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Clinical characteristics of Schizophrenia

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Title: Clinical characteristics of Schizophrenia


1
Clinical characteristics of Schizophrenia
  • Schizophrenia Is Not "a Split Personality"
  •  There is a common notion that schizophrenia is
    the same as "split personality a Dr.
    Jekyll-Mr. Hyde switch in character.
  •  This is not correct. (MPD).
  • That man is a Schizo, you should keep away from
    him, hes really dangerous.
  • (Watch video)

2
Psychopathology
3
Are People With Schizophrenia Likely To Be
Violent?
  • The News and media in general tend to link mental
    illness and criminal violence however, studies
    indicate that except for those persons with a
    record of criminal violence before becoming ill,
    and those with substance abuse or alcohol
    problems, people with schizophrenia are not
    especially prone to violence. Most individuals
    with schizophrenia are not violent more
    typically, they are withdrawn and prefer to be
    left alone. Most violent crimes are not committed
    by persons with schizophrenia, and most persons
    with schizophrenia do not commit violent crimes.
    Substance abuse significantly raises the rate of
    violence in people with schizophrenia but also in
    people who do not have any mental illness. People
    with paranoid and psychotic symptoms, which can
    become worse if medications are discontinued, may
    also be at higher risk for violent behaviour.
    When violence does occur, it is most frequently
    targeted at family members and friends, and more
    often takes place at home. Although there have
    been occasions where strangers to the person with
    schizophrenia have been victims of violence.

4
Positive symptoms.
  • Hallucinations (hearing voices usually
    transmitted through a radio or TV, seeing things
    imaginary) Delusions of grandeur (believing
    they are someone else usually a VIP such as God,
    the king/queen).
  • Distorted/disturbed thinking
  • Inappropriate behaviour
  • Unusual facial/body expressions/positions
  • Negative symptoms
  • Lack of emotion
  • Motivation
  • Speech impairments (repeating sounds-echolalia,
    and invented words-neologisms)
  • Word salad.
  • Diagnosis
  • There are different kinds of this disorder
    depending on the levels of severity. These
    include mild, Catatonic, Disorganised and
    Paranoid schizophrenia.

5
Explaining Schizophrenia
  • WHAT CAUSES SCHIZOPHRENIA?
  • There is no known single cause of schizophrenia.
    Many diseases, such as heart disease, result from
    an interaction of genetic, behavioural, and other
    factors and this may be the case for
    schizophrenia as well. Scientists do not yet
    understand all of the factors necessary to
    produce schizophrenia, but all the tools of
    modern biomedical research are being used to
    search for genes, critical moments in brain
    development, and other factors that may lead to
    the illness.

6
Is Schizophrenia Inherited?
  • It has long been known that schizophrenia runs in
    families. People who have a close relative with
    schizophrenia are more likely to develop the
    disorder than are people who have no relatives
    with the illness. For example, a monozygotic
    (identical) twin of a person with schizophrenia
    has the highest risk 40 to 50 of developing
    the illness. A child whose parent has
    schizophrenia has about a 10 chance. By
    comparison, the risk of schizophrenia in the
    general population is about 1 .
  • Scientists are studying genetic factors in
    schizophrenia. It appears likely that multiple
    genes are involved in creating a predisposition
    to develop the disorder. In addition, factors
    such as prenatal difficulties like viral
    infections, perinatal complications and various
    stressors, seem to influence the development of
    schizophrenia. However, it is not yet understood
    how the genetic predisposition is transmitted,
    and it cannot yet be accurately predicted whether
    a given person will or will not develop the
    disorder.
  • Several regions of the human genome are being
    investigated to identify genes that may confer
    susceptibility for schizophrenia. The strongest
    evidence to date leads to certain chromosomes
    (13 and 6) but remains unconfirmed.
    Identification of specific genes involved in the
    development of schizophrenia will provide
    important clues into what goes wrong in the brain
    to produce and sustain the illness and will guide
    the development of new and better treatments.

7
The Risks of Getting Schizophrenia
8
MRI scan showing decreased brain activity in
schizophrenia subjects (S) compared to normal
controls(N) in an fMRI study examining executive
functioning.
9
Is Schizophrenia Associated With A Chemical
Defect In The Brain?
  • Basic knowledge about brain chemistry and its
    link to schizophrenia is expanding rapidly.
    Neurotransmitters, substances that allow
    communication between nerve cells, have long been
    thought to be involved in the development of
    schizophrenia. It is likely, although not yet
    certain, that the disorder is associated with
    some imbalance of the complex, interrelated
    chemical systems of the brain, perhaps involving
    the neurotransmitters dopamine and glutamate.
    This area of research is promising

10
Is Schizophrenia Caused By A Physical Abnormality
In The Brain?
  • There have been dramatic advances in neuro
    imaging technology that permit scientists to
    study brain structure and function in living
    individuals. Many studies of people with
    schizophrenia have found abnormalities in brain
    structure (for example, enlargement of the
    fluid-filled cavities, called the ventricles, in
    the interior of the brain, and decreased size of
    certain brain regions) or function (for example,
    decreased metabolic activity in certain brain
    regions). It should be emphasized that these
    abnormalities are quite subtle and are not
    characteristic of all people with schizophrenia,
    nor do they occur only in individuals with this
    illness. Microscopic studies of brain tissue
    after death have also shown small changes in
    distribution or number of brain cells in people
    with schizophrenia. It appears that many (but
    probably not all) of these changes are present
    before an individual becomes ill, and
    schizophrenia may be, in part, a disorder in
    development of the brain.

11
  • Developmental neurobiologists funded by the
    National Institute of Mental Health (NIMH) have
    found that schizophrenia may be a developmental
    disorder resulting when neurons form
    inappropriate connections during fetal
    development. These errors may lie dormant until
    puberty, when changes in the brain that occur
    normally during this critical stage of maturation
    interact adversely with the faulty connections.
    This research has spurred efforts to identify
    prenatal factors that may have some bearing on
    the apparent developmental abnormality.

12
Other studies
  • In other studies, investigators using
    brain-imaging techniques have found evidence of
    early biochemical changes that may precede the
    onset of disease symptoms, prompting examination
    of the neural circuits that are most likely to be
    involved in producing those symptoms. Meanwhile,
    scientists working at the molecular level are
    exploring the genetic basis for abnormalities in
    brain development and in the neurotransmitter
    systems regulating brain function.

13
Enlarged Ventricles in the Brain
Individuals with schizophrenia, including those
who have never been treated, typically have
enlarged ventricles in the brain, as demonstrated
in over 100 studies to date

14
MRI imaging showing differences in brain
ventricle size in twins - one schizophrenic, one
not.
15
Significant Loss of Brain Gray Matter
  • People with schizophrenia, including those who
    have never been treated, have a reduced volume of
    grey matter in the brain, especially in the
    temporal and frontal lobes.
  • Recently neuroscientists have detected grey
    matter loss of up to 25 (in some areas). The
    damage started in the parietal, or outer, regions
    of the brain but spread to the rest of the brain
    over a five year period.
  • Patients with the worst brain tissue loss also
    had the worst symptoms, which included
    hallucinations, delusions, bizarre and psychotic
    thoughts, hearing voices, and depression.

16
Early late grey matter deficits in Schizophrenia
17
video
18
Brain of normal patient compared to brain of
person with schizophrenia
19
Summary of Schizophrenia
  • Biological
  • Low levels of the neurotransmitter (RGS4)
    gatekeepers of information admitted or discarded
    by the brain.
  • Dopamine hypothesis. Unusually High levels of
    neurotransmitter (dopamine) activity. Drugs that
    block dopamine activity seem to reduce the
    symptoms especially positive symptoms such as
    hallucination s delusions rather than negative
    symptoms such as catatonia The drug, L-dopa,
    which increases dopamine levels, can produce many
    of the symptoms of schizo.
  • There are also similarities (uncontrollable body
    movements) between people with Parkinsons (they
    have low levels of dopamine) and schizo who are
    given drugs to reduce dopamine level.
  • Genetics. Twin studies show high concordance
    rates MZ (50) DZ (20). Family studies also show
    high concordance rates between families.

20
Psychology
  • Social factors. Poor communication between
    families known as the double-bind theory.
  • This is where members of families communicate in
    a highly destructive and ambiguous manner.
  • This theory accounts for the confused thinking
    often present in sufferers. Family interaction
    may play a key part in schizo.
  • Poor expression of emotion such as hostility,
    constant criticism and being over emotionally
    involved with a child may lead to problems
    relating to the disorder.
  • Schizophrenics also tend to come from backgrounds
    of a lower social status, maybe due to having
    more stress to deal with at an early age and so
    make them more vulnerable to developing the
    disorder.
  • Three Psychological factors
  • Poor communication (the double-bind theory),
    (mixed signals)
  • Poor expression of emotion
  • Lower social status

21
Behaviourist
  • According to this approach, learning plays a key
    role in causing schizophrenia.
  • Early experience of punishment may lead children
    to retreat into a rewarding inner world.
  • This causes others to label them as odd or
    weird. And may lead to schizophrenia as the
    behaviour becomes more and more severe.
  • Support labelling theory suggests that Bizarre
    behaviour is rewarded by attention and so a
    person will conform to the label that has been
    given to them.
  • However, a patient who keeps his finger up his
    arse to keep his thoughts from running out,
    while with his other hand tries to tear out his
    hair because it really belonged to his dad
    suggests there is more to schizophrenia then
    labelling theory.

22
Labelling theory
  • Withdrawal
  • Reinforced by attention
  • Constant reinforcement for odd behaviour
  • might cause a continuous cycle.Labelled as
    oddConforming to label

23
Psychodynamics.
  • Freud suggested that conflicts and trauma are
    important in schizophrenia where Schizophrenics
    have returned to or regressed to an early state
    of psycho-sexual development.
  • Moreover, they have regressed to a state of
    primary narcissism (complete self interest and
    absorption) which occurs during the oral stage.
  • The ego has not separated from the id or sexual
    instinct. Schizophrenics lose touch with reality
    because their ego is not working properly.
  • Freud argued that schizophrenics are driven by
    sexual impulses whereas it has later been argued
    that it is more likely that they are driven by
    aggressive impulses
  • Support Driven by sexual and aggressive impulses
    typical of childhood. However, not much evidence
    exists, ignores the role of genetics as does
    every other psycho explanation.
  • An unconvincing explanation as there is much more
    to schizophrenia than that suggested by this
    theory.
  • Evaluation
  • Most evidence supports the theory that
    schizophrenia is a disease of the brain.

24
Clinical characteristics of Depression
  • Depression is one of the most common and most
    serious mental health problems facing people
    today. While it is only human to experience
    feelings of sadness, gloominess, or melancholy
    every now and then, clinical depression occurs
    when these feelings endure for long periods of
    time that can last for several weeks to several
    years if left untreated. Depression can interfere
    with a person's ability to function effectively
    throughout the day or even to have the motivation
    to get out of bed in the morning and go to work.

25
  • Depression is so common that over 1 in 5 people
    can expect to get some form of depression in
    their lifetime (USA). Over 1 in 20 people have a
    depressive disorder every year. Women are almost
    twice as likely as men to experience a depressive
    episode throughout their lives. Those who seem to
    be most likely to experience depression are
    married women, women in poverty, adolescents, and
    unmarried men. Fortunately, there are many highly
    effective treatments for depression today that
    alleviate much of the suffering associated with
    depressive symptoms.

26
  • We are able to treat depression much more
    effectively because we have a better
    understanding of the causes of clinical
    depression. Many people begin to feel depressed
    as the result of some recent, notable event or
    events, which occurred in their life. We also now
    know that family history and genetics play a part
    in the greater likelihood of someone becoming
    depressed in their lifetime. Increased stress and
    inadequate coping mechanisms to deal with that
    stress may also contribute to depression. We know
    that there are biological and psychological
    components to every depression, it is not a
    purely biochemical or medical disorder.

27
Depression 2
  • When people talk about having depression they are
    typically referring to what is known as Major
    Depression. This type of depression is when a
    person experiences the characteristics of
    depression with a certain degree of intensity
    either in a single episode or that keeps
    recurring over time.

28
  • Less common forms of depression, but still just
    as disruptive to a person's overall functioning,
    are the depressions related to Bipolar Disorder
    and Seasonal Affective Disorder. Bipolar
    Disorder, or what was commonly known as
    manic-depression, involves cyclical periods of
    severe depression with periods of extremely
    elevated or irritable mood known as mania.

29
Seasonal Affective Disorder (SAD)
  • Seasonal Affective Disorder (SAD) is a popular
    name given to describe depression that happens
    during particular seasons of the year, but it is
    not an actual DSM-IV (Diagnostic and Statistical
    Manual of Mental Disorders) diagnosis. The
    diagnosis a person would receive who experiences
    depression during the fall or winter months would
    be Major Depressive Disorder. To keep it simple
    we will call this form of depression Seasonal
    Affective Disorder. This diagnosis involves
    symptoms of depression that occur during the fall
    and winter seasons when the days are shorter and
    there is less exposure to natural sunlight. When
    the spring and summer seasons begin and there is
    greater exposure to longer hours of daylight, the
    symptoms of depression disappear.

30
Characteristics of Depression
  • Depression is Characterised by a number of daily
    symptoms over a period of time
  • Cognitive
  • (low self esteem, feeling hopeless, self-blame,
    low concentration or ability to think clearly,
    constant thoughts of death or suicide).
  • Emotional
  • (Sad, lonely, feeling low, over sensitive).
  • Motivational
  • (Lethargic, inactive, loss of interest and
    energy).
  • Somatic
  • (Insomnia and hypersomnia, tiredness).
  • Depression may be Reactive (caused by a stressful
    event(s) where psychological factors are the
    cause, or Endogenous (hormone imbalance) where
    biological factors may be to blame.
  • About 5 of the population suffer from depression
    at some stage of their lives although this is
    likely to be much higher!!

31
Explaining Depression
  • 1. Biological (genetics, biochemistry, hormones)
  • Genetics. Runs in the family, twin
    studies.(Allen, mz 40, dz11. Bertelsen,
    mz59, dz30. However, it may be due to sharing
    the same micro environment which accounts for
    these findings.
  • Biochemistry. Low levels of serotonin in
    depressed people, high levels of the stress
    hormone cortisol creating anxiety.
  • Permissive amine theory (Kety). Noradrenaline,
    serotonin and dopamine are neurotransmitters that
    play a role in arousal and so are related to
    mood.
  • Hormones. Changes in the body due to
    environmental, situational factors in a persons
    life. (PMS, SAD, PPD).

32
Psychological
  • 2. Psychology (Cognitive, Behavioural, social,
    psychodynamics)
  • Cognitive.
  • Becks cognitive triad.
  • Negative schemas from early experience (become
    pessimistic)Cognitive bias.
  • Learned helplessnesshopelessness attributing
    negative outcomes of an event to themselves
    (personal), everything will always be bad
    (stable).
  • Behavioural. Depression occurs as a result of a
    reduction in the level of reinforcement or
    reward. This may be caused by the loss of an
    important relationship, as these are usually
    positively rewarding. People may also behave in a
    depressed way is in some way reinforcing such as
    when they get sympathy from others.
  • Social. Life events and loneliness.

33
Clinical characteristics of Anxiety Disorders
(phobias)
  • Everybody knows what it's like to feel anxious
    butterflies in your stomach before a first date,
    the tension you feel when someone is angry at
    you, and the way your heart pounds if you're in
    danger. Anxiety rouses you to action. It gears
    you up to face a threatening situation. It makes
    you study harder for that exam, and keeps you on
    your toes when you're making a speech. In
    general, it helps you cope.
  • But if you have an anxiety disorder, this
    normally helpful emotion can do just the opposite
    -- it can keep you from coping and can disrupt
    your daily life. There are several types of
    anxiety disorders, each with their own distinct
    features.

34
  • An anxiety disorder may make you feel anxious
    most of the time, without any apparent reason. Or
    the anxious feelings may be so uncomfortable that
    to avoid them you may stop some everyday
    activities. Or you may have occasional bouts of
    anxiety so intense they terrify and immobilize
    you.
  • Anxiety disorders are the most common of all the
    mental health disorders. Considered in the
    category of anxiety disorders are Generalized
    Anxiety Disorder, Panic Disorder, Agoraphobia,
    Social Phobia, Obsessive Compulsive Disorder,
    Specific Phobia, Post-Traumatic Stress Disorder,
    and Acute Stress Disorder. Approximately 5.2
    million people per year suffer from
    post-traumatic stress disorder (USA). Specific
    phobias affect more than 1 out of every 10 people
    with women being slightly more at risk than men.
    Obsessive Compulsive disorder affects about every
    2 to 3 people out of 100, with women and men
    being affected equally.

35
Anxiety
  • Many people still carry the misperception that
    anxiety disorders are a character flaw, a problem
    that happens because you are weak.
  • They say, "Pull yourself together and get a
    grip!" and "You just have a case of the nerves."
  • Wishing the symptoms away does not work.
  • But there are treatments that can help.
  • Anxiety disorders and panic attacks are not signs
    of a character flaw.
  • Most importantly, feeling anxious is not your
    fault.
  • It is a serious mood disorder, which affects a
    person's ability to function in every day
    activities.
  • It affects work, family, and social life.
  • Today, much more is known about the causes and
    treatment of this mental health problem.
  • We know that there are biological and
    psychological components to every anxiety
    disorder and that the best form of treatment is a
    combination of cognitive-behavioural
    psychotherapy interventions.

36
  • Depending upon the severity of the anxiety,
    medication is used in combination with
    psychotherapy.
  • Contrary to the popular misconceptions about
    anxiety disorders today, it is not a purely
    biochemical or medical disorder.
  • There are as many potential causes of anxiety
    disorders as there are people who suffer from
    them.
  • Family history and genetics play a part in the
    greater likelihood of someone getting an anxiety
    disorder in their lifetime.
  • Increased stress and inadequate coping mechanisms
    to deal with that stress may also contribute to
    anxiety.
  • Anxiety symptoms can result from such a variety
    of factors including having had a traumatic
    experience, having to face major decisions , or
    having developed a more fearful perspective on
    life.
  • Anxiety caused by medications or substance or
    alcohol abuse is not typically recognized as an
    anxiety disorder.

37
Anxiety disorder. Types of Phobia.
  • Specific
  • Animals, environment, situational, injury.
  • A constant fear, an excessive anxiety response to
    a feared stimulus leading to avoidance behaviour.
    People are aware that very anxious and that the
    anxiety can effect their lifestyle.
  • Social
  • Agoraphobia) a fear of having a panic attack in
    public often leads to not going out. A person
    worries about having future panic attacks and
    fears situations where escape would be difficult.
    Fear of public speaking, failure.

38
Techno spider phobia
39
Explaining Phobias (Anxiety disorders)
  • Biological (genetics, evolution)
  • 2. Psychology (behavioural (conditioning
    modelling), cognitive, social factors).

40
Phobia FEAR
  • F alse
  • E xpectations
  • A ppear
  • R eal

41
Gender bias
  • Discuss evidence of Gender bias issues in
    Psychology
  • The performance of ps in psychological research
    tends to be influenced by the expectations of the
    investigator. It has been suggested that any
    people still have lower expectations or
    estimations for women than for men.
  • Gender stereotypes. There are many popular and
    misleading stereotypes about the differences
    between men and women. E.g. women are more
    emotional than men. Freud being one of the worst
    offenders often exaggerating differences (penis
    envy). Research has only found a small number of
    differences between boys and girls (Maccoby
    Jacklin). However, these differences are getting
    smaller than ever before.
  • If there are differences we need to consider the
    two types of bias that occur in gender bias.
  • Alpha bias (the tendency to exaggerate
    differences by the researcher) and Beta bias (the
    tendency to minimise differences).
  • Advantages of Androgyny. The ability for people
    to respond to any situation with either masculine
    (instrumental) characteristics or feminine
    (Expressive) characteristics are more flexible
    than a person who behaves in a more
    sex-stereotyped way.

42
Evidence
  • There is evidence of bias in experiments as ps
    are often treated according to their gender.
  • Investigators treated ps differently according
    to their gender.
  • Past research
  • Freud
  • Kohlberg
  • Studies involving all male ps.
  • Give examples of theories.
  • What are the consequences of gender bias?

43
Culture Bias
  • Discuss evidence of Culture bias issues in
    Psychology
  • Past research
  • Give examples of theories
  • Emic and Etic constructs
  • What are the consequences of gender bias?

44
Ethical issues
  • Past research
  • Aschs research was typical of the laboratory
    culture of American social psychology in the
    1950s, where the use of Deception was the norm.
  • The true participant may have found the
    experience distressing.
  • Those conforming must have experienced pressure
    to do so and may have felt distress at having to
    behave like sheep.
  • Those who resisted were also under pressure, in a
    later study similar to Aschs, participants
    experienced raised blood pressure levels during
    the study.
  • We have learned from these studies that ordinary
    people will conform to group pressure.
  • However, we often find ourselves disagreeing
    with the majority so this is nothing new.

45
Milgram
  • Milgram questioned obedience to authority in
    particular issues raised after WW2 with the Nazi
    atrocities and the My Lai massacre in Vietnam
    where those accused of war crimes attempted to
    excuse themselves by stating at trial they were
    simplyfollowing orders(An agentic state).
  • Milgrams experiments were the first efforts to
    understand the lengths that people were prepared
    to go under certain circumstances in an
    objective, scientific manner.
  • Despite the importance of his findings, it was
    shown that Milgram did put his participants under
    considerable pressure (psychological harm).
    However, most reported later that they were happy
    to have taken part as they had discovered
    something about themselves they did not know
    existed.

46
Milgram 2
  • Milgrams research perhaps shows the lengths
    people are prepared to go to even when following
    unjust commands.
  • Milgram also pioneered the debriefing procedure
    to monitor by providing information and support
    to the future well being of his participants.
  • Milgrams research has real-life implications
    such as explaining the Holocaust. But, it does
    account for dispositional factors such as an
    authoritarian personality (as identified by
    Adorno) or situational factors such as
    deindividuation (diffusion of responsibility) or
    the human condition (evolutionatary explanation
    for the destructive nature of humans and the
    survival of the fittest). It also detracts from
    other important factors such as racism,
    discrimination and prejudice.

47
Zimbardo
  • In a climate of prison unrest, insubordination
    rioting, Zimbardo set out to study to show how
    ordinary people can do things they would never
    have believed they were capable of doing.
  • The main aim of the study was to focus on power
    of roles, rules, group identity and situational
    validation of behaviour (social lpsychology) that
    would generally repulse ordinary individuals.
  • The study provided evidence of how people behave
    due to the roles they are given and what is
    expected of them.
  • Ethical issues included the deception, giving the
    right to withdraw and protecting the participants
    from harm.

48
Zimbardo
  • It is argued that Zimbardos study was not
    justified as participants were subjected to
    prolonged humiliation because the investigators
    became too involved with their roles and
    therefore, forgot about the welfare of their
    participants.
  • However, Zimbardos research has led to prison
    reform and closer monitoring of roles
    expectations and responsibilities.
  • On the other hand people are still in favour of
    punishment rather than rehabilitation of
    offenders in penal systems.

49
Questions to consider with your argument on
ethical issues
  • Other studies where ethical issues have been
    raised?
  • Sleep deprivation findings have been used in
    brainwashing techniques cult following. Jouvet
    the flower pot technique (depriving cats of REM
    sleep). Racial differences in intelligence?
    Gender differences. Conditioning (Watson Raynor
    little albert).
  • Did the importance of what was learned outweigh
    any harm done? (Were the researchers justified in
    their investigations)

50
Explaining Psychopathology
51
Have we learned anything from such research?
  • Yes. That these studies provide a special insight
    into human behaviour and experience (the
    darkside to human nature).
  • No. It tells us nothing about human nature that
    we dont already know!!

52
Summary table for ethical issues
53
Using animals in experiments
54
The use of non human animals in experiments
55
Some examples
  • Pavlov (dogs)
  • Brady (monkeys, stress ulcers)
  • Harlow (monkeys and attachment) Harlow (again)
    (monkeys social deprivation)
  • Riley (mice stress)
  • Jouvet (REM sleep deprivation with cats)

56
The cost-benefit analysis of using animals in
Psycho experiments
57
Article
  • Brain is affected by gory TV shows
  • VIOLENT television or video game images can
    affect the brain, new research has shown. A study
    of teenagers found part of the brain involved in
    decision making and self control was impaired by
    exposure to violent scenes. Significantly, this
    did not apply only to those with a history of
    violent and disruptive behaviour but also to well
    behaved individuals. Scientists believe there may
    be a link to previous reports of violent
  • TV shows triggering aggression.

58
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