Bloodbound Bus4. Disorganization, Negative and Cognitive. #Schizophrenia #BurdenOfIllness

Bloodbound Bus4

Disorganization, Negative, and Cognitive

May 23, 2015

Schizophrenia is the flagship of psychotic disorders, and is diagnosed when a person has at least a 6 month continuous disturbance in thinking and functioning.

During that half year there also must be a period of 1 month, of at least 2 out of 5 symptoms, of psychosis.

The 5 cardinal symptoms of psychosis are hallucinations, delusions, disorganized speech, disorganized behaviour, and negative symptoms.

Schizophrenia is a genetic condition.

It is caused by problems in how the brain pudding developed, a dash of base pairs at a time, reading from the recipe of your chromosomes.

This fresh batch then cooks, in the environmental bone bowl, as life simmers along.

mel;ting pot 2

In our entire melting pot, roughly 1% of all humans are diagnosed, and living with Schizophrenia.

Your genetic risk is related to how many of your ancestors wore the genes in question, and how many of these hand me downs were passed on to you.

Genetics have determined virtually everything about you, however, they require certain experiences in life, to fully express yourself.

The following list, will indicate the risk, of genetically inheriting Schizophrenia;


Perhaps subtle genetic differences exist, between identical twins that account, for any number less than 100%.

It is much more likely that the 50% of identical twins, who did not develop Schizophrenia, dodged significant life stresses at critical developmental windows.

brain sheild 1

Or at least, were able to accommodate, in some less neurologically damaging way.

Hallucinations and delusions are thought to occur mostly because the brain has too much Dopamine in the MESOLIMBIC part.

This can cause neuronal excitement in many parts of the brain, causing unusual things in the mind.

If the temporal lobe becomes activated, a person may experience sights and/or sounds, which are not actually present in the environment around them.

Delusions are a bit more complicated, so I hope you enjoy BBB, Part 9, where I will describe them in more detail.

Disorganization of speech and behavior represents fundamental deficits in how the mind processes most information.

Schizophrenia is not just a neuro-developmental (and neuro-degenerative) disorder with symptoms of psychosis; there are many cognitive abnormalities, due to brain wiring, cell death, and dopamine system irregularities.

These result in many problems with features of basic thinking.

Memory is affected, particularly the kind you use every day to learn new information; school, work, and relationships often become overwhelming.

Executive functioning, or the ability to integrate all information, and then interpret that information to make accurate decisions, is also affected.

There is also an inability to sustain attention, which




Disorganization in general represents a traffic jam of information in your mind. The thoughts act like cars, with mixed signals; struggling in gridlock.

While some ideas crawl along, with a heavy foot note on the brakes, others are blocked entirely, or on roads to nowhere.

traffic 3

Some are even turned on their sides, or stacked in precarious pyramids.

Only some thoughts are lucky enough to escape the jam, and find the off-ramp, intact enough, to be recognizable.  The rest try to tow out the morass of chaos and confusion.

puzzle 1

The thoughts that are pulled out of the mystery, are often single clues. This is not much to solve complex puzzles.

But the partial message is delivered to the Executive Suites, with most of the information poorly deciphered.  The CEO’s of the mind try to stay calm, and despite a partial media blackout, they still make decisions necessary to keep the company afloat.

Besides, it is rare when only one opinion is accurate, unless it is one’s own.

Those with Schizophrenia peer through this windshield, as life whips by.  The sideshow seems hard to focus on with turns out of sequence.  Their mind leans outside the window at times, to dodge the rush of psychosis trying to drag them down.

head out window 1

The worst accident; when they become passengers in their own vehicle; with psychosis at the wheel.

Disorganized speech further demonstrates the abnormalities that occur in general cognitive functioning, evidenced by repeating words, having difficulty finding words, and making up new words, called NEOLOGISMS.

Disorganized behaviours may look ritualistic, random, or drunken.  These actions are not goal driven, and include catatonia, where the person stops interacting with the world around them.

Negative features are the outcome of too little dopamine in the FRONTAL lobe area, which has projections to the REWARD centre of the entire brain, called the Nucleus Accumbens.

dop pathways

When these peeps don’t get their dope, there is a major impact on our personality, motivation, social skills and mood.  Typically, the symptoms are remembered using the letter A.

They include:

Anhedonia (unable to enjoy usual enjoyable activities)

Ambivalence (can’t decide)

Flat Affect (little if any show of emotions)

Apathy (no motivation)

Like other symptoms of Schizophrenia, negative features may also be caused by the excessive destruction of neurons that occurs after puberty and beyond.

dementia schizophrenia 1

In some cases, the pruning is so severe that the loss of brain matter resembles dementia.

To live life, one needs to patch together a continuous quilt of organized awareness.  To do this, one needs to grasp each moment by the thread, regardless of how frayed.  One then weaves their own integrated reality and hope it matches up with others.  The feel of security, from the warm blanket of self understanding and control follows, as well as love from within and beyond.

blanket 2

But the fabric of reality is unwinding behind their eyes, and the patterns are Escher’s.

The brain tries to grasp the sands; but much slips through disorganized fingers, and loose stitches.  One cannot help but still search for the beauty, like the blind, viewing art.  The senses of attention can’t focus, and people and places become cobbled together, by the thinnest of strings.  And life finds widening seams to slide through.

Your brain creates the train of thoughts for your journey.  The conductor tries in vain to wrestle with mind controls, while cargo becomes unhinged.  The first episodes derail plans, so steaming locomotives jump tracks, and switch courses.  Many of these new tracks inevitably lead to lower stations.

Like a desperate writer, switching metaphors.

Schizophrenia is more than bad luck.  Each episode carries a substantial risk that the person will not return to their previous level of functioning.  And every relapse may last longer, or become harder to treat.  Who has time in their busy schedule to spend a month in the hospital, perhaps biannually?  It is no vacation.  And once back to life, they recover with maybe less money, a few less friends, and perhaps a lost job or degree.  And maybe a feeling like they have lost a bit of themselves, and it is hard to know where to start again.

I will cover medications and violence in Bloodbound Bus Part 5.

Parts 7 – 12  will focus on the NCR controversy.

So tune in next week!

Simon Trepel, MD

Simon Trepel, MD FRCPC, is a practicing Child and Adolescent Psychiatrist, in Winnipeg, Canada.  He is an Assistant Professor, at the University Of Manitoba, in the Faculty of Medicine, and the Co-founder of the GDAAY Clinic.  He is, more importantly, the proud Father of 2 beautiful Daughters.  He writes in his spare time about things he knows something about, and occasionally about things he doesn’t; like Yoga, and Italian flavored coffees.  He was not referring to coffee that tastes like an Italian person.

Check out his Blog, called Simon Says Psych Stuff, at



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