PBL 2

# 1 Presentation theme
“Beautiful Mind”
PBL 2
Alreem Al-Naimi
Objectives
• Risk factors and causes of schizophrenia
• Clinical presentation of schizophrenia

• Types of hallucinations (which type does schizophrenic patients have?)
Schizophrenia
• Greek for “Split brain”
• Severe and chronic mental health disorder characterized by disturbance in thought, perception an
d behaviour
• Peak of onset:
• Males: earlier - (late teens to early 20s)
• Females: late 20s to early 30s
• Male: female ratio: 1.3:1

Risk Factors of
Schizophrenia
• Family history & twins
• Exposure to viruses, toxins, malnutrition during pregnancy
• Substance abuse (cannabis) & psychoactive drug use during adolescence/young adulthood
• Stress
• Social isolation - autism??
• Older age of parents

Cause is UNKOWN
• Multifactorial
• Different cascades merge into another
that ultimately lead to the symptoms of
schizophrenia.
• Molecular findings suggests however that

there is a complex interplay between
receptors, proteins, and hormones that
are all involved in schizophrenia.
Theories of Schizophrenia
• Most adopt a diathesis-stress model.
• A stressor coupled with a diathesis translates into ‘changes’ leading to the development of
schizophrenia
• Most of the time, this diathesis is genetic, but other cases probably reflect early damage to the
brain.
• Biological factors: genetics & twins
Genetic association is postulated to

account for 50%‐ 70% of the risk of
developing schizophrenia
• Biochemical factor: Dopamine hypothesis
Schizophrenia is caused by an excess of dopamine dependent neuronal activity in the brain. This
excess activity leads to increases release of dopamine, increased receptor sensitivity to
dopamine and number of dopamine receptors.
Pharmacological studies show that the use of amphetamines which is a stimulant to increase
dopamine levels produce schizophrenia symptoms. Antipsychotics such as haloperidol and
chlorpromazine block the dopamine receptors thus reducing the symptoms of schizophrenia.
Post-mortem studies of brain of persons who had schizophrenia show increased number of
dopamine receptors.
The areas affected by dopamine are mesolimbic pathway, mesocortical pathway, nigrostriatal
pathway, tuberinfundibular pathway.
• Biochemical Factors; Other Factors/hypothesis
According to various research studies other neurotransmitters and

neuroregulators such as norepinephrine, serotonine, acetylcholine,
glutamate (Hashimoto in 2006 ), GABA and prostaglandins also predispose
schizophrenia.
• Neurostructural theories:
Improper development of prefrontal cortex and limbic cortex in case of

schizophrenia.
Imaging study shows decreased brain volume, larger lateral and third ventricle, atropy of
frontal lobe, cerebellum and limbic structure etc, in case of schizophrenic patients.
Some studies reported that physical conditions such as epilepsy (temporal lobe),
birth trauma, head injury, huntington's disease, tumour etc, in childhood may cause
schizophrenia.
• Environmental Influences
Socio-cultural factors: Lower socio economic class experience more symptoms

of schizophrenia because of poverty, inadequate nutrition, absence of prenatal
care, few resources for stress management, lifestyle and feeling of hopelessness.
Stressful Life events: There is no scientific evidence to indicate the relationship

between stress and psychotic disorders. But few studies have shown that stress
may contribute to the severity of illness. It can precipitate psychotic problems and it
can exacerbate the condition and increase the
Clinical Presentation of
Schizophrenia
Positive Negative Cognitive
• Delusions • Flat or blunted affect

• Reduced ability to
• Hallucinations • Apathy understand or make
plans
• Unusual thought • Anhedonia (lack of
processes pleasure) • Diminished working
memory
• Disorganized speech • Alogia
• Inattention
• Bizarre behavior • Social withdrawal
Hallucinations
• A perception of something that is not present, i.e., a sensory perception that occurs in the absence
of an adequate stimulus.
• eg. seeing a light that is not actually present

Types of Hallucinations
A. Visual hallucinations - more commonly due to medical illness (eg. drug intoxication)
B. Auditory hallucinations - more commonly due to psychiatric illness (eg. schizophrenia) than medical illness
C. Olfactory hallucinations - as aura of temporal lobe epilepsy (burning rubber) and in brain tumors
D. Gustatory hallucination - rare, seen in epilepsy
E. Tactile hallucinations - alcohol withdrawal & stimulant use (eg. cocaine crawlies)
F. Hypnagogic hallucination - while going to sleep (seen in narcolepsy)
G. Hypnopompic hallucination - while waking from sleep (“get pomped up in the morning”)
Thank you!
Going back to the case…

• What type of hallucination did the patient have?
• Positive symptoms?
• Negative symptoms?
• Cognitive symptoms?

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# 1 Presentation theme

• Clinical presentation of schizophrenia

• Males: earlier - (late teens to early 20s)

• Females: late 20s to early 30s

• Male: female ratio: 1.3:1

• Exposure to viruses, toxins, malnutrition during pregnancy

• Older age of parents

• Molecular findings suggests however that

• Biological factors: genetics & twins

Genetic association is postulated to

• Biochemical factor: Dopamine hypothesis

• Biochemical Factors; Other Factors/hypothesis

According to various research studies other neurotransmitters and

Improper development of prefrontal cortex and limbic cortex in case of

Socio-cultural factors: Lower socio economic class experience more symptoms

Stressful Life events: There is no scientific evidence to indicate the relationship

• Delusions • Flat or blunted affect

• eg. seeing a light that is not actually present

D. Gustatory hallucination - rare, seen in epilepsy

F. Hypnagogic hallucination - while going to sleep (seen in narcolepsy)

Going back to the case…

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