SchizophreniaI. Definition: group of psychotic disorders characterized by major disturbances in:THOUGHT, EMOTION, BEHAVIOR**In Greek= division of two (often confused with DID disorder)  break from realityBrief psychotic episode: typically happens under extreme stress and has to last less than a month and no prior symptoms; does not happen commonly (pilot yelling bomb on plane)II. FeaturesA. prevalence: 1% (higher in 1st degree relatives parents, siblings, kids)B. onset: ♂ = early/ mid 20s in males  earlier, severity is higher ♀ (females) late 20s /early 30sC. gender: equally male and femaleIII. SymptomsA. NO essential symptoms: very heterogeneous Lack Insight don’t know that your belief is out of proportion B. Positive Symptoms (positive = excess)1. Types of positive symptomsa. delusions: a fixed false beliefs (can’t talk someone out of a delusions they believe that what they want)1) persecution: belief one is being punished (or followed or someone is trying to hurt you)2) grandeur: belief one is someone special or has special abilities (those things can’t happen in real life)Ex: Mary thought she was a spy for Jesus can control the weather 3 Christs of Ypsilanti Someone thought they were the emperor of AntarcticaSUBSET of grandeur: - Erotomania- (eros- sexual love) YOU believe that someoneof higher status is in love with you o Ex: celebrity stalkers (letterman got into his house, stole his car, and called herself ‘Mrs. Letterman’), - Truman show delusion: people are watching you constantly (reality feeds into this) FAIRLY NEW3) reference: Irrelevant stimuli has some special meaning to youEx: - when a dog barks  Jesus has a message for her- billboard, advertise, TVo yates watching cartoons and thought she was a bad mother (daughter= prostitute, and sons= pimps/ drug dealers)4) control: outside forces control self- Mircochips in head, teeth and listening to their thoughts- Amanda Bynes thought someone put a microchip in her head- GovenrnmentPeople who behave violently are prone to these (delusions= anger)1. Delusion of persecution2. Belief being spied on 3. You are the victim of a conspiracyEda’s presentation/symptomsPresentation- Looks greasy (lack of hygiene) - Repetitive behaviors (twitching of hands)Symptoms- Disorganized thinking actively psychotic- Hearing noises  god sending her a message- Eagle (part of GM, check from them) is trying to hurt her  shoot her (post office) - Government is trying to hurt you- 25 on the clock - knew Jesus was talking to her o answered all of Jesus’s messages and wrote on notebook paper to himo getting messages around the clock from Jesus- Lucid moments in her conversation- Without the diathesis she won’t develop the schizo (also stressors needed)- Reference nurse she was talking to need to get a guard dog, then on the news the guard dog killed a child b. hallucinations: sensory perceptions in the absence of adequate/any stimulation1) auditory (most common)- hearing voices a) usually: extremely negative, usually accusatory, unpleasantb)may affect: auditory center (lights up like a normal brain does, if there is a real sensation) near limbic system: Book question: what do we think is happening?2) visual (much less frequent), a result of severe alcohol withdrawalc. loose associations: vague connections of thoughts - Dogs guard dog kills child Jesus - Eagle wants to kill her  25 on the clock d. disorganized speech 1) neologisms: made up words; neo- new, logi- study of; a. literally can’t find the word they want2) word salad: string together a series of unrelated wordsa. example: the sun is red dog Tuesday3) perseveration: persistent repetition of sound, word; a. repeating the same words over and over again4) clanging: stringing together words that rhyme e. derealization: separation from sense of reality (no insight)f. inappropriate affect: your mood or emotion doesn’t match the context/ situation- not distressed that someone is out to get Eda (the eagle)2. What causes positive symptoms?a. Impaired perception1) alterations of:2) difficulty filtering sensory stimuli: sensation (reticular formation- what to pay attention to and what not to [cocktail party effect])a. External: sights, sounds, smellsb. Internal: thinking, body sensationsc. Overload= sensory stimuli, floods into brainb. difficulty interpreting and responding to stimuli (perception)a. brain attempts to: derive meaning in the world; a. misinterprets environmental cues 2) inability to sort, interpret, respond like normal brainsExample: (eda and dog barking) Gerald:- Delusion of persecution- Disorganized speech- Loose associations- Mood is absent- Delusion of grandeur- Constant twitching/ movingC. Negative symptoms (negative= deficits: absences in normal behavior)1. avolition: lack of will, motivation, purpose- Lack of hygiene2. alogia: absence of speech3. anhedonia: lack of pleasure (just like in depression)4. flat affect: lack of emotional responsivenessa. showed movie clips to schizophrenia and “normal to elicit emotionsi. many possibilities: just not having these emotions, having them but can’t express themii. normals laughed and cried appropriatelyiii. Schizo didn’t show affect but reported feeling the emotions, just couldn’t express them5. catatonia: motor freezing, waxy flexibility (don’t see now as much because of meds)IV. DSM Criteria: 6 months (with at least 1 month of symptoms), characterized by severe social/occupational dysfunction: Characteristic symptoms: 2 (or more) of the following, each present for a significant portion of time during a 1 month period (or less if successfully treated):1. delusions2. hallucinations3. disorganized speech4. grossly disorganized or catatonic behavior5. negative symptomscan receive diagnosis with only positive or only negative symptoms, can also have bothV. EtiologyA. Biological1. Genetics:a. Family studies: risk will increase the more genes you share, increase with closeness of relativesb. Twin studies: identical = 48% vs. fraternal= 17% and siblings = 9%we also watched the video of Gerald to note positive and negative symptoms- he has mostly positive symptoms- a lot of loose associations with his speech: quoting song lyrics, snoopy’s dead? trying to communicate but isn’t processing on the same level, gets very frustratedwe watched another video that portrayed some negative symptoms and changes after frontal lobotomy’s. The patient displayed