Classification of SZ and symptoms Flashcards
What is SZ?
Schizophrenia is a psychotic disorder.
This means… it is a severe mental illness where contact with reality and insight are impaired.
Schizophrenia affects about 1% of the population.
That’s one person in every hundred.
The age of onset differs between males and females:
Males - mid 20s
Females - early 30s
What is the prognosis and Blueler’s,1978, study on SZ?
According to Bleuler’s (1978) longitudinal study of 2000 schizophrenics:
Symptoms are most severe in early adulthood, during the
first 5 years after onset.
Bleuler discovered…
40% of individuals recover from positive symptoms
20% can make a full recovery if diagnosed early
40% continue to suffer from symptoms and distress for the rest of their lives
This implies a diagnosis of schizophrenia has poor predictive validity!
What are the two types of symptoms of SZ?
negative and positive
What are some examples and explanations of positive symptoms??
When a behaviour is present that is not normally present, it is referred to as a positive symptom.
These are rare in everyday life…
Examples:
Hallucinations
Delusions
Disorganised thinking and speech
explain hallucinations?
False sensations, that have no identifiable source. The most commonly reported types are auditory (eg hearing voices in one’s head) and visual (eg seeing people who aren’t there). Less common types are olfactory (phantom odours) and tactile (sensation of being touched on/ within the body).
explain delusions?
False beliefs, not based on fact/evidence. There are many types, including those of persecution (the belief that you are being victimised/ spied on), grandeur (the belief that you have great power/ status/ importance) and control (the belief that your thoughts/ actions are being controlled by others).
explain disorganized speaking and thinking??
This symptom makes it hard to concentrate on anything. Thoughts drift from one thing to another although there will be no connection between them. Some people describe their thoughts as being ‘misty’ or ‘hazy’. They will have trouble finishing reading an article or watching a TV programme and may also struggle with college / work. Words may also become jumbled or confused making it difficult for others to understand what is being said - known as ‘word salad’
explain and give some examples of negative symptoms?
When a behaviour is missing that we would usually expect to be displayed, it is called a negative symptom.
Can be seen in everyday life…
These tend to last longer than positive symptoms.
Examples:
Speech Poverty (Alogia)
Lack of Emotion (Flat affect)
Avolition (Social withdrawal)
Apathy
explain speech poverty?
Reduction in communication, which is thought to result from the slowing/ blocking of thoughts. This is often manifested as short, empty replies to questions. The patient has difficulty starting a conversation or finding it hard to speak to people
explain lack of emotion?
A reduction or flattening of emotions. The range and intensity of facial expressions, tone of voice and eye contact are reduced. Body language becomes difficult to interpret
explain avolition?
A reduction or flattening of emotions. The range and intensity of facial expressions, tone of voice and eye contact are reduced. Body language becomes difficult to interpret
explain apathy?
Difficulty in planning and setting goals. No interest in socialising or hobbies. A person does not want to do anything and will sit in the house for hours or even days
what are other symptoms of SZ and explain them?
- inappropriate effect = When individuals appear to have lost the ability to have emotions occur in a normal and expected way. This is because their affect is a reaction to their hallucinations or delusions and their assumptions about the reasons for other people’s actions.
Instead, they may have strange reactions that don’t seem to make sense to the outside observer. In this way, they show emotions and behavior that do not seem to be consistent with the reality of the situation, but they are in fact consistent with their internal experience of the situation.
what is symptom overlap?
Shared symptoms between disorders could lead to an unreliable / invalid diagnosis - the diagnosis may not be correct.
This is because the person may exhibit a symptom typical of schizophrenia, but could instead have another condition with the same symptom.
E.g.,
Delusions - shared by schizophrenia and bipolar
Hallucinations - shared by schizophrenia and PTSD
Attention difficulties - shared by schizophrenia and ADHD
Avolition - shared by schizophrenia and depression
Etc. (there is a very long list of shared symptoms!)
Explain Comorbidity??
Comorbidity refers to the occurrence of two illnesses or conditions together.
E.g., a person has both schizophrenia and another disorder.
Schizophrenia and depression = 50%
Schizophrenia and PTSD = 29%
Schizophrenia and OCD = 23%
Where two conditions are frequently diagnosed together, it calls into question the validity of classifying the two disorders separately.
What is the classification of SZ?
There are a number of systems by which we can classify abnormal patterns of thinking, behaviour and emotion into mental disorders. These systems not only classify abnormality, but give guidance on how to diagnose them
The two most widely used systems of classification and diagnosis are ICD and DSM
ICD: International Classification of the Causes of Disease and Death (World Health Organisation) – recognises a range of subtypes
DSM: Diagnostic and Statistical Manual of Mental Disorder (American Psychiatric Association) – used to also recognise the subtypes but the most recent DSM-5 have dropped these.
what is classification? (definition)
Diagnosing and classification involves identifying groups or patterns of behavioural, emotional, physical and/or motivational symptoms that occur together to form a type of mental disorder (e.g., schizophrenia).
Collectively, when groups of symptoms occur together, we call it a syndrome.
Hence, all MDs can be seen as syndromes.
why is it important to classify/ diagnose an individual with a disorder?
Put in place treatments for that individual
Identify the cause of their disorder
Predict the future course of the disorder (prognosis)
what is the DSM-5?
Diagnostic Statistical Manual
First published in 1952 and is used by the APA and much of the world;
Has undergone a number of revisions - 5th Ed. May 2013;
Contains over 300 mental disorders arranged into several main categories (i.e., ‘schizophrenia and other psychotic disorders’ and ‘anxiety disorders’);
Lists specific diagnostic criteria: symptoms (inc. duration) and exclusion criteria.
What is the ICD-11
International Classification of Disorders
Produced by WHO;
Has undergone a number of revisions - 11th Ed. 2017;
Very similar to the DSM - works in the same way - but there are some differences.
The DSM V criteria puts more emphasis on social or occupational dysfunction than the ICD-11.
The DSM V has removed the sub-classifications for schizophrenia, whilst the ICD-11 has 7 sub-classifications (e.g., paranoid / hebephrenic / catatonic etc.)
what is the diagnostic criteria of SZ?
A. Characteristic symptoms
Two or more of the
following for at least 1 month…
delusions
hallucinations
disorganized speech
grossly disorganized or catatonic behavior
negative symptoms, such as diminished emotional expression
At least 1 needs to be one of the symptoms in bold.
B. Social / Occupational
Dysfunction
Impairment in one of the major areas of functioning for a significant period of time since the onset of the disturbance: Work, interpersonal relations, or self-care.
C. Duration
Some signs of the disorder must last for a continuous period of at least 6 months. This six-month period must include at least one month of symptoms (or less if treated) that meet criterion A (active phase symptoms) and may include periods of residual symptoms. During residual periods, only negative symptoms may be present.
D) Schizoaffective and Mood Disorder exclusion
Schizophrenia affective disorder and mood disorder has been ruled out because the patient has not experienced any depressive, manic or mixed episodes at the same time as category A symptoms.
E) Exclusion of known organic causes
The disturbance is not caused by the effects of a substance or another medical condition
F) Relationship to autistic spectrum disorder (if any)
If there is a history of autism spectrum disorder or a communication disorder (childhood onset), the diagnosis of schizophrenia is only made if prominent delusions or hallucinations, along with other symptoms, are present for at least one month.
