The Psychology of Schizophrenia

DR Paula jean manners Highly Specialist clinical psychologist and lecturer

By end of this lecture

You should Know something about cause, symptoms and treatment of schizophrenia Know something about the experience of psychosis Know something about the controversies and future of treatment

Controversies and misconceptions

A mentally ill serial killer who murdered four people during a drug-fuelled rampage was failed by the NHS, according to an independent report. Paranoid schizophrenic Daniel Gonzalez received inadequate treatment from doctors and carers before arming himself with a variety of knives and launching a Freddy Kruegerinspired killing spree.
Read more: http://www.dailymail.co.uk/news/article-1158908/Schizophrenic-serial-killer-murdered-people-attackinspired-horror-film-failed-NHS.html#ixzz1j3g6AA7g

Schizophrenia in the news

Paranoid schizophrenic released into community to murder Paranoid schizophrenic Tennyson Obih who was sectioned twice before being released into care in the community went "off the radar" of the health services and murdered a policeman in broad daylight.

'Community care' schizophrenics have killed 60

DSM and ICD 10

Two or more (in last month) Delusions Hallucinations Disorganised speech Disorganised behaviour Negative symptoms (flat affect, social withdrawal)

Features
Perception (hallucinations Thought (delusions) Emotion (anxiety and depression) Behaviour (sleep disturbed, impulsive, OCD, mutism) Interpersonal adjustment (withdrawal/deterioration in relationships)

 Schizophrenia, paranoid type is characterized by persecutory (feeling victimized or spied on) or grandiose delusions, hallucinations, and occasionally, excessively religiosity (delusional focus) or hostile and aggressive behavior. Schizophrenia, disorganized type is characterized by grossly inappropriate or flat affect, incoherence, loose associations, and extremely disorganized behavior. Schizophrenia, catatonic type is characterized by marked psychomotor disturbance, either motionless or excessive motor activity. Motor immobility may be manifested by catalepsy (waxy flexibility) or stupor. Schizophrenia, undifferentiated type is characterized by mixed schizophrenic symptoms (of other types) along with disturbances of thought, affect, and behavior. Schizophrenia, residual type is characterized by at least one previous, though not a current, episode, social withdrawal, flat affect and looseness of associations.

Is it common?
Prevalence is 1 percent (more male than female) Many (25%) have a single episode with a good outcome Many (25%) have multiple relapses but function well in between 50% seem to struggle throughout their lives

Annoying Concepts of Schizophrenia

Delusions

Some Delusions are good for our confidence

Joan of Arc

God spoke to her She led France to victory She has been canonised Today she would be sectioned

Experiences are very strange

Distortion in perception

A part of the self becomes personified

The Experience of Psychosis in film

The Experience of psychosis in Film

I See Dead people

Causes
Genetic predisposition Dopamine dysfunction hypothesis Neurodevelopmental hypothesis (growing evidence for this from brain imaging) Psychological (brain overloaded and the mind fractures/splits)

Importance of Environment

CASE Examples

Treatments

Medication
CBT

CBT

Thoughts
Behaviour

Psychological treatment
Reducing sensory input Teaching distraction techniques and ways to cope with the voices Increasing physical activity Modulating social interactions Learning stress management

Medications
Side effects of typical antipsychotics can include: - Stiffness and shakiness this can often be reduced by lowering the dose. However, if a high dose is necessary, the shakiness can be treated with the same kind of medication that is used for Parkinsons disease. - Uncomfortable restlessness (akathisia) - Persistent abnormal movement, usually of jaw, lips and tongue (tardive dyskinesia) - Sexual problems due to hormonal changes Side effects of atypical antipsychotics can include: - Sleepiness and slowness (sedation) - Severe weight gain (obesity) - Diabetes - Stiffness and shakiness which can be treated with anti-parkinsonian medications - Sexual problems due to hormonal changes

Rufus May and the Doctor who heard voices

A Radical Approach

Conclusion
Psychosis is a symptom of lots of different mental illnesses Schizophrenia is one of these and there are several types of schizophrenia From a psychological perspective its more helpful to think about psychosis as a symptom to be understood and managed Psychotic experiences include delusions and hallucinations One in a hundred people will be diagnosed with schizophrenia. Psychotic experiences are even more common.

There are many interacting causes of psychosis

There are many ways of treating and helping people manage their symptoms The biggest barriers to recovery include stigma