1. diagnosis and classification

Question 1

define SCHIZOPHRENIA

Answer 1

is a severe mental disorder where contact with reality and insight are impaired (psychosis), experienced by 1% of world population.

Question 2

DIAGNOSIS AND CLASSIFICATION
There are two major systems for the classification of schizophrenia:

both require

Answer 2

· ICD-10, where two or more negative symptoms are sufficient for diagnosis.
· DSM-5, where at least one positive symptom must be present for diagnosis.
Both require 2 out of delusions, hallucinations, disorganised speech and avolition.

Question 3

POSITIVE SYMPTOMS
Are additional experiences beyond those of ordinary experience. They include:

Answer 3

HALLUCINATIONS: unusual sensory experiences, they can be experienced in relation to any sense. E.g. hearing voices
· DELUSIONS: irrational beliefs. E.g. being an important historical figure, having superpowers. Delusions can make a person behave in ways that make senso to them but seem bizarre to others.

Question 4

NEGATIVE SYMPTOMS
Involve the loss of usual abilities and experiences. They include:

Answer 4

· SPEECH POVERTY (ALOGIA): reduction in the amount and quality of speech in schizophrenia. This is sometimes accompanied by a delay in the person’s verbal responses during conversation.
· AVOLITION: finding it difficult to begin or keep up with goal-directed activity. Characterised by sharply reduced motivation to carry out a range of activities.
Andreasen identified three signs of avolition: poor hygiene, lack of persistence in work and education, a lack of energy.

Question 5

AO3: strength of diagnosis

GOOD RELIABILITY - osario

Answer 5

Reliability means consistency - a psychiatric diagnosis is said to be reliable when different diagnosing clinicians reach the same diagnosis for the same individual (inter-rater reliability), and when the same clinician reaches the same diagnosis on two occasions. Osorio et al. found excellent reliability for the diagnosis of schizophrenia in 180 individuals using the DSM-5. Pairs of interviewers achieved inter-rater reliability of +0.97 and test-retest reliability of +0.92.
This means that we can reasonably be sure that the diagnosis of schizophrenia is consistently applied.

Question 6

AO3: limitation of diagnosis

LOW VALIDITY - Cheneaux

Answer 6

There is low validity.
Validity concerns whether we assess what we are trying to assess. One way of assessing validity of psychiatric diagnosis is criterion validity (how accurately the test used to measure schizophrenia actually measures it). Cheneaux et al. had two psychiatrists independently assess the same 100 clients using the ICD-10 and DSM-5 criteria and found that 68 were diagnosed with schizophrenia using the ICD and 39 under the DSM.
This suggests that schizophrenia is either over or underdiagnosed according to the diagnostic system, showing low criterion validity.

Question 7

AO3: limitation of diagnosis

CO MORBIDITY - Buckley

Answer 7

There is co morbidity with other conditions.
If conditions occur together a lot of time, then this calls into question the validity of the diagnosis and classification because they might be a single condition. Schizophrenia is commonly diagnosed with other conditions. For example, Buckley found 50% of individuals with a diagnosis of schizophrenia also have depression, 47% have substance abuse and 23% have OCD.
This is a problem for classification because it means schizophrenia may not exist as a distinct condition, and it is a problem for diagnosis as at least some people diagnosed with schizophrenia may just have unusual cases of depression instead.

Question 8

AO3: limitation of diagnosis

CULTURAL BIAS - Pinto, Jones

Answer 8

There is culture bias in the diagnosis of schizophrenia.
Some symptoms, particularly hearing voices have different meanings in different cultures. Pinto and Jones found British people of Afro-Caribbean origin are up to 9 times as likely to receive a diagnosis compared to white British people, although people living in Afro-Caribbean countries are not, ruling out a genetic vulnerability. The likely explanation is that there is culture bias in diagnosis of clients by psychiatrists from a different cultural background.
This means that British African-Caribbean people may be discriminated against by a culturally biased diagnostic system