizophrenic
  Behavior.
• Environmental Determinism We are controlled by
  external forces
• According to behaviorists, we are determined by
  rewards and punishments
• social learning psychologists will add social
  models we observe and imitate
• blank slate concept
• Skinner Free will is an illusion
  implications for psychology and societies
• behaviour control, therapies, creating an ideal
  state and society
• Watson Give me a dozen of healthy infants ...)

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Learning Perspective

• This perspective has many weaknesses in
  explaining
• Schizophrenic parent children OK - , but how
  does separated parent children develop disease.
• Particular combinations of symptoms occurs
  regularly.
• Model does not clearly explain the causes
• Reinforcement can be used to improve behavior.
• Treatment Shaping behavior of wards, token
  economy.
• Atthowe and Krasner study patients who were
  hospitalized for a median duration of 22 years
  90 per cent of the 87 men participated and
  improved in a two year.
• With the discovery of chlorpromazine
  hospitalization dropped since the 1950 because of
  its questionable morality of rewarding passivity
  of patients.
• Behaviors modified in studies may be due to
  institutionalization, not schizophrenia.
• Fall of institutions decreased opportunity to
  implement reinforcement strategies.
• Certain behaviors can be modified by
  reinforcement, and help schizophrenic individuals
  function better
• But learning based in reinforcement does not even
  come close to explaining the origins of
  schizophrenia.

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The Cause of Schizophrenia Behaviourist Approach
The Behaviourist Approach interprets abnormal
behavior as simply maladaptive learning. From
this, the behaviourist approach would then say
that Schizophrenia is not regarded at all
differently to other forms of abnormal behaviour.
In other words, the behaviourist approach would
actually see the term Schizophrenia as having no
etiological value. Although the behaviourist
approach does not believe that there seems to be
an etiology for this disorder, it does have a
number of different treatments for it, such as
token economy.
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Treatments
Therapies technique application effectiveness Appropriateness
Classical Conditioning SYSTEMATIC DESENSITISA-TION (Joseph Wolpe) Gradual relaxation Relaxation techniques, Slowly but surely... e.g. Little Albert and rats rabbits phobia, Phobias from persecutions and allusions Very successful Ethical
Classical Conditioning FLOODING AND IMPLOSION (imagination) Forced reality testing, Continual and dramatic presentation, Forced Reality to withdraw patients from false beliefs exhaustion effect. Quick and cheap, Ethical problems of suffering and withdrawal.
Operant Conditioning Behavior modification BEHAVIOUR SHAPING Positively reinforcing (e.g. food) successive approximations to the desired behavior. Social interaction and speech for disorganized patients with schizophrenia effective Only superficial short term effects for serious psychoses like schizophrenia.
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Operant Conditioning Behavior Modificationg TOKEN ECONOMY PROGRAMMES Tokens act as secondary reinforcers, exchangeable for primary reinforcers. In psychiatric institutions Improvements on self care and pro-social behaviour, Problems with transferring improved behavior and skills to the outside world. Careful planning and structured environment.
Education

• We learn by association from the environment
  the contribution to education involves guidelines
  on how to alter environmental stimuli, e.g.
  classroom conditions, presentation of info,
  teacher behaviour, etc. to provide positive
  conditioned emotional responses.
• Also, providing positive consequences
  (reinforcement) for correct responses and
  pointing out associations between new and old
  stimuli will encourage correct responses.
  However, teachers can never control all the
  competing sources of punishment and reinforcement
  in the learning environment, e.g. from peers and
  influences outside the classroom.

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PSYCHOSOCIAL TREATMENTS

• Psychosocial treatments help most with
  psychological, social, and occupational problems.
• Useful for patients with less severe symptoms or
  for patients whose psychotic symptoms are under
  control.
• Focus on improving the patient's social
  functioning.

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REHABILITATION

• Includes a wide range of non-medical
  interventions.
• Social and vocational training helps patients
  overcome difficulties.
• Vocational counseling, job training,
  problem-solving and money management skills, use
  of public transportation, and social skills
  training.
• Provided by Partial Hospital or Day Treatment
  Programs (4 to 6 hrs per day, several days per
  week).
• Learning is both educational and experiential.

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COGNITIVE BEHAVIORAL PSYCHOTHERAPY

• More effective than other types of psychotherapy
  in treating depression and panic attacks.
• Two approaches combine to effectively treat
  schizophrenia.
• Cognitive treatment helps treat distorted
  perceptions of the world, including self, and
  disordered or disorganized thinking.
• Behavioral therapy is used within a structured
  psychosocial rehabilitation program rather than
  individually because schizophrenia is seen as a
  life-long illness.
• Behavior therapy teaches the social skills never
  learned, and helps understand when to apply those
  skills to problems in the world.
• Examples of training Stress Management Training,
  Assertiveness Training, Communication Skills
  Training, Problem Solving Skills.

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FAMILY EDUCATION

• It is important for family members to lern all
  they can about schizophrenia when they have to
  take care of a family member who has been
  discharged from the hospital.
• Family psycho education includes teaching various
  coping strategies and problem-solving skills. It
  is a cognitive-behavioral treatment approach to
  family therapy.
• This approach helps families to deal more
  effectively with their ill relative and to
  contribute to an improved outcome for the patient.

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SELF-HELP GROUPS

• Members provide continuing mutual support as well
  as comfort in knowing that they are not alone in
  the problems they face.
• Families working together can more effectively
  serve as supporters for needed research and
  hospital and community treatment programs.
• Patients acting as a group rather than
  individually may be better able to dismiss
  dishonor and draw public attention to such abuses
  as discrimination against the mentally ill.
• Groups are very active and provide useful
  information and assistance for patients and
  families of patients with schizophrenia.

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COMMUNITY AND SOCIAL SUPPORT

• Patients with schizophrenia may need help from
  people in their family or community.
• Ensuring that a person with schizophrenia
  continues to get treatment after hospitalization
  is important.
• Encouraging the patient to continue treatment and
  assisting him or her in the treatment process can
  positively influence recovery.
• A positive approach may be helpful and perhaps
  more effective in the long run than criticism.

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Cognitive Perspective

• Focuses on analyzing the various types of symptom
  and suggests information based on the faulty
  cognitive processing.
• Suggests interesting insights into the nature of
  schizophrenic behavior
• There are specifically three aspects it focuses
  on Delusions, language, and thought
  disturbances.
• Cognitive Symptoms of SchizophreniaCognitive
  symptoms refer to the difficulties with
  concentration and memory. These can include
• disorganized thinking
• slow thinking
• difficulty understanding
• poor concentration
• poor memory
• difficulty expressing thoughts
• difficulty integrating thoughts, feelings and
  behavior

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Cognitive Perspective

• Faulty cognitive processing
• Delusions , beliefs contradictory to reality,
  Roger Brown, found 3 people, believing they were
  Jesus Christ, each convinced the others were
  deluded.
• Delusional individuals usually recognize false
  delusions of other patients. Loss of reality only
  in specifics.
• Language picture of infantile speech is not
  accurate,
• Roger Brown - no child like utterances , words
  used in incoherent ways. Words have specific
  meaning to person. Words suggest many
  connotations, meanings which might be confused.
• A model to explain this use of language is
  impossible.
• Thought disturbances
• Faulty references, misinterpretation of
  significance of stimulus and events. Person
  attributes meaning to event which most people
  would not.
• Logical errors lapses in reasoning.
• Silvano Arieti person uses different kind of
  reasoning. The Virgin Mary is a virgin. I am a
  virgin. Therefore I am the virgin Mary. Logical
  using unconventional rule of reasoning.
• Individuals problem of defective attention -
  difficulty in selecting and attending to the
  relevant stimuli in a situation.
• Individuals who develop schizophrenia reported
  early symptoms such as memorizing details,
  distraction, misinterpreting instructions. Unable
  to control.
• The negative responses o other people would
  aggravate the social impact of the initial
  problem of defective attention.
• Common mechanism underlying many unrelated
  symptoms.
• Explains why schizophrenic can function normally
  in some respect and have other bizarre behaviors.
  

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Treatments
Therapies (THESE ARE COGNITIVE BEHAVIOURAL THERAPIES!!!!!) applications effectiveness Appropriateness
Becks cognitive restructuring therapy (gently challenging faulty thinking patterns) Elliss rational emotive behaviour therapy (forcible persuasion and reality testing, fight awfulizing!) Meichenbaums self-instructional training (substituting maladaptive and self-defeating inner dialogues for better inner statements extended Banduras concepts of imitation to imitation of thought processes). Depression Anxiety disorders. Depression Personality disorders Panic disorder and anxiety Eating disorders Impulsive children (dialogues of self-control), Stress management Effective with anxiety disorders With depressions as effective as drug therapies Lower relapse rates are gained, if cognitive therapy is combined with medication. Complete in their approach to the problem (e.g. Elliss ABC A activating event, e.g. a stressor, B intervening belief, C emotional consequence. Directive (ethical issue of control).
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INDIVIDUAL PSYCHOTHERAPY

• Involves regularly scheduled talks between the
  patient and a mental health professional
  (psychiatrist, psychologist, psychiatric social
  worker, nurse).
• Talks focus on current or past problems,
  experiences, thoughts, feelings and
  relationships.
• Individuals gradually come to understand more
  about themselves and their problems.
• Psychotherapy is not a substitute for
  antipsychotic medication.
• It is most helpful once a patients psychotic
  symptoms have first been relieved by drug
  treatment.

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Credits
http//encarta.msn.com/medias_761552061/Schizophre
nia.html
http//www.hubin.org/facts/history/history_schizop
hrenia_en.html
http//www.psychologyinfo.com/schizophrenia/treatm
ent.htm Newton, David Olendorf, Donna
Jeryan, Cristine Boyden, Karen
"SCHIZOPHRENIA." SICK! Diseases and Disorders,
Injuries and Infections. 2000. http//www.schizo
phrenia.com/schizpictures.html Glassman
Approaches to Psychology