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 !" # - essential features of this disorder are the presence
of characteristic psychotic symptoms during the active phase of the illness and a deterioration in normal
functioning and development

 Tendency toward deteriorating function in 30-50% of patients. The remainder stays stably
impaired and some (10-20%) get better enough to be considered recovered.

$ Underlying disturbances in psychological processes, Bleuler¶s Four A¶s

- ambivalence (volitional disturbance)
- flat affect
- loose associations (thought disorder)
- autism (idiosyncrasies)

% DSM IV-TR criteria

- field tests provide evidence supporting the reliability & validity for diagnosis using these
criteria
- four subtypes:
* disorganized
* catatonic
* paranoid
* undifferentiated

& Crow¶s Type I and Type II Distinction

- Type I ± positive symptoms predominate (hallucinations, paranoid ideation)
- Type II ± negative symptoms predominate

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 Many different ³types´ of schizophrenia clinically and genetically

$ Similarity to other mental illnesses (i.e., bipolar disorder)

% Paranoid psychosis similar to (and must be dissociated from) that brought on by drugs
(amphetamine, LSD, PCP)

& Multiple genetic and environmental determinants

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 Lifetime Prevalence 1% across all cultures

$ $80 to $100 billion/year is lost in direct and indirect costs due to the illness

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Inheritance: (Dr. Irving Gottesman) If the ³probands´ (patient) has schizophrenia, then:
Parentage: Concordance:
Monozygotic Twins 65% or greater
Dizygotic twins, Siblings approx. 12%
One Parent Affected 5-10%
Two Parents Affected 46%
Second Degree Relative 2-4%
Baseline ± Population 1%

Adoption Studies: provide further evidence for genetically-linked risk factors

High incidence of schizophrenia in the adopted offspring of parents with schizophrenia who have been
reared by parents who do not have the disorder.

The genetics of schizophrenia is complex, very similar to diabetes and hypertension, and involves
(susceptibility) gene-environment (e.g., amphetamine use) interactions.

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  # #.*"*1 Two (or more) of the following, each present for a significant portion of
time during a 1-month period (or less if successfully treated):
(1) Delusions
(2) Hallucinations
(3) Disorganized speech (e.g., frequent derailment or incoherence)
(4) Grossly disorganized or catatonic behavior
(5) Negative symptoms, i.e., affective flattening, alogia, or avolition

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'  )2
/"  )./1 For a significant portion of the time, since the onset of the
disturbance, one or more major areas of functioning such as work, interpersonal relations, or self-care
are markedly below the level achieved prior to the onset. In a few cases, the premorbid adjustment is
extremely impaired.

 /# 1Continuous signs of the disturbance persist for a least 6 months (unless treated
successfully)

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 /)# ().3c# ).: Traits/Disorders are modestly ³predictive´
  suspicious personality (paranoid)
( withdrawn personality (schizoid)
 odd, eccentric personality (schizotypal)
$ /)# ().3 (see above)

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 drugs, like LSD
( post partum
 stimulant drugs (dopamine agonists like amphetamine) are major ³offenders´
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 ): stress which is translated into brain functional changes
%#3 *).: stress does not ³cause´ schizophrenia, but a ³high expressed emotion´
environment can affect the course of the disorder

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chrlorpromazine 300-800 mg high high low low

(Thorazine)*

Olanzapine 2.5-15 mg moderate moderate none high

(Zyprexa)

haloperidol 6-20 mg low low high high

(Haldol)*

risperidone 4-8 mg low low moderate high

(Risperdal)

clozapine 300-450 mg low moderate low low

(Clozaril)#

Half-life: 10-20 hours; only need to be administered once per day.

* High potency antipsychotics show less sedation, less anticholinergic effects and more
extrapyramidal side effects. Low potency antipsychotics have the opposite effect.

# Requires weekly blood test during treatments because clozapine can produce agranulocytosis
(loss of white blood cells).

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