Classification and diagnosis of Schizophrenia

Question 1

What % of the world are diagnosed w schizophrenia

Answer 1

1%
thats like 8mil ppl
a lot
damn
cud b nearly 1 in 2
avani i have smth to tell u

Question 2

What is the world’s most common mental dsorder

Answer 2

Schizophrenia
surprise
Accounts for 50% of all mental health in-unit services

Question 3

What is psychosis

Answer 3

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)

Question 4

How are mental health disorders classified

Answer 4

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

Question 5

What is disorganised schizophrenia

Answer 5

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

Question 6

What is catatonic schizophrenia

Answer 6

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

Question 7

What is echolaia

Answer 7

The involuntary parrot-like repetition (echoing) of a word or phrase just spoken by another person

Question 8

What is echopraxia

Answer 8

The involuntary imitation or repetition of the body movements or another person, sometimes practiced by catatonic patients

Question 9

What is paranoid schizophrenia

Answer 9

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

Question 10

What is undifferentiated SZ

Answer 10

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

Question 11

What is residual SZ

Answer 11

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

Question 12

What +ve symptoms can SZ patients have

Answer 12

Hallucinations
Delusions
Disorganised speech
Grossly disorganised or catatonic behaviour

Question 13

What are some -ve symptoms

Answer 13

Avolition
Speech poverty
Affective flattening
Anhedonia

Question 14

What are some secondary symptoms

Answer 14

Depression
Loss of employment
Breakdown of relationships

Question 15

What does the Mental Health Act 1983 state

Answer 15

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

Question 16

What is a -ve evaluation of diagnosing SZ

Answer 16

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

Question 17

What is co-morbidity and how does it affect reliability and validity as a -ve evaluation for diagnosis

Answer 17

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

Question 18

How is symptom overlap a -ve evaluation

Answer 18

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

Question 19

How is consistency of diagnosis (reliability) a -ve evaluation

Answer 19

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

Question 20

How is gender bias a -ve evaluation in diagnosis

Answer 20

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)