Brain Changes in Schizophrenia (Nursing)

00:00 Schizophrenia is a brain disorder. It affects all parts of the brain, from the basal ganglia right up to the frontal lobes. Each area of the brain sends signals that gather and increase or decrease the positive and negative symptoms of schizophrenia and we will be talking a lot more about positive and negative symptoms. Now, this presentation will examine each of the regions that are involved in all of the different symptoms that we notice when a person is diagnosed with schizophrenia. So we're going to be looking at that frontal lobe, the parietal lobe, the occipital lobe, the cerebellum, the brainstem, and the temporal lobe.

00:57 And remember, each one of these lobes of the brain has a specific pattern of behavior and thoughts and capacities that are associated with it. So, for example if you have a healthy brain, a person with a healthy frontal lobe is able to do their executive functioning. A person who has a healthy occipital lobe, their vision is going to be really clear and correctible. When we see a person who has schizophrenia disorder, then we have a healthy brain that starts out but as schizophrenia which is a chronic disease continues, schizophrenia starts affecting different parts of the brain and it starts putting the brain at high risk. Remember, we think about the brain as really important organ for mental illness.

02:00 The brain is the organ of mental illness and so as schizophrenia progresses, we go from a healthy brain to a brain at high risk of disability to that brain that has schizophrenia.

02:19 So, it's important to understand that people who have schizophrenia have anatomically altered different brain structure. The brain does not stay the same. Schizophrenia actually changes the structure of the brain. They have enlarged ventricles. We also see that the ventricles are no longer symmetric with each other. All of a sudden there is asymmetry in the ventricles. That 3rd ventricle, we see that there is a real dilation of that 3rd ventricle. And then there's cortical atrophy and so we're thinking about how this is going to affect movement, how this is going to affect all of the other body movements that are so critically managed by a healthy brain, the cerebellar atrophy. How are all of our movements and our positioning in the world, our balance, what is happening when all of these different parts of our brain suddenly become injured by schizophrenia? With the pathophysiology, we see that there are low rates of blood flow and glucose metabolism directed into the frontal and pre-frontal lobes. And when you think about the brain so small in organ and using 25% of the glucose of our body generating all of these energy that when you have a lower blood flow and decreased glucose metabolism, it really affects our capacity for thought, for thinking, for clear thinking. So let's think about those frontal lobes. That frontal lobe where I usually caught our oval office, it's where we have our executive functioning, it's where we learn to have problem solving, it's where we're able to take care of planning. It's also where we organize. We can organize our day, we can organize our year. And the higher the signs and symptoms that we see of schizophrenia, actually the lower capacity for functioning and reasoning that we see in our patients. Also, we have the auditory system that is affected. And this is really instrumental, the Wernicke's area is our area of speech and when the Wernicke's area is affected like we often see with people who have strokes, the person's speech is affected. Their capacity for speaking is affected.

05:12 And also, this area of the brain being affected increases that likelihood of auditory hallucinations which means that the person starts hearing people or things that are not there. It is not unusual for a person who is having auditory hallucinations to hear bells ringing or to hear a person speaking when there is no no one in the room. Imagine how frightening this might be. It doesn't sound to that person like the television is on, it sounds like there is a real person in the room speaking to them that usually they cannot see. The basal ganglia is responsible for our movement and also for our emotions. Imagine what happens when your basal ganglia had been affected by this disease. We now then would have an increase in the sense of paranoia. We also have an increase in the hallucinations.

06:21 Now the occipital lobe really is helping us with our vision and being able also for our balance and so when we're thinking about the occipital lobe, it increases the likelihood of visual hallucinations and it makes it for the person really difficult to be able to read and read emotions on other people's faces. So, when we show them a number of different faces with different faces like they might say "That looks really sad." They're just not able to connect and visually see what the emotion is in the picture in front of them. Our limbic system is our emotional highway. Our limbic system allows us to feel emotions and translate those emotions into actions. So when our limbic system is affected by schizophrenia, what we find is that our experiences of emotions are completely changed and instead of having emotions we might find that the person is really agitated or fearful rather than being able to express or have emotions. So we're thinking about the hippocampus. I like to think of the hippocampus as our memory box. This is where we can mediate learning and we have memory formation. In our hippocampus, we have our long-term memory stored and as well as our short-term memories. And unfortunately, when the hippocampus is affected by a person's disease process like schizophrenia, memory learning is very seriously impacted.