Disorders Part IV / Notes

Psych 12 – Behavioralism08

- Disorders Part IV / Notes

Disorders Part IV

Schizophrenic Disorders

Schizophrenic literally translated means “split mind”. From a psychological point of view it is associated with fragmented delusional thinking, and is characterized as the most chronic and disabling of all mental disorders. Schizophrenia is a relatively common disorder. About 1% of the population, will develop schizophrenia.

Contrary to popular belief, schizophrenia is not a split personality. Instead it results in the afflicted person not being able to tell the differences between what is real and what is imaginary. As you can imagine, this can be quite frightening for the individual, not being able to tell if the voices he hears or the things he is imagining are real or not.

Although the cause of Schizophrenia is not known, there are strong indications that it may be genetic. Recently, there have been studies that have shown that there may be a genetic-viral link to Schizophrenia. This means that in some people, there may be a gene that when triggered by something like a flu virus, may bring about Schizophrenia.

There are four basic types of schizophrenics;

Paranoid schizophrenia: People with this type are preoccupied with false beliefs (delusions) about being persecuted or being punished by someone. Their thinking, speech, and emotions, however, remain fairly normal.

Disorganized schizophrenia: People with this type often are confused and incoherent, and have jumbled speech. Their outward behavior may be emotionless or flat or inappropriate, even silly or childlike. Often they have disorganized behavior that may disrupt their ability to perform normal daily activities such as showering or preparing meals.

Catatonic schizophrenia: The most striking symptoms of this type are physical. People with catatonic schizophrenia are generally immobile and unresponsive to the world around them. They often become very rigid and stiff, and unwilling to move. Occasionally, these people have peculiar movements like grimacing or assume bizarre postures. Or, they might repeat a word or phrase just spoken by another person. People with catatonic schizophrenia are at increased risk of malnutrition, exhaustion, or self-inflicted injury.

Undifferentiated schizophrenia: This subtype is diagnosed when the person's symptoms do not clearly represent one of the other three subtypes.

What Are the Symptoms of Schizophrenia?

People with schizophrenia may have a number of symptoms involving changes in ability and personality, and they may display different kinds of behavior at different times. When the illness first appears, symptoms usually are sudden and severe.

The most common symptoms of schizophrenia can be grouped into three categories: Positive symptoms, disorganized symptoms, and negative symptoms.

Positive symptoms

In this case, the word positive does not mean "good." Rather, it refers to obvious symptoms that are not present in people without schizophrenia. These symptoms, which are sometime referred to as psychotic symptoms, include:

Delusions: Delusions are strange beliefs that are not based in reality and that the person refuses to give up, even when presented with factual information. For example, the person suffering from delusions may believe that people can hear his or her thoughts, that he or she is God or the devil, or that people are putting thoughts into his or her head.
Hallucinations: These involve perceiving sensations that aren't real, such as seeing things that aren't there, hearing voices, smelling strange odors, having a "funny" taste in your mouth and feeling sensations on your skin even though nothing is touching your body. Hearing voices is the most common hallucination in people with schizophrenia. The voices may comment on the person's behavior, insult the person or give commands.

Disorganized symptoms

Disorganized symptoms reflect the person's inability to think clearly and respond appropriately. Examples of disorganized symptoms include:

Talking in sentences that do not make sense or using nonsense words, making it difficult for the person to communicate or engage in conversation
Shifting quickly from one thought to the next
Moving slowly
Being unable to make decisions
Writing excessively but without meaning
Forgetting or losing things
Repeating movements or gestures, such as pacing or walking in circles
Having problems making sense of everyday sights, sounds and feelings

Negative symptoms

In this case, the word negative does not mean "bad," but reflects the absence of certain normal behaviors in people with schizophrenia. Negative symptoms include:

Lack of emotion and expression; or emotions, thoughts and moods that do not fit with situations or events (for example, crying instead of laughing at a joke)
Withdrawal from family, friends and social activities
Reduced energy
Lack of motivation
Loss of pleasure or interest in life
Poor hygiene and grooming habits
Problems functioning at school, work or other activities
Moodiness (being very sad or very happy, or having swings in mood)
Catatonia (a condition in which the person becomes fixed in a single position for a very long time)

Are People With Schizophrenia Dangerous?

Popular books and movies often depict people with schizophrenia and other mental illnesses as dangerous and violent. This is not true. Most people with schizophrenia are not violent; more typically, they prefer to withdraw and be left alone. In some cases, however, people with mental illness who also abuse alcohol or drugs may engage in dangerous or violent behavior.

On the other hand, people with schizophrenia can be a danger to themselves. Suicide is the number one cause of premature death among people with schizophrenia. According to the World Fellowship for Schizophrenia and Allied Disorders, 1 in 10 people with schizophrenia commits suicide and 4 in 10 are known to have attempted suicide.

How Is Schizophrenia Treated?

The goal of treatment is to reduce the symptoms of schizophrenia and to decrease the chances of a relapse, or return of symptoms. Treatment may include:

Medications: The primary medications used to treat schizophrenia are called antipsychotics. These medicines do not cure schizophrenia but help relieve the most troubling symptoms, including delusions, hallucinations and thinking problems.
Psychosocial Therapy: While medication may help relieve symptoms of schizophrenia, various psychosocial treatments can help with the behavioral, psychological, social and occupational problems associated with the illness. Through therapy, patients also can learn to control their symptoms, identify early warning signs of relapse and develop a relapse prevention plan. Psychosocial therapies include: Rehabilitation, which focuses on social skills and job training to help people with schizophrenia function in the community and live as independently as possible; Individual psychotherapy, which can help the person better understand his or her illness, and learn coping and problem-solving skills; Family therapy, which can help families deal more effectively with a loved one who has schizophrenia, enabling them to better help their loved one; Group therapy/support groups, which can provide continuing mutual support.
Hospitalization: Most people with schizophrenia may be treated as outpatients. However, people with particularly severe symptoms, or those in danger of hurting themselves or others may require hospitalization to stabilize their condition.
Electroconvlusive Therapy (ECT):This is a procedure in which electrodes are attached to the person's head and a series of electric shocks are delivered to the brain. The shocks induce seizures, causing the release of neurotransmitters in the brain. This form of treatment is rarely used today in the treatment of schizophrenia. ECT may be useful when all medications fail or if severe depression or catatonia makes treating the illness difficult.
Psychosurgery: Lobotomy, an operation used to sever certain nerve pathways in the brain, was formerly used in some patients with severe, chronic schizophrenia. It is now performed only under extremely rare circumstances. This is because of the serious, irreversible personality changes that the surgery may produce and the fact that far better results are generally attained from less drastic and hazardous procedures.

Could there be a Genetic Cure?

Son with Schizophrenia Inspires Genetic Discovery

CBC NEWS: Thursday, May 3, 2007

When Toronto cancer researcher John Roder discovered his son Nathan had schizophrenia, he switched gears in his career, a change that has paid off with the discovery of a genetic link for the mental illness.

A cure for schizophrenia is likely years away, and will likely involve more than one factor, said Roder, a senior investigator at Toronto's Mount Sinai Hospital.

He estimated that schizophrenia research funding is about one-tenth the amount devoted to cancer, his first field of investigation after completing a PhD in immunology.

Switching so successfully from one field of basic science research to another is rare, but Roder's son was an inspiration.

"It's hard for people with mental illness to advocate for themselves," Roder told CBC Radio's Metro Morning on Thursday.

"If you imagine that Terry Fox had schizophrenia, probably he would have had that same grand idea, but he would never have got out of the first town because he would have been lost in his own thoughts."

Diagnosis brought 'fear and devastation and disbelief'

Roder said he spent about six months reading up on neuroscience and psychiatric disorders before making the switch when his son was diagnosed in his final year of high school in 2001.

Nathan Roder's grades started to slip, he stopped handing in assignments, and there was "a dramatic change in his ability to cope," his mother, Mary-Lou Roder, recalled.

"I remember seeing that word, schizophrenia, on the doors of the hospital, and it was like this fear and devastation and disbelief that this actually could have happened to us," she said.

While her husband changed his focus in hope of making a contribution to schizophrenia research, Mary Lou Roder became a caregiver for her son and an advocate for mental health who is trying to break the stigma surrounding the disease.

According to the Schizophrenia Society of Canada, about 300,000 Canadians, or one per cent of the population, will have the illness.

Response to treatment depends on mutation

As with Nathan, symptoms usually develop in late adolescence or early adulthood, and cases often occur in families with a history of mental illness.

As they report in Thursday's issue of the journal Neuron, Roder and colleagues in Toronto, Scotland and Japan used a mouse model to show that a malfunctioning gene can cause symptoms of schizophrenia and depression.

"These mice could represent a model system to explore novel treatment and preventative strategies for certain symptoms of major mental illness," the study's authors wrote.

Mutant mice carrying the malfunctioning gene, called Disrupted in Schizophrenia 1 or DISC1, showed the same kind of reduced brain volume seen in people with schizophrenia and depression, as well as similar biochemical abnormalities.

Mice with genes with one type of damage responded better to antipsychotics used to treat schizophrenia, while anti-depressants worked better in mice with another type of damage to the gene, the researchers found.

"We also found remarkable, clear-cut differences between the different types of damage to the gene and the treatment that was the most effective," said study co-author Prof. David Porteous of the University of Edinburgh.

An editorial accompanying the study cautions that mouse models offer a promising avenue of research for schizophrenia, which needs new strategies to reduce incidence and lessen severity. But the animal research is fraught with difficulties in interpretation and should be used cautiously, it warned.

"Psychiatric illnesses are highly prevalent, devastating to the affected individuals and their families, and enormously costly to society," wrote Nancy Low, of the department of psychiatry at Montreal's McGill University, and John Hardy, of the neurogenetics laboratory at the U.S. National Institutes of Health in Bethseda, Md.

John Roder said he talks to his son, now 21, about the work he is doing in the lab.

"I'd say he feels very supported and cared for, and I think he appreciates the contributions that his dad has made," said Mary-Lou Roder.

Psych 12 – Behavioralism08

- Disorders Part IV