Clasification And Diagnosis

Question 1

what are positive symptoms?

Answer 1

those that are added to everyday experiences

Question 2

what are negative symptoms?

Answer 2

they involve the loss of everyday functioning

Question 3

what is a delusion?

Answer 3

bizarre beliefs that seem real but aren’t

Question 4

what is an experience of control?

Answer 4

the person believes they are under control of an alien force that has invaded their mind.

Question 5

what is an hallucination?

Answer 5

bizarre, unreal perceptions of the environment that are usually auditory

Question 6

what is disordered thinking?

Answer 6

the feeling that thoughts have been inserted or withdrawn from the mind

Question 7

what are the 4 examples of positive symptoms?

Answer 7

delusions
hallucination
disordered thinking
experience of control

Question 8

what are the 3 examples of negative symptoms?

Answer 8

affective flattening
alogia
avolition

Question 9

what is affective flattening?

Answer 9

a reduction in the range and intensity of emotional expression

Question 10

what is alogia?

Answer 10

poverty of speech, characterised by the lessening of speech fluency and productivity.

Question 11

what is avolition?

Answer 11

the reduction of, or inability to initiate goal-directed behaviour

Question 12

what is chronic onset schizophrenia?

Answer 12

an insidious change in someone who gradually loses drive and motivation and slowly begins drifting from friends

Question 13

what is acute onset schizophrenia?

Answer 13

obvious signs appear e.g. hallucinations suddenly usually after a stressful event. Shows disturbed behaviour within a few days.

Question 14

what is reliability?

Answer 14

the consistency of the measuring instrument

Question 15

what is inter-rater reliability?

Answer 15

when more than one experimenter gives the same results

Question 16

ISSUES OF RELIABILITY:

The DSM-III has been updated to have inter-rater reliability, however, what have studies shown?

Answer 16

they found correlations as low as +11 with the diagnosis of schizophrenia so showing low reliability.

Question 17

ISSUES OF RELIABILITY:

Study by Rosenhan

Answer 17

this included ‘normal’ people presenting themselves with hearing voices in their heads. They were all diagnosed as having schizophrenia and admitted. Throughout the stay, none of the staff realised they were actually normal. Showing the classification and diagnosis system needs to be altered because simply just claiming to hear voices is not evidence enough.
In a further study, he warned hospitals of his ‘normal’ patients and this resulted in a 21% detection rate. Showing more reliable but still issues.

Question 18

ISSUES OF RELIABILITY:

Bizarre and non-bizarre delusions

Answer 18

For a diagnosis of schizophrenia, only one of the characteristic symptoms are required. 50 psychiatrists were asked to differentiate between bizarre and non-bizarre delusions. They produced inter-rater reliability of +40. Meaning the central diagnosis requirement (bizarre delusions) lacks reliability and so cannot be a sufficient method of diagnosing schizophrenia.

Question 19

ISSUES OF RELIABILITY:

Schizophrenia was more commonly diagnosed with the ICD-10. why is this?

Answer 19

This could be due to the ICD putting more emphasis on the first rank symptoms where as the DSM emphasises the cause of the disorder and the functional impairment with it.

Question 20

what is test-retest reliability?

Answer 20

the consistency over time

Question 21

is the test-retest reliability high or low? how do we know this?

Answer 21

high with .84. Wilkes administered 2 forms of the test to schizophrenics and found this.

Question 22

ISSUES OF RELIABILITY:

Cultural differences

Answer 22

They gave psychiatrists a description of a patient. 69% of the US psychiatrists diagnosed them as being schizophrenic compared to 2% of the British, suggesting the diagnosis lacks validity.

Question 23

ISSUES OF VALIDITY:

what is validity?

Answer 23

the extent you measure what you intend to measure

Question 24

ISSUES OF VALIDITY:

what is comorbidity

Answer 24

this refers to the extent that 2 or more conditions co-occur e.g. depression and schizophrenia.

Question 25

ISSUES OF VALIDITY:

Comorbidity

Answer 25

Comorbid depression occurs in 50% of patients and 47% have a lifetime diagnosis of comorbid substance abuse. The creates difficulties in deciding which disorder to treat, you tend to treat one and not the other

Question 26

ISSUES OF VALIDITY:
Evaluation
Comorbidity and medical complaints

Answer 26

The poor levels of functioning in schizophrenics may be down to their untreated comorbid disorder rather than their psychiatric disorder. Webber examined 6 million hospital discharge records to calculate comorbidity rate. Psychiatric and behaviour related diagnosis accounted for 45% comorbidity. However, the study also found evidence for many comorbid non-psychiatric diagnosis. Many with primary diagnosis of schizophrenia were also diagnosed with medical problems. Concluding that a consequence of being diagnosed with schizophrenia is that patients receive a lower standard of medical care which affects their prognosis.

Question 27

ISSUES OF VALIDITY:
Evaluation
Comorbidity and suicide rates

Answer 27

Kessler found the rate for attempted suicide rose from 1% for those with schizophrenia alone to 40% for those wit at least one comorbid disorder. Showing the diagnosis of schizophrenia is so wide that another illness cannot be identified meaning it is not valid.

Question 28

ISSUES OF VALIDITY:

Positive symptoms

Answer 28

positive symptoms were more useful for diagnosis than negative symptoms. Ellason and Ross point out that those with DID have more schizophrenic symptoms than those with schizophrenia suggesting the diagnosis lacks validity.

Question 29

ISSUES OF VALIDITY:

Prognosis

Answer 29

A diagnosis of schizophrenia has little predictive validity with the outcomes and symptoms being different for people. Varying from 20% recovering their previous levels of functioning, 10% achieving lasting improvement and 30% showing some improvement but with relapses.

Question 30

ISSUES OF VALIDITY:

Some people believe what about the diagnosis of schizophrenia?

Answer 30

that it should be dimensional as opposed to categorical. It should related to the degree to which problems are experienced not just the presence of them.

Question 31

ISSUES OF VALIDITY:
Evaluation
Ethnicity may lead to misdiagnosis

Answer 31

Rates among African-Caribbeans are much higher for schizophrenia when compared with white populations. Harrison found it to be 8 times higher. Some of this increase may be due to poor housing, high rates of unemployment and social isolation. Misdiagnosis may play a part in cultural differences in language and mannerisms.

Question 32

ISSUES OF VALIDITY:
General evaluation
Coping strategies

Answer 32

Some who are not diagnosed as schizophrenic hear voices but have coping strategies to deal with them and so do not feel disabled by them.

Question 33

ISSUES OF VALIDITY:
General evaluation
multiple disorder

Answer 33

Some say there is no single causal factor so schizophrenia is a multiple disorder. Treatments show that people respond differently and so the validity is questioned. This has created the suggestion of abandoning the name schizophrenia altogether and each of the symptoms should be seen as a disorder inits own right.