lecture 15 from a college level introduction to psychology course taught Fall 2011 by Brian J. Piper, Ph.D. (psy391@gmail.com) at Willamette University, includes DSM-IV TR, positive symptoms, negative symptoms, hallucinations, epidemiology, famous patients, catatonic, disorganized, paranoid, genetics, neuroanatomy, Genain sisters, antipsychotics, dopamine

1. Schizophrenia
Brian J. Piper, Ph.D.

2. Goals
 Symptoms of Schizophrenia
 Causes
 Treatments

3. Schizophrenia
The Greek translation is schizein “split” and
phren “mind” which refers to a split from
reality. A group of severe disorders
characterized by atypical:
1. Cognition
2. Behavior
3. Emotions

4. Symptoms of Schizophrenia
Positive symptoms: the presence of inappropriate
behaviors
delusions
hallucinations: auditory >>> visual > other
disorganized talking: “word salad”
movements
Negative symptoms: the absence of appropriate
behaviors
flat affect: joy, anger, disgust
anhedonia
catatonia: waxy flexibility

5. Disorganized & Delusional Thinking
This morning when I was at Hillside [Hospital], I was
making a movie. I was surrounded by movie stars …
I’m Mary Poppins. Is this room painted blue to get me
upset? My grandmother died four weeks after my
eighteenth birthday.”
(Sheehan, 1982)
Other forms of delusions include, delusions of
This monologue illustrates fragmented, bizarre
thinking with (“someone is following delusions
persecution distorted beliefs called me”) or
grandeur (“I am a king”).
(“I’m Mary Poppins”).

6. Example Patient
Haldol: classic antipsychotic drug
Delusions of grandeur: inappropriate beliefs about one’s self-worth or special
powers
Gerald (upto 2:30): http://www.youtube.com/watch?v=gGnl8dqEoPQ

7. Auditory Hallucinations
For almost 7 years, except during sleep, I continue to hear voices. They accompany me
to every place and at all times, when I’m in conservations with other people, they persist,
undeterred, even when I concentrate on other things, for instance, read a book, play the
piano, etc. Only when I’m talking aloud to other people or to myself are they drowned by
the stronger sound of the spoken word and therefore inaudible to me.
Recounted by Ann M. Kring, Ph.D.
Pros & Cons
Behavioral strategies (& family discord)
Command Hallucinations

8. Epidemiology of
Schizophrenia
Frequency: 0.7%
Onset: 18-20s
Sex: Males > Females in # and severity
Low SES/African-Americans
Rule of thirds
Sources: Anna K. Kring, Brad Olson, & Peter Gray

10. Vincent van Gogh
1853-1890
Mary Todd Lincoln
1818-1882
Brian Wilson
1942-
Schizophrenia & Artists?
Jack Kerouac
John Nash
1922-1969
1928-

11. DSM-IV Criteria for Diagnosis
• Impaired social/occupational/self-care
• 2 or more of the following:
– Delusions: delusions of grandeur or
persecution
– Hallucinations
– Disorganized speech
– Disorganized behavior: mannerisms
– Negative symptoms

12. Subtypes (DSM-IV-TR only)
• Catatonic: immobility
• Disorganized: disorganized speech or
behavior, affective flattening
• Paranoid:
– Present: delusions & auditory hallucinations,
possible religiosity
– Absent: disorganized behavior & affective
flattening

13. Typical?
The relationship between schizophrenia and aggression is
controversial.
Renfrew (1996). Aggression & Its Causes.

14. Typical?
John Hinckley, Jr.
Jared Lee Loughner
The relationship between schizophrenia and aggression is
controversial.
Disorganized: Increased risk of victimization
Paranoid: small increase
Renfrew (1996). Aggression & Its Causes.

15. Causes
• Demonic possession
– Blood loss
– Damage to brain
• “Refrigerator mothers”
• Neurodevelopmental Disorder

16. Abnormal Brain Morphology
Schizophrenia patients may exhibit
morphological changes in the brain like
enlargement of fluid-filled ventricles.
Both Photos: Courtesy of Daniel R. Weinberger, M.D., NIH-NIMH/ NSC

17. Meta-Analysis
• 58 studies Region (Left or Right) % of
Control
• 1,588 SCZ patients L Lateral Ventricle 130
R Lateral Ventricle 120
Gray Matter 96
White Matter 98
L Frontal Lobe 95
L Hippocampus 95
L Amygdala 91
L Thalamus 96
R Thalamus 96
Wright et al. (2000). Am J Psychiatry, 157, 16-25.

18. Genetic Factors
The likelihood of an individual suffering from
schizophrenia is 50% if their identical twin has
the disease (Gottesman, 2001).
0 10 20 30 40 50
Identical
Both parents
Fraternal
One parent
Sibling
Nephew or niece
Unrelated

19. Genetic Factors
The following shows the prevalence of
schizophrenia in identical twins as seen in
different countries.

20. Genain Sisters
“Genain”: Greek “dire birth”, born 1930, all
hospitalized for schizophrenia by early 20s,
probability = 1.5 billion
Nora: intermediate (jobs, no family)
Iris: intermediate (jobs, no family)
Myra: secretary, married, 2 sons
Hester: showed signs at age 11, institutionalized
Genetics: identical
Environment: identical (schizophrenic mom)
Prenatal: ?

21. Neuropsych Testing of Genain
Sisters at age 68
• Digit Span: working
memory
• Trail Making Test: set
shifting
• Continuous
Performance Test:
attention
Mirsky et al. (2000). Schizophrenia Bulletin, 26, 699-708.

22. Viral Infection
Schizophrenia has also been observed in
individuals who contracted a viral infection
(flu) during the middle of their fetal
development.

23. Natural Logarithm of Relative Risks (and 95% Confidence Intervals) for Subjects Included in
Eight Ecological Studies from Europe, America, and Australia (Type A Studies) of Risk for
Schizophrenia Associated with Exposure to 1957 Influenza Pandemic During Second
Trimester of Prenatal Life.
http://en.wikipedia.org/wiki/Natural_logarithm
Selten J et al. Schizophr Bull 2009;36:219-228

24. Individual Differences in SCZ

25. Neurochemical Imbalance
Typical
Origin 1952
Example Chlorpromazine
Haloperidol
Mechanism D2 antagonist
Treats + symptoms
Side-Effects Tardive dyskinesia
TD (20 sec): http://www.youtube.com/watch?v=fLwZQBJs8fI

26. Drug Therapies
Psychopharmacology is the study of drug effects
on mind and behavior.
With the advent of drugs, hospitalization in mental
institutions has rapidly declined.

27. Neurochemical Imbalance
Typical Atypical
Origin 1950s 1970
Example Chlorpromazine Clozapine
Haloperidol
Mechanism D2 antagonist D2 & 5-HT2A antagonist
Treats + symptoms + symptoms
Side-Effects Tardive dyskinesia Weight gain
TD (20 sec): http://www.youtube.com/watch?v=fLwZQBJs8fI

28. Concern
• Adult monkeys
received typical *
(haloperidol) or *
atypical (olanzapine)
antipsychotics for 2
years at doses similar
to schizophrenics.
• Gray matter in
parietal cortex was
examined.
Konopaske et al. (2007). Neuropsychobiol 32, 1216-1223.

29. Self-Medication?
• Marijuana
• Nicotine

30. Art During Disease Progression
• A English artist, who was
fascinated by cats, painted
these pictures over a period of
time in which he became
mentally ill.
• Pro
– Paranoia
– Disorganization
• Con Louis Wain (1860-1939)
– Schizophrenia
– Order

31. Summary
• Symptoms ( + and - )
• Current Biological Components
– Genetics
– Brain Structure
– Dopamine Receptors