emil kraepelin (1898)

dementia praecox “premature dementia”

• paranoia (all delusions)

• hebephrenia

• catatonia

eugene bleuler (1908)

schizophrenia

• “split mind”

schizophrenia

1 month of at least two of the following:

• delusions

• hallucinations

• disorganized speech

• disorganized behavior

• negative symptoms

positive/psychosis

6 mo course includes prodromal or residual period

disorganized

negative

1 MO 5 MO5 MO

schizophrenia symptoms

residual symptoms

prodromal symptoms

6 mo course includes prodromal or residual period

delusions

What types of schizophrenic delusions have you heard of?

persecutiongrandeurcontrol

reference

hallucinations

What kinds of schizophrenic hallucinations have you heard of?

disorganized speech

• tangentiality

• derailment

• neologisms

• clanging

A.K.A. THOUGHT DISORDER

disorganization

DISORGANIZED BEHAVIOR

inappropriate affect

bizarre behavior

negative symptoms

alogia (few words)

affective flattening

avolition (lack of motivation)

social withdrawal

age of onset

stats

• 1% prevalence• equal sex ratio• course: better for women

brain abnormalities

STRUCTURAL • enlarged ventricles• cytoarchitecture of frontal lobe

FUNCTIONAL• “hypofrontality” • cognitive deficits of frontal lobe

cognitive deficits

working memory

perseveration

disinhibiton

executive functions

endophenotypes

biological markers for disease genese.g. eye tracking

genetics disease risk in family & twin

(also, equal risk in offspring of discordant MZ twins)

neurodevelopmental hypothesis

prenatalbrain defect

environmental stressorin early

adulthood

+ = SZ

2nd trimester

Flu Epidemics

1957 Kochi Japan1949-1981 France40 yr study Finland & Denmark

Starvation

1944-1945 WWII Dutch Winter1959-1961 famine in China

DA pathways

mesocortical

mesolimbic

nigrostriatal

substantia nigra > striatum

VTA > all cortical areas

VTA > limbic system

medicationANTIPSYCHOTICS (A.K.A. neuroleptics)

treats + symptoms

side effect:tardive dyskinesia

TYPICAL ATYPICAL

treats + & - symptoms?

less side effects?

10x price

• 74% noncompliance w/in 18 mo • extrapyramidal side effects

Parkinsonian symptomstardive dyskinesia

therapy

• “token economy” – operant conditioning

• teach social skills & give insight• manage medication• identify signs of impending relapse