• Thought disorder
• Hallucinations
• Delusions

• Social withdrawal
• Lack of affect
• Reduced motivation

• Persecution
• Control (influence)- thought broadcasting, thought insertion, thought withdrawal
• Reference
• Sin and guilt
• Delusions
• Hypochondriacal - typically to bizarre afflictions (e.g., Brains full of mold)
• Nihilistic - e.g., Patient is spirit returned from the dead
• Grandeur

• Neologisms
• Clanging
• Poverty of content
• Word salad

• 25% recover fully from first episode and have no/few recurrences
• 50% recurrent, with periods of remission
• 25% severe course, overall worsening

• Greater risk of developing schizophrenia with a 1st degree relative with schizophrenia
• Problem with this approach?

• 38% concordance in MZ twins
• 14% for DZ
• Type II has stronger genetic component

• Small sample
• MZ more similar environment that DZ
• So, looked at children of the DZ twins, 1 twin schizophrenic, 1 not
• Greater % in schizophrenic’s children

• greater likelihood of having schizophrenia if parent is schizophrenic
• greater than even if adopted parent has schizophrenia, but biological parent doesn’t

• Larger ventricles
• Related to cognitive impairment
• Poor response to drug tx.
• Poor premorbid adjustment
• More negative than positive symptoms
• More likely in males

• 2nd trimester
• R>L frontal and temporal lobes in normals
• Fingerprints/palm lines
• Monochorionic/dichorionic

• Incidence twice as high during Dutch “hunger winter” (1944-45)
• Refeeding after a thiamine deficiency
• Particularly during the 2nd trimester

• Direct effect?
• Or suppression of immune system?
• Children of women whose husbands were killed in WWII

• Home movies
• Schizophrenics as children showed more negative affect and abnormal movements

• Dopamine Hypothesis
• Action site for older antipsychotics - D1 receptors and D2 receptors

• Antipsychotic drugs block the brain’s receptor sites for dopamine
• Amphetamines increase DA activity in the brain and can produce psychotic states similar to schizophrenia.
• What happens when schizophrenic patients take amphetamines?

• Type I = excessive DA activity (D2)
• Type II = underactivity, particularly in the frontal lobes (D1)

• Drug response is slow (6 weeks), although DA receptors blocked in a few hours
• Clozapine - weak effect on DA receptors, but blocks serotonin receptors

• Which months?
• Why?
• Is it more likely in urban or rural populations?
• Why?

• Farther from the equator, more or less schizophrenia?
• Why?

• 1948 - “schizophrenogenic mother”
• Cold, domineering, rejecting, and overprotective

• Schizophrenic pts. show higher autonomic arousal to high EE vs. low EE relatives
• Discharged patients who lived with high EE relatives were 3 to 4 times more likely to have been rehospitalized within 9 months than those with low EE relatives
• No support for etiology

• 1950s theory - “double-bind communication”

•  “A young man who had fairly well recovered from an acute schizophrenic episode was visited in the hospital by his mother.  He was glad to see her and impulsively put his arm around her shoulders, whereupon she stiffened.  He withdrew his arm and she asked, “Don’t you love me anymore?”  He then blushed, and she said, “Dear, you must not be so easily embarassed and afraid of your feelings.”  The patient was able to stay with her only a few minutes more and following her departure he assaulted an aide.”  (Bateson, Jackson, Haley, et al., 1956, p. 251)

• Problem With Theory?

• Generally accepted
• Combination of a genetically inherited diathesis, or predisposition, and environmental stress

• Thorazine used within 8 months by 2 million patients
• Stellazine, prolixin, mellaril, haldol
• Positive symptoms only

• Tardive dyskinesia
• Pts. Over 40 and after at least 6 months of treatment
• Does not disappear when meds discontinued
• 20-30% prevalence rate

• 25% tx resistant
• 1990 clozaril introduced
• Agranulocytosis, monitored weekly
• Works on negative symptoms, as well
• Initially $9000/year

• 38 patients
• Rehospitalization rate dropped by 83%
• Over half could go to work or school
• Fewer side effects than other meds
• Works on D4 receptors - doesn’t cause TD (D2)

• D2, serotonin, adrenergic, and histamine receptors
• Affects positive and negative symptoms
• Available in liquid form

• Serotonin, D1-D4, histamine, norepinephrine, acetylcholine

• Social Skills
• Cognitive/Behavioral