Classification of schizophrenia

Question 1

What is schizophrenia

Answer 1

A mental illness where you see, hear or believe things that aren’t real.

A serious mental condition involving a breakdown in the relation between thoughts, emotions and behaviour.

Question 2

When is schizophrenia likely to occur?

Answer 2

Late adolescence or early adulthood, but it can occur at any time in life.

Question 3

Who is more likely to experience schizophrenia?

Answer 3

It is more commonly diagnosed in men, city-dwellers and lower socio-economic groups.

It is a serious mental disorder experienced by about 1% of the world population.

Question 4

What is classification?

Answer 4

A classification system collects the symptoms of a disorder.
Psychiatrists then use this list of symptoms to diagnose the disorder.

Question 5

What are the 2 major systems for the classification of mental disorders?

Answer 5

International Classification of Disease edition 10 (ICD-10)
American Psychiatric Association’s Diagnostic and Statistical Manual Edition (DSM-5)

Question 6

Explain the difference between the ICD-10 and DSM-5 classification of schizophrenia

Answer 6

DSM-5 = one positive symptom must be present
ICD-10 = 2 or more negative symptoms are sufficient for diagnosis

Question 7

What are positive symptoms?

Answer 7

Positive symptoms reflect additional experiences beyond those of ordinary existence / atypical symptoms experienced in addition to normal experiences.

Question 8

What are the positive symptoms of schizophrenia?

Answer 8

Hallucinations and delusions

Question 9

Define delusions

Answer 9

Delusions are false beliefs that are firmly held despite being completely illogical, or for which there is no evidence. They involve beliefs that have no basis in reality.

Question 10

Name the different types of delusions in schizophrenia

Answer 10

Delusions of persecution
Delusions of grandeur
Delusions of control

Question 11

Define delusions of persecution

Answer 11

The belief that others want to harm, threaten or manipulate you. For example, schizophrenics may believe that they are being spied on, that nasty rumours are being spread about them or that people are plotting to kill them.

Question 12

Define delusions of grandeur

Answer 12

This is the idea that you are an important individual, even god-like and have extraordinary powers. One of the most frequent of this type of delusion is the belief that they are Jesus Christ.

Question 13

Define delusions of control

Answer 13

Individuals may believe that they are under the control of an alien force that has invaded their mind and/or body. This may be interpreted, for example, as the presence of spirits or implanted radio transmitters.

Question 14

Define hallucinations

Answer 14

A positive symptom of schizophrenia. They are sensory experiences that have either no basis in reality or are distorted perceptions of things that are there.

Question 15

What are hallucinations?

Answer 15

Hallucinations involve disturbances in perception (rather than disturbances in thought). They are false perceptions that have no basis in reality. The most common hallucinations are auditory ones (hearing voices) but can include smell, touch and sight.

Question 16

What are negative symptoms?

Answer 16

Atypical experiences that represent the loss of a usual experience such as a loss of clear thinking or loss of motivation. Negative symptoms appear to reflect a loss of normal function.

Question 17

What are the negative symptoms of schizophrenia?

Answer 17

Speech poverty and avolition

Question 18

What is speech poverty?

Answer 18

Reduction in the frequency and quality of speech.

Question 19

Explain speech poverty as a negative symptom of schizophrenia

Answer 19

The ICD-10 recognises speech poverty as a negative symptom. This is because the emphasis is on reduction in the amount and quality of speech in schizophrenia. This is sometimes accompanied by a delay in the sufferers verbal responses during conversation. Nowadays, the DSM system places its emphasis on speech disorganisation in which speech becomes incoherent or the speaker changes topic mid-sentence

Question 20

What is avolition?

Answer 20

Avolition is the reduction, difficulty, or inability to start and continue with goal-directed behaviour. It is often mistaken for apparent disinterest.

Question 21

Give some examples of avolition

Answer 21

no longer being interested in going out and meeting with friends, no longer being interested in activities that the person used to show enthusiasm for, no longer being interested in anything, sitting in the house for many hours a day doing nothing.

Question 22

What did Andreasen do?

Answer 22

Andreason (1982) identified three identifying signs of avolition

Question 23

What 3 signs of avolition did Andreasen identify?

Answer 23

poor hygiene and grooming, lack of persistence in work or education. And lack of energy

Question 24

What are the limitations of schizophrenia diagnosis?

Answer 24

• low reliability
• validity
• comorbidity
• symptom overlap
• gender bias
• culture bias

Question 25

What is reliability?

Answer 25

This means consistency

Question 26

What is an important measure of reliability?

Answer 26

Inter-rater reliability - the extent to which different assessors agree on their assessments.

Question 27

Explain reliability in terms of sz + diagnosis

Answer 27

In the case of diagnosis this means the extent to which two or more mental health professionals arrive at the same diagnosis for the same patients

Question 28

Explain why schizophrenia diagnosis has low reliability

Answer 28

Cheniaux et al asked 2 psychologists to independently diagnose 100 patients using the DSM and ICD. One diagnosed 26 using the DSM and 44 using the ICD. The other diagnosed 13 with DSM and 24 with the ICD.

Question 29

What does this suggest in terms of reliability?

Answer 29

Lack of reliability with diagnosis and classification. Doesn’t have inter-rater reliability as you wouldn’t diagnose sz as often with DSM as they would with ICD. This is an issue because it could be a wrong diagnosis and people who need treatment can’t have it because they don’t meet the classification.

Question 30

What is validity?

Answer 30

The extent to which we are measuring what we are intending to measure

Question 31

How do you assess validity?

Answer 31

One standard way to assess validity of the diagnosis is criterion validity; do different assessment systems arrive at the same diagnosis for the same patient

Question 32

What is criterion validity?

Answer 32

Tests if different assessment systems arrive at the same diagnosis for the same patient.

Question 33

Cheniaux et al’s study shows that sz is much more likely to be diagnosed with the ICD rather than the DSM. What does this suggest explain in terms of criterion validity?

Answer 33

Lacks criterion validity because the different classification systems didn’t arrive at the same diagnosis for the same patients. It’s easier to observe negative symptoms than positive symptoms so if you use ICD, you might get people over diagnosed and if you use DSM you might get people underdiagnosed.

Question 34

what is co-morbidity?

Answer 34

Is the phenomenon that two or more conditions occur together. For example, a person has both schizophrenia and a personality disorder.

Question 35

Why is this an issue?

Answer 35

Where two conditions are frequently diagnosed together it calls into question the validity of the classification of both illnesses. It could be that the findings of research are due to psychiatrists not being able to tell the difference between the two conditions. In terms of classification, it may be that, if very severe depression looks a lot like schizophrenia and vice versa, then they might be better seen as a single condition.

Question 36

What did Buckley et al do?

Answer 36

Conducted a review and found that around half patients with a diagnosis with schizophrenia also have a diagnosis of depression or substance abuse. PTSD also occurs in 29% of cases and OCD in 23%.

Question 37

What does Buckley’s research suggest in terms of classification, diagnosis and validity?

Answer 37

Patients may be getting wrongly diagnosed because psychiatrists may find it difficult to differentiate symptoms. Buckley’s research suggests medical professionals may not be sure of diagnosis which questions the reliability + validity of schizophrenia diagnoses.

Question 38

What is symptom overlap?

Answer 38

Occurs when 2 or more conditions share symptoms. Where conditions share many symptoms this calls into question the validity of classifying the 2 disorders separately.

Question 39

Give an example of symptom overlap?

Answer 39

For example, schizophrenia and bipolar disorder both share positive symptoms like delusions and negative symptoms like avolition. This lack of distinction calls into question the validity of both the classification and diagnosis of schizophrenia.

Question 40

Why does schizophrenia and and bipolar disorder sharing positive symptoms create an issue for the validity of diagnosis and classification?

Answer 40

There is a symptom overlap which means psychiatrists might not be able to tell the difference between the 2 conditions. Thus, lacks validity + reliability as it may be a misdiagnosis. This is a problem for classification because it means schizophrenia may not exist as a distinct condition, and is a problem for diagnosis as at least some people diagnosed with sz may have unusual cases of conditions like depression.

Question 41

Explain how schizophrenia diagnosis is gender biased

Answer 41

Research has shown that studies since the 1980s men have been more diagnosed than women have. Cotton et al found women with schizophrenia function better than men with schizophrenia. This may explain how some women escape diagnosis due to better interpersonal functioning compared to men.

Question 42

What does Cotton’s findings suggest in terms of gender bias and validity?

Answer 42

• Women may be less vulnerable than men because of genetic factors
• women are underdiagnosed because they have closer relationships and get support which means they function better.
  This underdiagnosis is a gender bias and means women may not be receiving treatment.

Question 43

Explain how schizophrenia diagnosis is culturally biased

Answer 43

African Americans and English people with African origins are more likely to be diagnosed with schizophrenia in the UK. However, rates within the West Indies + Africa aren’t as high. This can’t be due to a genetic vulnerability because rates within West Indies + Africa aren’t as high.

Question 44

What does this suggest?

Answer 44

• There is a higher rate of diagnosis in the UK because there is culture bias in diagnosis of clients by psychiatrists from a different cultural background. This leads to an overinterpretation of symptoms in black people. This is an example of an ethnocentric diagnostic system which discriminates against African people. It lacks validity because it is based on the psyhciatrist’s interpretation and the system is based on UK values so anything that deviates from this is seen as an abnormality.