Schizophrenia Description Term literally means split mind confusion with Dissociative Identity Disorder Bleuler Swiss psychiatrist coined term in 1911 Observation of split between thoughts feelings also between different thoughts loose associations These splits are known collectively as formal thought disorder The hallmark of the disorder is psychosis a split with reality Delusions and hallucinations are the two varieties of psychosis Delusions beliefs that don t conform with reality Ex delusions of grandeur persecution reference thought broadcasting etc Hallucinations perceptions that don t conform with reality all 5 primary sensory modalities may be affected Language disturbances e g disorganized speech neologisms Goal directed behavior impaired logical sequencing Diagnostic Criteria A Two or more of the following for at least one month 1 Delusions 2 Hallucinations 3 Disorganized speech 4 Grossly disorganized behavior 5 Stupor catatonia flat affect Note Only 1 of the above is required if auditory hallucinations or bizarre delusions B C D Six months of some continuous signs of the disturbance 6 mos schizophreniform Impaired functioning No obvious organic cause e g not amphetamine psychosis Schizophrenia is heterogeneous i e symptoms vary dramatically across patients DSM IV recognizes five distinct subtypes Most useful distinction is between so called positive versus negative symptoms Other Characteristics 1 Prevalence about 1 of US adults nearly 2 million 2 Occurs in virtually all known societies cultures 3 Slightly higher prevalence in males 4 Median age of onset is 18 for males 25 for females 5 Low socioeconomic status 3 8 times as likely to be diagnosed Medical disease Model of Schizophrenia A Genetic Evidence Monozygotic concordance rate about 40 50 Dizygotic concordance about 10 Adoption studies interaction of genetics family environment B Disordered Brain Development Maternal influenza during 2nd trimester of pregnancy Maternal malnutrition Low birth weight Subtle neurological deficits eye tracking motor incoordination Excessive neural pruning during late adolescence C Hypofrontality D Dopamine Hypothesis increased cerebral dopamine activity All anti psychotic drugs block DA transmission Amphetamines increase DA transmission and cause psychosis at high doses Parkinsonian patients low DA don t get schizophrenia Overall model helpful but too simplistic DA has complex interactions with other transmitters peptides in brain Important new finding links DA with loss of glutamate NMDA receptors E Disordered Lipid Metabolism in Brain Excessive breakdown oxidation of lipids in neuron membrane Reduced transport of lipids into neuron membrane EPA form of omega 3 helps corrects both problems above F Medical Treatment Neuroleptic drugs Haldol Thorazine Melloril etc Novel antipsychotic drugs Clozaril Seroquel Zyprexa Geodon Risperdol 80 90 achieve some response reduced psychosis only 5 recover and stay fully remitted for 7 years Side effects weight gain sedation motor spasms Psychoanalytic Model Weakly developed ego psychosis intrusion of material from id superego Cause schizophrenogenic mother Psychoanalysis as treatment no evidence for effectiveness Cognitive Behavioral Model Focus on specific behaviors associated with schizophrenia Moderately successful for functional deficits not for psychoses Family Therapy Expressed Emotion from family critical emotionally overinvolved Reduces relapse risk