Classification and diagnosis of Schizophrenia Flashcards
What % of the world are diagnosed w schizophrenia
1%
thats like 8mil ppl
a lot
damn
cud b nearly 1 in 2
avani i have smth to tell u
What is the world’s most common mental dsorder
Schizophrenia
surprise
Accounts for 50% of all mental health in-unit services
What is psychosis
Term used to describe a severe mental health problem where the individual loses contact with reality (unlike neurosis where the individual is aware that they have certain symptoms)
About 1/4 of people w schizophrenia will “get better” after only one episode of the illness
50-65% will improve, but continue to have bouts of the illness
The remainder will have persistent difficulties (Stirling and Hellewell 1999)
How are mental health disorders classified
ICD-10
International Classification of the Causes of Disease and Death (World Health Organisation)
Recognises a range of subtypes
DSM-V
Diagnostic and Statistical Manual of Mental Disorder (American Psychiatric Association) - used to also recognise the subtypes but the most recent DSM-V have dropped these
What is disorganised schizophrenia
The person’s behaviour is generally disorganised and not goal directed
Symptoms include thought disturbances (including delusions and hallucinations), an absence of expressed emotion, incoherent speech, large mood swings and a loss of interest in life - social withdrawal
Usually diagnosed in adolescence/young adulthood
What is catatonic schizophrenia
If the patient has severe motor abnormalities such as unusual gestures or use of body language
Sometimes patients gesture repeatedly, using complex sequences of finger, hand and arm movements, which appear to have some meaning for them
This type often involves doing opposite to what is being asked or repeating everything that is said
The main features is almost total immobility for hrs at a time with the patient simply staring blankly
Echolalia
Echopraxia
What is echolaia
The involuntary parrot-like repetition (echoing) of a word or phrase just spoken by another person
What is echopraxia
The involuntary imitation or repetition of the body movements or another person, sometimes practiced by catatonic patients
What is paranoid schizophrenia
Involves delusions of various kinds (persecution and grandeur)
But patient remains emotionally responsive
More alert than patients w other types of schizophrenia
People who are more diagnosed w PD tend to be argumentative
What is undifferentiated SZ
This is a broad, ‘catch-all’ category which includes patients who do not clearly belong within any other category
They show symptoms of SZ but do not fit into the other types
What is residual SZ
This is the category that describes people who. although have had an episode of SZ during the past 6 month and still exhibit some symptoms, these are not strong enough to merit putting them in the other categories
This type consists of patients who are experiencing mild symptoms
What +ve symptoms can SZ patients have
Hallucinations
Delusions
Disorganised speech
Grossly disorganised or catatonic behaviour
What are some -ve symptoms
Avolition
Speech poverty
Affective flattening
Anhedonia
What are some secondary symptoms
Depression
Loss of employment
Breakdown of relationships
What does the Mental Health Act 1983 state
Someone w SZ may not realise they are ill and can refuse treatment when they need it
AS a result can be admitted to a hospital against their will and given treatment without their consent under the Mental Health Act
Should only happen if their health is at risk, if they are in danger to themselves, or if they may be a danger to others
What is a -ve evaluation of diagnosing SZ
Validity - Rosenhan ‘On being sane in insane places’
Diagnosis of SZ lacks validity, as psychiatrists cannot distinguish between real and pseudo-patients
Being diagnosed w SZ is a ‘sticky label
- difficult to remove, with serious consequences - and yet it is manufactured by psychiatrists with low degrees of accuracy
What is co-morbidity and how does it affect reliability and validity as a -ve evaluation for diagnosis
Is the occurrence of 2 illnesses or conditions occurring simultaneously
Can create problem w reliability of diagnosis as may be confusion over which disorder is being diagnosed, e.g. SZ or depression
Patients w SZ also have a diagnosis of depression (50%), substance abuse (47%), PTSD (29%) and OCD (23%), Buckley et al 2009
Co-morbidity raises issues of descriptive validity, as having simultaneous disorders suggests that SZ may not actually be a separate disorder
How is symptom overlap a -ve evaluation
Considerable overlap of symptoms pf SZ and other conditions
Both SZ and bipolar disorder involve +ve symptoms like delusions and -ve symptoms like avolition
Calls into questions both validity and classification and diagnosis of SZ
Under ICD a patient might receive a diagnosis of SZ but many of same patients would receive diagnosis of bipolar disorder under DSM criteria
How is consistency of diagnosis (reliability) a -ve evaluation
Important measure of reliability is inter-rater reliability
In relation to diagnosis, means different clinicians make identical, independent diagnosis of the same patient
Cheniaux et al 2009 had 2 psychiatrists independently diagnose 100 patients using both DSM and ICD criteria
How is gender bias a -ve evaluation in diagnosis
Longeneck et al 2010 - since 1980 men have been diagnosed w SZ more often than women
Men are more genetically vulnerable to developing the disorder
Loring and Powell 1988 - 290 psychiatrists were asked to diagnosis 2 patients w the same symptoms
Cotton et al 2009 - female patients typically function better than male patients (better interpersonal functioning)
56% of those men diagnosed other men w SZ but only 20% of women (gender difference exaggerated to point of ignoring abnormal behaviour)
