Hello. My name is Matt Kurtz, and I'm a professor of psychology and neuroscience and behavior at Wesleyan University in Middletown, Connecticut, in the United States. I wanted to introduce you to our course which is called Schizophrenia and its Treatment. It's a course that's going to be focused on the psychiatric disorder labeled as schizophrenia. And it will be a multi component course in which we review the psychology of the disorder, the neuroscience of the disorder and studies regarding treatment of the disorder as well. We will also have a section on history and historical antecedents of our current approaches to understanding the disorder and its treatment. There are a few things that I want to say sort of in an introductory way. The first thing that I would like to mention is that this is in no way to be construed as an approach to a treatment for schizophrenia for individuals who maybe watching this course. If you suffer from the symptoms that I describe for the disorder, I would encourage you to seek professional help immediately. And again, this is not an approach to treating the disorder specifically, but rather it is a course focused on the academic study and the use of the scientific method for understanding schizophrenia as a disorder. So it's a approach using the scientific method and this is in no way an approach to treating people with schizophrenia specifically. The other thing that I wanted to just mention is the course is largely based on a book that I recently wrote it's called Schizophrenia and its Treatment, Where is the Progress? This is a copy of the book so you can see it. And in no way are you required to buy the book. You can get through the course without actually owning the book. But it might be helpful, it might deepen your understanding of some of the concepts that we talk about in the course. Might help you to get a certain deeper understanding of some of the contemporary literature. Okay, so I want to just begin by saying a few things about the disorder. We'll be understanding the academic study of schizophrenia as it is defined by the ICD10, International Classification for Diseases Version 10 that's been published by the World Health Organization. And in terms of how its defined by the Diagnostic and Statistical Manual V from the American Psychiatric Association. So we will be using both those approaches to define the disorder. While the definitions in the DSM V and the ICD 10 are somewhat different, they are largely overlapping and I will be focusing more primarily on the ICD set of criteria for diagnosing the disorder. Well, when you think about schizophrenia, there are really two things initially that, two myths that you want to dispel. And the first myth is the idea that schizophrenia involves split personalities. I think that we've all heard of this, the idea that some have might alternate between one personality and then shift to another personality and somehow that this represents schizophrenia. This common misconception I think comes from the actual label of the disorder. So schizophrenia literally, schizo means split and phrenia means mind. So I think that has led people to the idea that it can, that the disorder might consist of multiple personalities. I want to be clear that that's not at all what the diagnosis of schizophrenia represents. But instead, the idea of schizophrenia came down to us from the Swiss psychiatrist by the name of Eugen Bleuler. I use the term schizophrenia to describe a splitting of perception on the one hand and thinking on the other. So it wasn't a disruption in personality per se, but rather a breakdown in specific mental processes and that's the way that Bleuler had defined it. I think because of those words, it's frequently been thought of as being a disorder involving split personalities. The other common misconception is that people with schizophrenia are highly violent. And I think this view has come down from some very widely publicized cases. So there have been some very public acts of murder In the past ten to 15 years in the US. We can think of the Gabby Giffords shooting in 2011, 2012 the Aurora, Colorado, movie theater attack. And in both cases the people who performed those attacks had a diagnosis of schizophrenia. And I think this has led us to come to the conclusion that people with schizophrenia are more violent than the average population. In fact nothing could be further from the truth. In fact our current studies indicate that the rates among people schizophrenia just might be slightly elevated relative to the general population. And there was a recent study by the MacArthur Foundation for understanding risk that in fact found that other psychiatric diagnoses that are thought to be less serious than schizophrenia, such as depression, may actually have slightly higher rates of violence than in people with schizophrenia. The other key thing to understand about, other key element to understand about schizophrenia and violence is that people with schizophrenia are much more likely to be the victims of violence rather than the perpetrators. This is because they often do not have a lot of money. They are often unable to work. They often end up living in neighborhoods that might be more dangerous. And their cognitive difficulties and their symptoms may make them more vulnerable to predators in their home environment. Okay, so what we'll be talking about today, is I mentioned before is looking at what we've sort of understood about the psychology of the disorder. So what we've learned about cognition in schizophrenia, concentration, attention, memory, those types of functions, what we've learned about emotional functioning in people with schizophrenia. Then what we're going to do is also talk about the neuroscience of this disorder, and this a very exciting aspect of schizophrenia. This is where we're starting to learn more about, how does the brain operate in people with schizophrenia? What might be structural brain differences? That is the actual structure of the brain and how might that be different from people without the disorder? Similarly, we'll be studying activation patterns in the brains of people with schizophrenia. And a lot of this work has been advanced by working what is called a functional MRI, a technique for imaging the brain that is really just emerged in the 1980s, so be describing very exciting neuroscience findings from those studies. I'll also be talking about the scientific study of treatment, that is what randomized control trials using the scientific method have taught us about what are the most effective empirically based evidence based treatments for people with schizophrenia. And we'll also be talking about the history of treatment of the disorder starting from the 1890s and going up through the current time. Another focus of the course will be covering all those different areas. But we'll also be asking the question why on the one hand we've had such profound progress in the scientific study of schizophrenia. In fact the last 100 years have really yielded some very important and interesting findings. But then contrast that on the other hand with the fact that most studies indicate that actual clinical outcome for people with the disorder has not improved a whole lot over the past 100 years. There's actually what's called a med analysis which is a approach to pooling quantitative data across different studies. And in one of these med analyses, it's actually been shown that if you look at outcome over the past 100 years, you find that rates of improvement remain under 50%. And they remain largely unchanged, whether you look at rates of improvement in the early 1900s, 1910, 1920, through the middle of the century in the 40s and 50s, up through the current time. The findings are particular notable in that our treatment for schizophrenia has changed so rapidly over those 100 years. So in the first 20 to 30 years, schizophrenia was treated largely through what's been called the fresh air treatment. The fresh air treatment came over to us from enlightenment ideals from Western Europe and both in America and in Western Europe in the early 1900s. It was thought that it was best to treat schizophrenia with basically beautiful relaxing environments, bucolic scenes where they could walk around in sort of relax settings and become better. And this was referred to as the fresh air treatment. In the 30s, 40s, and 50s begin to see the institutionalization of many very aggressive forms of somatic therapy. These included methods such as psychosurgery, where actually parts of the brain were cut out and this also involved treatments such as inducing seizures, right, insulin coma therapy was one of the common approaches. So we do see comas or seizures was another approach to treating the disorder in the 50s. And then you go up to the 70s and 80s with the advent of the anti-psychotic medications. These are oral anti-psychotic medications. And while they have undoubtedly had great profound facts on the management of symptoms in the disorder, outcomes remains impaired even with the emergence of that treatment. So part of the course will be looking at this discrepancy between on the one hand all these very powerful and fascinating advancements in our scientific understanding of schizophrenia. Versus on the other hand, are treatment data which suggests that many people with schizophrenia continue to have poor outcomes and why there might be this discrepancy.
