classification of schizophrenia

Question 1

what is the AO1 for classification of schizophrenia

Answer 1

• Schizophrenia is a serious mental disorder suffered by only 1% of the population.
• Psychologists have labelled it the “cancer” of mental health. → you can treat it but you are always a diagnosed schizophrenic
• It is more commonly diagnosed:
• In men than women
• In cities than towns
• In working class rather than middle class
• More diagnosed in the west - if you hear voices in the west its a bad thing, other places in the world it might not be seen as an issue
• Voices are different depending on location, where you grew up, social factors
• Many sufferers end up homeless if hospitalised.

Question 2

what are the 2 diagnostic tools + how do they diagnose + differ from eachother

Answer 2

• ICD-10
• DSM-V
• In the ICD-10 - european, you only need to present two or more negative symptoms, but in the DSM - american, you also need to present positive ones.
• Different locations may display different symptoms, therefore that affects the validity of the diagnosis
• The ICD-10 also recognises a range of subtypes of schizophrenia-
• Paranoid schizophrenia- characterised by powerful delusions and hallucinations
• Hebephrenic schizophrenia- presents only negative symptoms
• Catatonic schizophrenia- loss of movement or gain of significant over-activity
• People are now moving away from subtypes, as its very hard to narrow them down, and differentiate them

Question 3

what are positive symptoms of schizophrenia

Answer 3

Additional experiences beyond those of ordinary existence.

Question 4

what are examples of positive symptoms of schizophrenia

Answer 4

• hallucinations
• delusions
• disordered thinking
• psychomotor disturbances

Question 5

hallucinations

Answer 5

• Auditory hallucinations such as hearing voices in your head, these voices usually increase paranoia and negative thoughts “they are from the FBI! They are looking into you!” “He hates you. He is only pretending to like you. What are you going to do about it?”
• Visual or tactile hallucinations are also possible

Question 6

delusions

Answer 6

• Beliefs which could not possibly be true, although they seem very real to the patient.
  a) Delusions of persecution – when the belief creates delusion or paranoia about people being out to get them
  b) Delusions of grandeur- beliefs of being powerful and important e.g. believing that they are God or a powerful historical figure, celebrity.

Question 7

disordered thinking

Answer 7

• When a person believes their thoughts are being interfered with in some way:
• INSERTIONS- belief that thoughts are being inserted into their mind
• WITHDRAWLS- belief that thoughts are being removed from their mind
• BROADCASTS- belief that thoughts are being transmitted to others

Question 8

psychomotor disturbances

Answer 8

• Stereotypyical - Rocking backwards and forwards, twitches, & repetitive behaviors.
• Catatonia- staying in position for hours/days on end, cut off from the world.

Question 9

what are negative symptoms of schizophrenia

Answer 9

The characteristic is noticeable by its ABSENCE i.e. the sufferer fails to display characteristics we would expect to see.

Question 10

what are examples of negative symptoms of schizophrenia

Answer 10

• speech poverty (alogia), derailment - feature of speech poverty
• avolition
• flattening of affect

Question 11

speech poverty (alogia)

Answer 11

The sufferer rarely speaks or when they do, they speak incoherently or very briefly

Question 12

derailment

Answer 12

• a particular feature of speech poverty characterised by speech consisting of a sequence of unrelated or only remotely related ideas.
• The topic/focus changes from one sentence to the next.

Question 13

avolition

Answer 13

• The inability to engage in goal-directed behaviours e.g. going to school, work, the shops.
• Sufferer may spend hours or days at home doing and achieving nothing

Question 14

flattening of affect

Answer 14

• Affect = emotion
• Sufferers do not demonstrate emotion e.g. facially, in terms of body language, eye contact or tone of voice (monotone).

Question 15

what is the AO1 for reliability (diagnosis)

Answer 15

• Reliability = Consistency
• Inter-rater reliability is the extent to which two or more clinicians will agree with the diagnosis

Question 16

what is the AO3 for reliability (diagnosis) (-ve)

Answer 16

• Cheniaux (2009) asked two psychiatrists to diagnose 100 patients using the ICD-10 and DSM-V criteria. Reliability was very poor:
• Psychiatrist 1- 26/100 diagnosed with S via DSM-V, and 44/100 using ICD-10
• Psychiatrist 2- 24/100 using DSM-V and 13/100 using ICD-10
• This along with Rosenhan’s study on being Sane in Insane Places, illustrates the poor reliability in diagnosing schizophrenia → could this be due to the complexity of schizophrenia, or due to the lack of understanding and experience with them

Question 17

what is the AO1 for validity

Answer 17

• Is the extent to which we are measuring what we claim to measure.
• One way of measuring the validity of diagnosis for schizophrenia is using “criterion validity”- seeing if a variety of different assessment systems lead to the same diagnosis for the same patient?

Question 18

what is the AO3 for validity (-ve)

Answer 18

• Studies have shown that the ICD-10 is much more likely to lead to diagnosis of schizophrenia than that DSM-V.
• This suggests the schizophrenia could be over-diagnosed using the ICD, or under-diagnosed using the DSM.
• Either way, this is poor validity and a weakness of diagnosis.

Question 19

what is the AO1 for co-morbidity

Answer 19

• This is the likelihood that different mental disorders co-exist or occur together
• When disorders are co-morbid, this calls into questions the validity of the diagnosis as they might be one single condition

Question 20

what is the AO3 for co-morbidity (-ve)

Answer 20

Buckley (2009) found those with diagnosed with schizophrenia are also diagnosed with:
- Depression (50%)
- Substance abuse (47%)
- PTSD (29%)
- OCD (23%)

Question 21

what is the AO1 for system overlap

Answer 21

Diagnosis is not made easy because many symptoms overlap with other disorders

Question 22

what is the AO3 for system overlap (-ve)

Answer 22

• Bipolar also has positive symptoms of delusions and negative symptoms of avolition
• Under ICD a patient is likely to be diagnosed with Bipolar instead of schizophrenia, however the same patient would be diagnosed with Schizophrenia using the DSM. → This highlights a major issue in classification and diagnosis.
• This has an impact on people’s perception of the person

Question 23

what is the AO1 for gender bias in diagnosis

Answer 23

Gender Bias is a tendency to treat one gender in a different way to the other.

Question 24

what is the AO3 for gender bias in diagnosis (-ve)

Answer 24

• A meta-analysis conducted in 2010 showed that for the preceding 30 years, schizophrenia was more commonly diagnosed in men than women.
• Prior to this data show no difference.
• Men may be more genetically vulnerable, or there may be gender bias at play.
• Many psychologists believe that schizophrenia is undiagnosed in women because of their considerably superior emotional and social functioning, whereas for men this is not the same. (women are much better at hiding/masking things)
• Most research was originally conducted on men, females may present different symptoms

Question 25

what is the AO1 for cultural bias in diagnosis

Answer 25

Culture bias is the tendency to ignore cultural differences and interpret behaviour through the lens of your own culture.

Question 26

what is the AO3 for cultural bias in diagnosis (-ve)

Answer 26

• African Americans and English people with Afro-Caribbean origin are several times more likely to be diagnosed with schizophrenia than their white counterparts.
• Given that rates in the Caribbean and Africa are NOT high/in line with this, the issue cannot be biological- and is likely to be culture biased
• In many African cultures, hearing voices is a social norm, as are beliefs in communicating with Gods/dead ancestors.
• The issue may be that when reporting these symptoms to a white British psychiatrist, (have to go to medical school, tend to be white, middle class, affluent), they are not regarded in the same light, leading to bias in diagnosis.