Mental Health & Public Policy Mental Health & Public Policy SymposiumSymposium

SCHIZOPHRENIA:

A BRAIN DISEASE

Alex Kopelowicz, M.D.

UCLA School of Medicine

San Fernando Mental Health Center

SCHIZOPHRENIAS ARE:SCHIZOPHRENIAS ARE:

• A group of biological disorders . . .

• That produce handicaps in thinking, learning and social relationships ...

• For which no cure is known . . .

• But new treatments promote improved quality of life.

SCHIZOPHRENIAS ARE NOTSCHIZOPHRENIAS ARE NOT

• All psychoses

• Split personality

• Contagious

• Anyone’s fault

• Hopeless

SYMPTOM CLUSTERSSYMPTOM CLUSTERSPOSITIVEPOSITIVE NEGATIVENEGATIVEHallucinationsHallucinations Few feelingsFew feelings

DelusionsDelusions Loss of motivationLoss of motivation

IMPAIRMENTSIMPAIRMENTS workwork relationshipsrelationships self-careself-care

COGNITIVECOGNITIVE MOODMOODMemoryMemory Depression DepressionProblem-solvingProblem-solving Hopelessness Hopelessness

SCHIZOPHRENIA ALTERSSCHIZOPHRENIA ALTERSBRAIN FUNCTIONINGBRAIN FUNCTIONING

FRONTAL LOBES GOVERNFRONTAL LOBES GOVERN

• Drive and Ambition

• Problem solving

• Cognitive flexibility

• Capacity to plan

• Time sequential thinking

• Social awareness

• Empathy

• Mood

• Insight

• Impulsivity

• Judgment

• Abstraction

• Working memory

MISSING FRONTAL LOBESMISSING FRONTAL LOBES

REDUCED FRONTALREDUCED FRONTALLOBE ACTIVITYLOBE ACTIVITY

Normal Schizophrenia

BRAIN FAILS TO ACTIVATEBRAIN FAILS TO ACTIVATETO DO TASKTO DO TASK

TEMPORAL LOBE FUNCTIONSTEMPORAL LOBE FUNCTIONS

PerceptionPerception

Reality OrientationReality Orientation

MemoryMemory

REDUCED TEMPORALREDUCED TEMPORALLOBE STRUCTURESLOBE STRUCTURES

BASAL GANGLIA FUNCTIONSBASAL GANGLIA FUNCTIONS

• Inhibit unwanted sensory input

• Filter out irrelevant sensory input

• Regulate arousal

• Govern concentration

REDUCED BASAL REDUCED BASAL GANGLIA ACTIVITYGANGLIA ACTIVITY

VARIATION IN BASAL VARIATION IN BASAL GANGLIA ACTIVITYGANGLIA ACTIVITY

LIMBIC SYSTEM FUNCTIONSLIMBIC SYSTEM FUNCTIONS

• Understanding emotional events

• Linking current perception to

past memories

• Learning from experience

REDUCED LIMBICREDUCED LIMBICSYSTEM STRUCTURESSYSTEM STRUCTURES

TANGLED CELLS INTANGLED CELLS INLIMBIC SYSTEMLIMBIC SYSTEM

GENETIC RISK OF GENETIC RISK OF SCHIZOPHRENIASCHIZOPHRENIA

If you have aIf you have a Your chance of gettingYour chance of getting

Schizophrenic. . .Schizophrenic. . . schizophrenia is ... schizophrenia is ...

Identical twinIdentical twin 46% 46%

Both parentsBoth parents 48%48%

Sibling or ParentSibling or Parent 12%12%

Aunt, Nephew, GrandparentAunt, Nephew, Grandparent 5% 5%

First cousin, great auntFirst cousin, great aunt 2% 2%

No relativesNo relatives 1% 1%

ANTIPSYCHOTIC ANTIPSYCHOTIC MEDICATIONS REDUCEMEDICATIONS REDUCE

Hallucinations and delusionsHallucinations and delusions Negative symptomsNegative symptoms Bizarre behaviorBizarre behavior AgitationAgitation Hostility and aggressionHostility and aggression Disordered thinkingDisordered thinking

MEDICATION RESTORES MEDICATION RESTORES BRAIN FUNCTIONINGBRAIN FUNCTIONING

ANTIPSYCHOTIC ANTIPSYCHOTIC MEDICATIONMEDICATION

Reduces relapse ratesReduces relapse rates

Reduces brain dysfunctionReduces brain dysfunction

Improved medications availableImproved medications available

Unique and individual responseUnique and individual response

First step to recoveryFirst step to recovery

STRATEGY OF TREATMENTSTRATEGY OF TREATMENT

Control symptoms with medicationControl symptoms with medication

Form a personal relationship Form a personal relationship

Teach disease management skillsTeach disease management skills

Teach compensatory techniquesTeach compensatory techniques

Help maximize unique potentialHelp maximize unique potential