3 - Schizophrenia Flashcards
Define schizophrenia
A mental disorder characterised by profound disruption of cognition and emotion. It is a type of psychosis in which thoughts and emotions are severely impaired. It affects an individual’s perceptions, emotions, language and sense of self.
What is a psychosis?
A severe mental disorder in which thought and emotions are so impaired that contact is lost with external reality
What is a positive symptom?
A symptom that adds to everyday experiences. This may be an excess or distortion of normal functions eg: hearing voices, hallucinations, feeling like someone is spying on them.
They can be present without negative symptoms.
What is a negative symptom?
A symptom that takes away from everyday experiences. This makes it difficult to carry on with day to day activities.
What is a hallucination?
Is it a positive or negative symptom?
Give some examples
An unusual sensory experience that can relate to all senses. This can be linked to what is happening in the environment or completely unrelated. They may distort what is actually there.
Positive symptom.
Eg: warping faces, poster turning to obscenities, jeering voices, smelling gas.
What is disorganised speech?
Is it a positive or negative symptom?
Give some examples
Disorganised speech reflects problems in organising thoughts. Derailment is one aspect of this - where a person may shift from topic to topic so that what they are saying doesn’t follow a coherent story.
Positive symptom.
Eg: “red change dog well”
What are delusions?
Is it a positive or negative symptom?
Give some examples
Firm but false beliefs that can take many forms.
Positive symptom.
Eg: delusions of grandeur, paranoid delusions, a person may feel chosen to complete a secret mission, government sending messages in the paper, martians are trying to poison water.
What is speech poverty?
What is it also known as?
Is it a positive or negative symptom?
Deficits in fluency of spoken language. Fewer words are spoken with less complex grammar. They also reflect blocked thoughts.
Alogia.
Negative symptom.
Define avolition
Is it a positive or negative symptom?
Give some examples
Lack of motivation for self-goals/self-directed purposeful activities. Apathy is also a part of this, and can lead to doing nothing for ages.
Negative symptom.
Eg: poor hygiene and grooming, unable to maintain a job or education, constant lack of energy.
State the 2 types of classification systems for schizophrenia.
Who published them?
What are their full names?
Where are they used?
DSMV (Diagnostic and Statistical Manual Edition 5).
Published by the American Psychiatric Association.
Used in the USA.
ICDX (International Classification of Disease Edition 10).
Published by the World Health Organisation.
Used in Europe.
What are the requirements of the DSM-5 needed to diagnose someone with schizophrenia?
The following 3 categories:
A: symptoms - 2 or more from:
Delusions, disorganised speech, grossly disorganised or catatonic behaviour, hallucinations, negative symptoms eg: avolition, alogia etc.
B: social/occupational dysfunction - problems affecting work, personal relationships or self-care.
C: duration - approx. 6 months of disturbances with at least 1 month of symptoms from category A.
How much of the global population are affected by schizophrenia?
Approximately 1%
What gender is more commonly diagnosed with schizophrenia?
Men
At what age are people commonly diagnosed with schizophrenia?
Late adolescence/early adulthood
A good classification system…
Should help professionals to diagnose Sz and suggest treatment to alleviate symptoms
If a diagnosis is not reliable…
It can’t be valid
Define inter-rather reliability
Consistency between clinicians. Eg: if different clinicians look at the same set of symptoms, they should give the same diagnosis.
Define test-retest reliability
Consistency over time. Eg: a person presenting the same set of symptoms should receive the diagnosis on different occasions.
State 2 differences between DSM 5 and ICD 10
DSM 5: only 1 symptom needed for diagnosis.
ICD 10: 2 or more symptoms needed for diagnosis.
DSM 5: dropped subtypes of Sz when DSM 5 was published.
ICD 10: recognises subtypes of Sz. Eg: catatonic Sz.
List the 3 studies that are evidence for poor reliability in diagnosis of schizophrenia
Rosenhan (‘73): on being sane in insane places
Copeland (‘71): cultural differences - USA and UK
Cheniaux (‘09): diagnosis of 100 patients by 2 psychiatrists
Explain the procedure and findings of Rosenhan’s study on being sane in insane places. How did this show poor reliability in diagnosis?
He tested reliability of mental health diagnosis and the effect of labelling diagnoses.
Patients were interviewed and reported symptoms - they were admitted into an asylum but once they were in their symptoms ended.
Findings:
Initial study - no pseudo-patients were suspected by staff. 12 diagnosed with Sz and 1 for manic depression.
Follow up study - all were genuine patients - 193 arrived - 41 rated as pseudo-patients by 2 members of staff. 23 by psychiatrists and 19 by both.
Explain the procedure and findings of Copeland’s study on cultural differences. How does this show poor reliability in diagnosis?
It has cultural bias as he only looked at 2 Western societies and ignored all the other non-western societies.
USA and U.K. psychiatrists diagnosed Sz differently to each other.
Explain the procedure and findings of Cheniaux et al’s study on diagnosis of 100 patients by 2 psychiatrists. How does this show poor reliability in diagnosis?
2 psychiatrists independently diagnosed 100 patients using DSM and ICD. The inter-roster reliability was poor - 1 psych diagnosed 26 people with Sz (DSM) but another (ICD) diagnosed 22. Then the 2nd DSM psychiatrist diagnosed 13 and the second ICD diagnosed 24.
There is no consistency between classification systems.
Evaluate reliability in diagnosis and classification of schizophrenia
- Rosenhan’s study highlighted reliability problems in diagnosis. The study showed there was a lack of consistency in diagnosis. This is because most of the patient who got sent to hospitals didn’t actually have Sz but they still got admitted to the ward. This suggests that there is a lack of reliability in diagnoses. Demonstrates hows people’s expectations alter their diagnosis.
- cultural differences impact reliability (shown by Copeland). C.D also lower reliability of a diagnosis. This questions validity of the concept of Sz as it suggests that the understanding of it is not consistent across different cultures.
- reliability problems in DSM and ICD. Inter-rather reliability. Different psychologists come to different conclusions using the same diagnosis method. Both DSM and ICD have problems diagnosing Sz reliably. But Cheniaux only based this on 2 psychologists.
+ reliability of diagnosis has improved. Critics say we shouldn’t generalise. Research findings may not reflect day to day diagnoses. Inter-rather reliability can be strengthen by using standardised assessment that improves diagnosis reliability. Moore recent studies have shown that the overall concordance rate between diagnosis is improved to 98% according to Jakobsen et al (‘05). The issues may be reducing over time.