Schizophrenic disorders is a class of disorders marked by disturbances in
thought
that spill-over to affect perception, social and emotional processes. About one to 1.5
percent of the people
in the world suffer, so you figure, you know, around four million people in
America.
There are two prominent symptoms that happen to coincide with one another
that lead you toward the diagnosis of schizophrenia.
Clearly it's a rare thing to begin with.
It's unusual. But when you see it,
it's hard to mistake it. Because if it is pronounced,
the person is then in psychosis, psychotic process.
I've said a couple times here, I think we're all a little crazy, by which I mean
neurotic, eccentric, we have our proclivities, we have our issues,
but we're all dealing with reality by and large, right?
Psychosis is to depart from reality in such a way as that it is not any more
a question
about the way you see things.You aren't dealing with reality in a
consensus-based sense
at all. And so it depends on what level of dysfunction
that you have as to how problematic that would be for you
tends to be a chronic problem. So I said before, I say there's two
cases where you could look at medication being likely
a life long issue where you should probably take medication: Bipolar 1,
diagnosed appropriately, and schizophrenia.
And they have been looking at some, recently, some connections, potentially,
and the mechanisms by which these share development.
So delusion is maintaining a false belief
in the face of contrary evidence. Now contrary evidence is the key.
It's not just a different way of thinking, right? It's not just, "I don't agree
with people, most people," et cetera, right?
Just because a few million people agree doesn't make them all right,
does it? Millions and millions of people agree that the Sun goes Around the earth.
The vast majority of us no longer think that. Just because they all thought it did
not make it correct, right?
But it's maintained in the face of contrary evidence. So, for example,
if you believe in ghosts, I have no contrary evidence to that. Maybe they do
exist.
I don't have definitive scientific evidence to say that they don't exist.
The absence of evidence is not evidence of absence. So I couldn't say,
'Oh, you're maintaining a false belief. I would say you are maintaining a fairly common belief
that most people don't admit to having
for fear of social repercussions that they are judged negatively by other people
who claim not to believe in such things, right? Aliens?
Gosh, there's an awful lot of planets out there is and there's an awful lot of stars out there is an
awful lot of universe
explored. The probability is probably high that there's life somewhere else in the
universe.
To my knowledge, we have never seen it on the planet, but some people say yeah,
there's evidence to that. And
there's other people who would share that. There's no evidence to the contrary. I
can't prove
that aliens have not visited the planet. So that's just
a different believe set that may be what the norm is but they're not delusions.
They're just unconventional, unusual or
beliefs that are fairly common that people won't admit to each
other,
right? Hallucinations, then, are perceptions in the
absence of external stimuli. You can create hallucinations through the use of
certain drugs.
You could also have delerium through high fevers, an experience where people
see things that are not seen by anybody else. They
hear things that are not heard by anybody else. They feel things that,
that don't seem objectively possible, like bugs crawling under their skin
or things like that and you say, "Well there are no bugs," and we can get out a microscope.
We can
diagnose that there's nothing there and yet you persist in believing it because
you feel it. The feeling,
the sensation, in the absence of a stimulus that explains a sensation
would be hallucination. So this is what you have, in this case, is a
sensory experience that is contrary to reality
and also the possibility of belief systems
that are contrary to reality. And this is very unusual for people.
Now auditory hallucinations are the most common of the hallucinations.
It's much more rare to have visual hallucinations. I have
met with people, worked with people in the past who have had visual hallucinations and
they're very disturbing to the person
but they'll usually tell you about the ones that they had, not the ones they are
having, right?
It's not common to have them and when they do occur, they don't occur all
the time.
Auditory ones are much more common and if you can imagine just think for
yourself like I said the other day
like having one of those little ear worms, the little song in your head that
keeps going, but you don't want it to go.
But it's there and it's generating itself. Imagine a voice as clear as mine
inside your head
telling you to do things that you don't account for yourself, that you don't
think of
as your own thought processes,
that seem to you to be from either outside your body
or from another entity projecting thoughts into your head,
right. So that's not what most people have an experience of. We all hear
things that we
said you hear that and someone else goes no I didn't hear that and you go like, 'Huh, that's weird.'
That's not a hallucinations necessarily, right. But if you have them
regularly, now we are looking at hallucinations as a possibility.
Now positive and negative symptoms are very similar to the way we look at the words positive and
negative when we are talking about learning. Don't look at that is good and bad.
Look at that as absence
and addition,
subtraction and addition. Negative symptoms in schizophrenia
are behavioral deficits. Things that would be there for most people that
are not there for these people during the time that they are having
a psychotic episode. Because you can get better, right?
You can get medication, you can get treatment and it can be usually,
if it's maintained, it can usually be abated the symptoms,
overtime anyway. So this is something that during the course of the
flare-up of a psychotic episode,
the person is now missing that most people have. Things such as
apathy. Most people care. Just kind of a lack of caring about things, a lack of motivation,
flattened emotions. So just this experience of not emoting like most people
told bad news would, would be sad about hearing somebody's bad news.
Told good news they would be a little happier about it. How effective is your moment to moment expression
of emotion that goes congruent with the situation.
So there's a lack of that, where most people would have that.
Withdrawal: most people like to stay engaged with people. Everybody has their own
differences in personality, right? Introversion vs.
extroversions. But most introverts love their family and care about them and they
want to interact with them.
This is a withdrawal in the sense of even the closest people to the person
are shut out. Positive symptoms, now, are the additional of issues
or syndromes that are not what most people experience. So these be
superimposed on top of the experience that we have. In this case, we're looking
at adding in delusions,
adding in hallucination. There's nothing good about positive symptoms so
again take that synonym out of the vocabulary for the moment. Positive
means things are present that shouldn't be present. Negative means things
are absent that should be present.
That's what we're talking about.
There are definitive genetic implications and this is one that I use,
people want a simple explanation. When they see there are people suffering they are
like, "That's genetic isn't it?
That's just the chemical imbalances isn't it?" They want a very simple
answer to what they see their loved ones go through.
It's not that simple. It's not simple at all.
It's complicated. You can't just say that's genetic.
Oh, you are an alcoholic. Isn't that genetic? Is there someone in your family
that's also an alcoholic?
Maybe. Even probably. But that doesn't mean there's a gene for alcoholism.
But with schizophrenia it seems that the strongest genetic implications,
and, in this case, we see that now we go from about one in 100
possibility of having schizophrenia in the general population
to if you have a parent diagnosed, a biological,
first-degree relative, parent - mother or father -
who have been diagnosed with schizophrenia, now you have a one in 10 chance of
having schizophrenia. That's a tenfold increase.
And so some people get scared when they have family members that have
mental illnesses. They are like, "Wow. If my mom or my dad has
schizophrenia, does that mean that I am going to have it?" No.
Because even with a one in 10 chance that's still ninety cases out of a hundred
right that don't have it.
Your chance is still ninety percent that you won't get it.
So if it was purely genetic, though, we would see
that identical twins who share virtually identical
DNA makeup if one had it, the other would have it.
If one didn't have it, the other wouldn't have it. If it was all about genetics,
it would be that straight forward. But we see
about a fifty (a .5) correlation,
concordance rate between identical twins. Meaning
that if one twin evidences schizophrenia or is diagnosed with it, it's
like a flip of the coin whether the other person,
other identical twin will also manifest schizophrenia. Maximal uncertainty, yes?
That squared correlation
of .5 says that we can account for about 25 percent of shared variance,
meaning 75 percent is unaccounted for.
So there are definitely environmental implications.
We just can't untangle it yet, as to how,
what contributes to the emergence of this
or the inhibition of this yet, there are certainly genetic
predispositions, but that does not doom one to yes you have it, or no you won't
get it.
You will see that that varies.