Classification of Schizophrenia

Question 1

What is schizophrenia?

Answer 1

A mental disorder characterised by withdrawal from reality.

It comes from two Greek words: ‘schizo’ meaning split, and ‘phren’ meaning mind.

It is a form of psychosis.

Question 2

Outline Dr. Kraepelin in the emergence of schizophrenia.

Answer 2

First classified mental disorders into different categories in 1896.

First used the term ‘dementia praecox’ for individuals that we now associate with schizophrenia.

He believed schizophrenia was a brain disease and a form of dementia that affected young people.

Question 3

Outline Bleuler in the emergence of schizophrenia.

Answer 3

Coined the term ‘schizophrenia’ in 1910.

He felt that ‘dementia praecox’ was inaccurate and intended his term to refer to the disassociation or loosing of thoughts and feelings.

First to distinguish between positive and negative symptoms.

Question 4

Outline Schneider in the emergence of schizophrenia.

Answer 4

Was the first to provide detailed first-rank symptoms of schizophrenia in 1959, by using subjective experiences based on verbal reports by the patients.

He was able to recognise the symptoms of schizophrenia sufferers.

(Type 1 - positive symptoms).

Question 5

Outline Slater and Roth in the emergence of schizophrenia.

Answer 5

Added four more symptoms in 1969.

These were found by directly observing behaviours of patients.

They also included negative symptoms such as avolition.

(Type 2 - negative symptoms).

Question 6

What are type 1 symptoms of schizophrenia?

Answer 6

Mainly positive symptoms (pathological excesses) which are intense but short term.

Question 7

What are type 2 symptoms of schizophrenia?

Answer 7

Mainly negative symptoms (pathological deficits).

Chronic, and normally resistant to treatments.

Question 8

State the 4 positive (type 1 symptoms) of schizophrenia.

Answer 8

Delusions.

Experiences of control.

Hallucinations.

Distorted thinking.

Question 9

State the 4 negative (type 2 symptoms) of schizophrenia.

Answer 9

Affective flattening.

Alogia.

Avolition.

Psychomotor disturbances.

Question 10

Outline delusions as a symptom of schizophrenia.

Answer 10

Firm, unshakeable beliefs that the individual feels.

Question 11

Outline experiences of control as a symptom of schizophrenia.

Answer 11

Not accountable for their actions, someone else is controlling them.

Question 12

Outline hallucinations as a symptom of schizophrenia.

Answer 12

Distorted perception of the environment, linked to all
senses but most commonly auditorily or visually.

Question 13

Outline distorted thinking as a symptom of schizophrenia.

Answer 13

Feeling of someone or something taking away your thoughts and speech, non- coherent speaking.

Question 14

Outline affective flattening as a symptom of schizophrenia.

Answer 14

Communication and facial expression are reduced, mono tonal.

Question 15

Outline alogia as a symptom of schizophrenia.

Answer 15

Reduction of speech productivity and fluidity (speech poverty).

Question 16

Outline avolition as a symptom of schizophrenia.

Answer 16

Lack of motivation and ability to make decisions, no enthusiasm, energy, or sociability.

Question 17

Outline psychomotor disturbances as a symptom of schizophrenia.

Answer 17

Sufferers adopt frozen, statue-like poses, exhibit twitches and
repetitive behaviour; e.g. pacing up and down.

Question 18

How is schizophrenia diagnosed?

Answer 18

According to the most recent DSM-5, at least two of the following symptoms needs to be shown continuously for more than a month for schizophrenia to be diagnosed:

Hallucinations.
Delusions.
Disorganised speech.
Disorganised or catatonic behaviour.
Negative symptoms.

As well as social and occupational dysfunction.

Question 19

What is social and occupational functioning? State 2 examples.

Answer 19

Refers to the fact that for a significant amount of time, the individual cannot function in one or more major areas of their life:

For example:
- Interpersonal relationships.
- Self-care.
- Being unable to work.
- Greatly reducing speech/ conversation.
- Appearing lazy and unmotivated.

Question 20

How do schizophrenics seek treatment?

Answer 20

Self-referral.

Concerns from family and close friends.

Question 21

What is the prevalence of schizophrenia?

Answer 21

1% lifetime risk in the general population, this holds true for most geographical areas.

Torrey, (2002) stated that abnormally high in Southern Ireland and Croatia. Significantly lower levels in Italy and Spain.

Question 22

How is schizophrenia diagnosis an androcentric beta bias?

Answer 22

Schizophrenia symptoms have been created from largely male samples, so they’re potentially gender specific symptoms ignore that of women’s.

This may explain why men are diagnosed more readily than women.

This is an example of an androcentric beta bias

Question 23

Outline two schizophrenia risk factors.

Answer 23

Risk factors include minority ethnicity and urban residence.

Question 24

Outline ‘rule of thirds’ as schizophrenia prognosis.

Answer 24

1/3 recover more or less completely.
1/3 experience episodic impairment.
1/3 experience a chronic decline.

Stevens, (1975) confirmed this to be valid, in the US and the UK. With treatment about 60% of patients manage a relatively normal life. Prognosis is better in non-industrialised sections.

Question 25

How has the DSM improved reliability?

(Reliability in Classification and Diagnosis of Schizophrenia)

Answer 25

The DSM-5 discussion (2010-2013) addressed problems with the complexity of schizophrenia diagnosis.

DSM-5 was published and used from May 2015, and has now moved away from categories of schizophrenia, deeming them not useful diagnostic tools nor helpful in planning treatment.

Question 26

Outline Seto’s study form 2004.

(Challenges the reliability of schizophrenia diagnoses)
(Reliability in Classification and Diagnosis of Schizophrenia)

Answer 26

Challenges the reliability of schizophrenia diagnoses.

This is because they reported that the term ‘schizophrenia’ was relabelled ‘integration disorder’ in Japan due to the difficulty of attaining reliable diagnoses.

This suggests that schizophrenia as a separate identifiable disorder does not exist.

Question 27

What are the 3 ways of testing reliability? Explain them.

Answer 27

Test-retest:
Occurs when a clinician makes the same diagnosis on separate occasions from the same information.

Inter-rater reliability:
Occurs when different clinicians make identical, independent diagnoses of the same patient.

Different tool, same result:
Occurs when clinicians make the same diagnosis using different diagnostic systems or methods.

Question 28

Outline Read et al’s study from 2004.

(Challenges the use of test-retest as a schizophrenia diagnosis)
(Research for Test-retest)

Answer 28

Challenges the use of test-retest as a schizophrenia diagnosis.

This is because they reported test-retest reliability of schizophrenia diagnosis to have only a 37% concordance rate.

This suggests that the method is not valid.

Question 29

Outline Copeland et al’s study from 1970.

(Challenges inter-rater reliability in the diagnosis of schizophrenia)
(Research for Inter-rater Reliability)

Answer 29

Challenges inter-rater reliability in the diagnosis of schizophrenia.

This is because when a description of a patient was given to 194 UK and 134 US psychiatrists, 69% of US psychiatrists diagnosed the patient with schizophrenia, compared to 2% of UK psychiatrists.

This suggests diagnoses of schizophrenia has never been fully reliable.

Question 30

Outline Vares et al’s study from 2006.

(Supports the idea of different tools giving the same result)
(Research for Different Tool, Same Result)

Answer 30

Supports the idea of different tools giving the same result.

This is because they looked at different methods for diagnosing schizophrenia e.g. interviews and medical, finding good concordance rates.

This suggests the method has reliability strength.

Question 31

What are the ways in which validity can be measured? Explain them.

(Validity in Classification and Diagnosis of Schizophrenia)

Answer 31

Predictive validity:
If a diagnosis led to successful treatment, it is seen as valid.

Descriptive validity:
To be valid, patients diagnosed with different disorders should differ from each other.

Aetiological validity:
To be valid, all patients with the same disorder should have the same cause.

Question 32

Outline Rosenhan’s study from 1973.

(Challenges the validity of schizophrenia diagnoses)
(Validity in Classification and Diagnosis of Schizophrenia)

Answer 32

Challenges the validity of schizophrenia diagnoses.

This is because when they used the DSM-2 classification system, psychiatrists could not distinguish between sanity and insanity in real and pseudo-patients.

This suggests that the diagnosis of schizophrenia lacks validity.

Question 33

Outline Mason et al’s study from 1997.

(Supports predictive validity)
(Research for Predictive Validity)

Answer 33

Supports predictive validity.

They tested the ability of 4 different classification systems of diagnosis to predict the outcome of the disorder over a 13-year period on 99 schizophrenics, finding more modern classification systems had higher predictive validity.

This suggests that predictive diagnosis has improved over time - as classification systems have improved.

Question 34

Outline Jager et al’s study from 2003.

(Supports descriptive validity)
(Research for Descriptive Validity)

Answer 34

Supports descriptive validity.

This is because they found it was possible to use ICD-10 to distinguish 951 cases of schizophrenia from 51 persistent delusional disorders, and 470 other mental health problems.

This suggests that schizophrenia diagnoses have high descriptive validity.

Question 35

Outline Baillie et al’s study from 2009.

(Challenges aetiological validity)
(Research for Aetiological Validity)

Answer 35

Challenges aetiological validity.

This is because they surveyed 154 British psychiatrists, finding that other than an agreement as to the influence of genetics, biochemistries, and substance abuse; they had widely differing views on the causes of schizophrenia.

This suggests that the aetiological validity of schizophrenia is low.

Question 36

What are the 4 ways in measuring bias? Explain them.

(Bias in Classification and Diagnosis of Schizophrenia)

Answer 36

Co-morbidity:
The presence of one or more additional disorders or diseases simultaneously occurring with schizophrenia.

Culture Bias:
The tendency to over-diagnose members of other cultures as suffering from schizophrenia.

Gender Bias:
The tendency for diagnostic criteria to be applied differently to males and females and for there to be differences in the classification of the disorder

Symptom Overlap:
The perception that symptoms of schizophrenia are also symptoms of other mental disorders.

Question 37

Outline Sim et al’s study from 2006.

(Supports the idea of co-morbidity in the diagnosis of schizophrenia)
(Research for Co-morbidity)

Answer 37

Supports the idea of co-morbidity in the diagnosis of schizophrenia.

This is because they reported that 32% of 142 hospitalised schizophrenics had an additional mental disorder.

This suggests that co-morbidity can create problems in achieving valid diagnoses.

Question 38

Outline Whaley et al’s study from 2004.

(Supports the idea of a culture bias in the diagnosis of schizophrenia)
(Research for Culture Bias)

Answer 38

Supports the idea of a culture bias in the diagnosis of schizophrenia.

This is because they believed the main reason for schizophrenia incidence among black Americans (2.1%) being greater than among white Americans (1.4%) is ethnic differences in symptom expression being overlooked or misinterpreted by practitioners.

This suggests culture biases have a lack of validity, and have altered schizophrenia diagnoses.

Question 39

Outline Lewin et al’s study from 1984.

(Supports the idea of a gender bias in the diagnosis of schizophrenia)
(Research for Gender Bias)

Answer 39

Supports the idea of a gender bias in the diagnosis of schizophrenia.

This is because they found that if clearer diagnostic criteria were applied, the number of female sufferers decreases.

This suggests a gender bias in the original diagnosis.

Question 40

Outline Serper et al’s study from 1999.

(Challenges issues of symptom overlap in the diagnosis of schizophrenia)
(Research for Symptom Overlap)

Answer 40

Challenges issues of symptom overlap in the diagnosis of schizophrenia.

This is because they assessed patients with co-morbid schizophrenia and cocaine abuse, cocaine abuse on its own and schizophrenia on its own; finding that although there was considerable symptom overlap in patients with schizophrenia and cocaine abuse, it was possible to make accurate diagnoses.

This suggests that overlapping bias can be worked around in order to accurately diagnose.