classification of SZ

Question 1

What is Schizophrenia (SZ)

Answer 1

It is a mental disorder characterised by disruption of cognition and emotion. It effects thought, language, perception, emotion and their sense of self. Approximately 1% of the population suffer it. 
It usually begins between ages 15-35
more diagnosed in:
men than women 
cities than rural areas
working class than middle class people

Question 2

Psychotic disorders and SZ

Answer 2

SZ is a psychotic disorder not a neurotic one, psychotic means that mental issues are causing abnormal thinking and perception meaning they loose touch with reality.

Question 3

What are the two classification systems used to diagnose SZ?

Answer 3

1) The DSM 5, created by the American Psychological Association (APA)- it is not in it’s 5th edition
2) The ICD 10, devised by the World Health Organisation (WHO)- In it’s 10th edition

Question 4

Differences between the DSM 5 and the ICD 10

Answer 4

The DSM is mainly used in America while the ICD is used in Europe and other parts of the world.

Both use symptoms to diagnose, and look at positive and negative symptoms.

The DSM states you need two or more positive symptoms, or one positive and one negative symptoms, to diagnose. This needs to occur for one month and extreme social withdrawal for 6 months for their to be a diagnosis.

The ICD needs one positive and one negative, or two negative, symptoms for at least a month for diagnosis.
It also recognises subtypes of schizophrenia such as Catatonic and Paranoid SZ. The DSM does not recognise these subtypes.

Question 5

What are the types of Schizophrenia?

Answer 5

Type 1- characterised more by positive symptoms, which are an addition to someone’s behavior. Has better prospects for recovery

Type 2-characterised more by negative symptoms, generally poorer prospects for recovery.

Question 6

6 Positive symptoms of SZ

Answer 6

Hallucinations- sensory experiences of stimuli that have no basis in realty or are distorted perceptions of real things. There are 3 types of them.

Auditory (hearing) hallucinations- Experiencing hearing voices making comments or talking to them in their head normally criticisng them.

Visual (seeing hallucinations) - seeing things that are not real

Olfactory (smelling) hallucinations- smelling things that are not real

Tactile (touching) hallucinations- touching and feeling things that are no there

Delusions/paranoia- irrational beliefs that seem teal the person with SZ. It can take a range of forms from believing yourself a historical figure to believing your persecuted by the government.

Disorganised speech- The result of an abnormal thought process: they have problems organising their thoughts and feelings, will slip from one topic to another (derailment), and may only speak incoherently in gibberish.,

Question 7

4 negative symptoms of SZ

Answer 7

Speech poverty/Alogia- SZ is characterised by changes in patterns of speech, reduction in the quality of speech and delay of verbal responses in conversation.

Avolition/apathy- finding it difficult to start or keep up with goal orientated activities. SZ effected people iften have reduced motivation

Affective flattening- reduction in the range and intensity in emotional expression, such as facial expression, tone, body language etc. When speaking they may show deficit in intonation, tempo loudness etc which give clues to emotions.

Anhedonia- a loss if interest or pleasure in almost all activities, or lack of reaction to normally pleasurable stimuli. This can be physical with a lack of physical pleasure from food, hugging etc. It can also be social such as when there is no pleasure from interacting with others.

Question 8

Weaknesses of classification of SZ

Answer 8

• ) Whaley found that inter rater reliability for DSM was as low as +0.11 in 2001. Another study in 2009 used two psychiatrists independently diagnose SZ patients using both criteria. Inter rater reliability was poor with both ICD and DSM, one diagnosed 26 with DSM and 44 to ICD. The other diagnosed 13 with DSM and 24 with ICD. this all proves that diagnosing SZ is not reliable.
• ) One study found that in ICD there are much more diagnosis’s then DSM, suggesting either that DSM is underdiagnosing or ICD is over diagnosing. This supports the idea that their is poor validity.
• ) A study found that around half of SZ patients have a diagnosis of depression (50%) or have a substance abuse diagnosis (47%). This supports the idea of C0-MORBIDITY, which is when two or more mental disorders occur at the same time. This makes diagnosis harder, if half the patients are diagnosed with both SZ and depression then that may mean we find it hard to distinguish between the two disorders. It is therefore a weakness of diagnosis and classification.
• ) A study found that if people with Dissociative Identity Disorder actually have more SZ symptoms then people with SZ. Most people with SZ have enough symptoms that they could receive another diagnosis. This SYMPTOM OVERLAP questions the validity of SZ classification and diagnosis. Under different classification types the same person could be diagnosed with SZ or DID.
• ) A study found since the 1980s men are more likely to be diagnosed with SZ than women. This may be because men are more genetically vulnerable to SZ or it could be gender bias. This could be due to them having good family relationships and more likely to work according to some psychologists.
• ) There could be cultural bias, a study found that African Americans and people of afro Caribbean origins are 9 times more likely to be diagnosed with SZ. This could be due to some symptoms of SZ such as auditory hallucinations being more acceptable in Africa because of cultural beliefs in communicating with ancestors.

Question 9

Strengths of classification and diagnosis

Answer 9

• ) Communication shorthand, patients often have multiple symptoms. Incorporating them into a single diagnosis makes communication between health professionals easier.
• ) Treatments are often specific to certain disorders, ie people of SZ respond well to anti psychotic drugs but not anti anxiety drugs. A reliable diagnosis makes treatment and recovery easier by providing the best therapy.
• ) There may be variation but there are underlying biological abnormalities seen in people with SZ. Greater understanding of these can lead t better treatment.