Clinical characteristics of Schizophrenia

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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)

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Psychopathology
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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  typically, they are withdrawn and prefer to be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.

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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.

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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.

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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.

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The Risks of Getting Schizophrenia
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MRI scan showing decreased brain activity in
schizophrenia subjects (S) compared to normal
controls(N) in an fMRI study examining executive
functioning.
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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

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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.

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• 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.

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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.

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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

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MRI imaging showing differences in brain
ventricle size in twins - one schizophrenic, one
not.
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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.

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Early late grey matter deficits in Schizophrenia
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video
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Brain of normal patient compared to brain of
person with schizophrenia
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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.

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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

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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.

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Labelling theory

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

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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.

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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.

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• 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.

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• 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.

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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.

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• 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.

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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.

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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!!

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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).

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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.

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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.

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• 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.

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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.

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• 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.

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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.

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Techno spider phobia
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Explaining Phobias (Anxiety disorders)

• Biological (genetics, evolution)
• 2. Psychology (behavioural (conditioning
  modelling), cognitive, social factors).

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Phobia FEAR

• F alse
• E xpectations
• A ppear
• R eal

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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.

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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?

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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?

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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.

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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.

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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.

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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.

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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.

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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)

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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!!

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Summary table for ethical issues
53
Using animals in experiments
54
The use of non human animals in experiments
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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)

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The cost-benefit analysis of using animals in
Psycho experiments
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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.

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