classification schizophrenia Flashcards
What is the difference between classifying and diagnosing?
Classification - identifying a cluster of symptoms that occur together and classifying one as a disorder
Diagnosing - identifying symptoms and deciding what disorder a person has
What are the two major systems for the classification of mental disorders and how do they differ when diagnosing schizophrenia?
the World Health Organisation’s International Classification of Disease edition 10 (ICD-10) and the American Psychiatric Association’s Diagnostic and Statistical Manual edition 5 (DSM-V). These differ slightly in their classification of schizophrenia. For example, in the DSM-V one positive symptoms must be present for diagnosis whereas two or more negative symptoms are sufficient under ICD. Previous editions of ICD and DSM recognised subtypes of schizophrenia (e.g. paranoid/catatonic), however, these have now been dropped as symptoms are too inconsistent.
What are the 2 positive symptoms of schizophrenia
- hallucinations
- delusions
What are hallucinations
Hallucinations:
Unusual sensory experiences. Some hallucinations are related to the environment and some bear no relationship to what the senses are picking up from the environment.
Hallucinations can be experienced in relation to any sense:
Auditory hallucinations:
Usually experienced as voices, whether familiar or unfamiliar, that are perceived as distinct from the individual’s own thoughts
Visual hallucinations:
Seeing lights, objects or faces that other people can’t see
Olfactory hallucinations:
Smelling things that other people can’t smell
Tactile hallucinations:
Feeling that bugs are crawling on or under the skin, or something touching the skin
What are delusions
Delusions:
Irrational beliefs that seem real to the person, but they are not, and may seem bizarre to others.
Persecutory delusions:
Belief that one is going to be harmed, harassed, and so forth by an individual, organisation, or other group
Delusions of grandeur:
When an individual believes that he or she has exceptional abilities, wealth or fame
Delusions of reference:
Belief that certain gestures, comments or environmental cues, and so forth are directed at oneself
What are the 2 negative symptoms of schizophrenia
- speech poverty
- avolition
what is speech poverty
Characterised by the lessening of speech fluency and productivity. The patient produces fewer words or speaks in shorter utterances and there may be a delay in the person’s verbal responses.
NOT THE SAME AS DISORGANISED SPEECH - this would be positive
what is avolition
- Described as finding it difficult to begin or keep up with goal-directed activity. Sufferers of schizophrenia often have sharply reduced motivation to carry out a range of activities.
- Signs of avolition include poor hygiene and grooming, lack of persistence in work or education and lack of energy.
Evaluation of the reliability of classification of schizophenia
P - One strength of the diagnosis of schizophrenia is its reliability
E - Reliability means consistency. An important measure of reliability is inter-rater reliability, the extent to which different assessors agree on their assessments. In the case of diagnosis this means the extent to which two or more mental health professionals arrive at the same diagnosis for the same patient. Test-retest reliability is also important, and this is whether the same diagnosis can be reached at two different points in time. Reliability of diagnosis of schizophrenia is generally high as DSM-V has improved the reliability of diagnosis of schizophrenia. Osorio et al. (2019) found using DSM-V that interviewers achieved inter-rater reliability of +0.97 and test-retest reliability of +0.92.
E - This means that we can be reasonably sure that the diagnosis of schizophrenia is consistently applied
Evaluation of the validity of classification of schizophrenia
P - One limitation of the diagnosis of schizophrenia is its validity
E - Rosenhan sent 8 confederates into 12 different hospitals in 5 US states. When they arrived, they complained of hearing voices saying “empty”, “hollow” and “thud” and that the voices were unclear, unfamiliar and of the same sex as the pseudo patient. Once they gained admission, they stopped pretending symptoms and behaved normally and were discharged only when they convinced staff that they were sane. All pseudo patients were admitted, showing how psychiatric staff cannot always distinguish sanity from insanity. This was further highlighted in Rosenhan’s follow-up study where he told the hospitals he was sending in pseudo patients when in reality he did not send any. After three months they were confident that approximately a third of new patients they were sent were pseudo patients.
E - This suggests the validity of psychiatric diagnoses was low and the DSM was flawed.
Evaluation of co-morbidity in diagnosis of schizophrenia
P - Another limitation of schizophrenia diagnosis is its co-morbidity with other conditions
E - Co-morbidity is the phenomenon that two or more conditions occur together. If conditions occur together a lot of the time, then this calls into question the validity of their diagnosis and classification because they might actually be a single condition. Peter Buckley et al. (2009) concluded that around half of patients with a diagnosis of schizophrenia also have a diagnosis of depression (50%) or substance abuse (47%). Post-traumatic stress disorder also occurred in 29% of cases and OCD in 23%.
E - This is a problem for classification because it means schizophrenia may not exist as a distinct condition, as is a problem for diagnosis as at least some people diagnosed with schizophrenia may have unusual cases of conditions such as depression. Classification currently not extensive enough because it doesn’t include depression, lowering validity
Evaluation of culture bias in diagnosis of schizophrenia
P - A further limitation is the existence of culture bias
E - African Americans and English people of Afro-Caribbean origin are nine times more likely than white British people to be diagnosed with schizophrenia. There may be several factors at work here. One issue is that positive symptoms such as hearing voices may be more acceptable in African cultures because of cultural beliefs. When reported to a psychiatrist from a different cultural tradition these experiences are likely to be seen as bizarre and irrational, and therefore a symptom of schizophrenia.
E - This means that British African-Caribbean people may be discriminated against by a culturally biased diagnostic system (imposed etic).
Evaluation of gender bias in diagnosis of schizophrenia
P - another limitation is the existence of gender bias
E - Julia Longenecker et al. (2010) reviewed studies of the prevalence of schizophrenia and concluded that since the 1980s men have been diagnosed with schizophrenia rather more often than women. Cotton et al. (2009) found that female patients typically function better than men, and are more likely to work and have good family relationships, i.e. support.
E - This high functioning may explain why some women have not been diagnosed with schizophrenia when men with similar symptoms might have been. This means women may not be getting the correct diagnosis therefore not receiving treatment and support that they need. This suggests the validity for diagnosis is only high for one gender - men.
Evaluation of symptom overlap in diagnosis of schizophrenia
P - One limitation of schizophrenia diagnosis is system overlap with other conditions
E - There is a considerable overlap between the symptoms of schizophrenia and other conditions. For example, both schizophrenia and bipolar disorder involve positive symptoms like delusions and negative symptoms like avolition. As with co-morbidity, symptom overlap means that schizophrenia may not exist as a distinct condition.
E - This again calls into question the validity of both the classification and diagnosis of schizophrenia.
