Classification Of SZ Flashcards
What is schizophrenia
A mental psychotic disorder characterised by a profound disruption of cognition and emotion
The onset of the disorder is between (…) and (…) years of age
15
35
In the past, sz was more commonly diagnosed in what groups of people
Men > women
Cities > countryside
Working class > middle class
What are the 2 classification systems used to diagnose SZ
- the DSM 5
- the ICD 11
Where is the DSM used?
America
Where is the ICD 11 used?
Europe
How many types of SZ are there
2
Who made a distinction between the two types of SZ
Crow
What is type 1 syndrome characterised by
More positive symptoms (which are an addition to an individuals behaviour) e.g. visual or auditory hallucinations, or delusions of grandeur
Which type of SZ has better prospects for recovery
Type 1
What is type 2 syndrome characterised more by
Negative symptoms e.g. loss of appropriate emotion of poverty of speech
Generally poorer prospects for recovery
What are the two types of symptoms of SZ
Positive and negative
What are the positive symptoms of SZ (4)
- Hallucinations
- Delusions
- Disorganised speech
- Grossly disorganised or catatonic behaviour
Wdym by hallucinations
These are sensory experiences of stimuli that have either no basis in reality or are distorted perceptions of things that are
What are the 4 diff types of hallucinations you can have
- auditory (hearing voices making comments or criticising)
- visual (seeing things not real e.g distorted facial expressions on animals)
- olfactory (smelling things not real)
- tactile (touching or feeling things not there e.g. bugs)
What are delusions (aka paranoia)
Irrational, bizzare beliefs that seem real to the person
Common delusions e.g. being persecuted by the government, or aliens, or being an important figure e.g. Jesus
What’s disorganised speech
- individual has problems organising their thoughts therefore may slip from one topic to another (derailment)
What is grossly disorganised / catatonic behaviour
The inability / motivation to imitate or even complete a task
What does it mean by negative symptoms of SZ
Those that appear to reflect a reduction or loss of normal functions which often persist during periods of low (absent) positive symptoms
What are the negative symptoms of SZ
- Speech poverty (alogia)
- Avolition
- Affective flattening
- Anhedonia
What is speech poverty (alogia)
SZ is characterised by changes in patterns of speech - the emphasis is on the reduction in the amount and quality of speech
This is sometimes a delay in verbal responses during conversation
Speech poverty may also be reflected in less complex syntax e.g. shorter utterances
What’s avolition (aka apathy)
Finding it difficult to begin or keep up with gosl-directed activity e.g. actions performed in order to achieve a result
Signs of avolition
Poor hygiene
Grooming
Lack of persistence in work or education and lack of energy
What’s affective flattening
A reduction in the range and intensity of emotional expression, including facial expression, voice tone, eye contact and body language
Individuals who are schizophrenic have fewer body and facial movements and smiles, and less co-verbal behaviour
Patients may also show a deficit in prosody (e.g. intonation, tempo, loudness & pausing), which gives cues to the emotional content of the conversation
What’s anhedonia
A loss of interest or pleasure in all / most activities, or a lack of reactivity to normally pleasurable stimuli
Physical anhedonia is the inability to experience pleasure from physical pleasures e.g. food, bodily contact
Social anhedonia is the inability to experience pleasure from interpersonal situations like interacting with others
What are the 6 issues associated with the classification and diagnosis of SZ
1) reliability
2) validity
3) co-morbidity
4) symptom overlap
5) gender bias
6) cultural bias
How is reliability an issue for the diagnosis of SZ (like what evidence was there for it)
Whaley (2001) found the interrater reliability between diagnosticians as low as +0.11 (using the DSM)
The Cheniaux et al study where psychiatrists independently diagnosed SZ patients
Findings of Cheniaux et al (2008)
- 100 sz patients diagnosed independently by 2 diff psychiatrists
- inter rated reliability was poor with
one psychiatrist diagnosed 26 with SZ according to the DSM, and 44 with the ICD - other psychiatrist diagnosed 13 with the DSM and 24 according to the ICD
What studies are evidence for the validity of SZ diagnosis being weak
Rosenhans study of pseudo patients sneaking into asylums
What was Rosenhans (1973) study thatt showed how poor diagnosis was of SZ
- 8 fake patients able to get admitted into psych hospitals
- did this by faking symptoms of hearing voices etc
- all patients stayed for 7-52 days, and acted normally during their stay
- all but 1 patient charged with schizophrenia in remission
Con of Rosenhans study
Old so ofc diagnosis was much poorer then because the DSM wasn’t reliable
What does the use of newer classification systems improve
Predictive validity of diagnosis
What is co-morbidity
Co-morbidity is where two conditions co-exist in the same individual at the same time/have a tendency to co-exist alongside each other
So a person with SZ might also at the same time be suffering from another condition, e.g. personality disorder, depression, alcoholism
Evidence for co-morbidity (what did Buckley find out)
Out of the patients diagnosed with SZ
(50% = also diagnosed with depression)
(47% = also diagnosed with substance abuse)
What’s symptom overlap?
Considerable overlap between the symptoms of SZ and other conditions legal depression & bipolar
How does symptom overlap question the validity of sz diagnosis etc
Under the ICD, a person may be diagnosed with SZ, but under the DSM, may be with bipolar - maybe the two diff disorders are just one thing?
Gender bias in sz?
Men more likely to be diagnosed with it
Why tho? Is it bc of genetic vulnerability or women being able to function better as they form more family relationships
Cultural bias in SZ diagnosis
Pinto & Jones - 2008 - afro carribean origin or African American people 9 times more likely to be diagnosed with SZ
Maybe because auditory hallucinations are more acceptable there than here e..g thinking hearing voices is communication with ancestors or smth
What are the advantages of the classification and diagnosis of SZ
Treatments are often specific to certain disorders so a reliable diagnosis can point to an effective treatment
E.g. specific drugs only work for certain disorders like anti-psychotic for sz, but not anti-anxiety
Easier to incorporate a bunch of the symptoms into a single diagnosis to make communication between professionals easier
