Classifying Schizophrenia Flashcards
What’s the difference between positive and negative symptoms?
Positive symptoms are behaviours concerning a loss of touch with reality, they respond well to drugs
Negative symptoms are behaviours concerning a disruption of normal emotions/actions, they don’t respond well to drugs
What’s the difference between Type I and Type II classifications?
Type I is an acute type, mainly positive symptoms, more likely to recover
Type II is a chronic type, mainly negative symptoms, less likely to recover
What are the 3 sub-types of schizophrenia?
Paranoid (powerful delusions + hallucinations)
Hebephrenic (mainly negative symptoms)
Catatonic (mobility disturbances)
What are the 2 forms of diagnosis criteria?
DSM-5 (USA)
ICD-10 (world health organisation)
What’s the difference between the two classification systems?
DSM-5 requires 2 symptoms from a list to be present for 6 months, seen as more reliable
ICD-10 only requires one month and still used sub-types
What were Schneider’s first rank symptoms? What year?
1-Passivity experiences and thought disorders
2-Auditory hallucinations
3-Primary delusions
1959
What are Slater and Roths 4 added symptoms? what year?
1-disturbances of effect
2-thought process disorders
3-psychomotor disturbances
4-avolition
1969
What are the 5 ‘axes’ (turned into 3) that the DSM-5 classification system uses?
1-(1-3)clinical disorders, personality disorders, physical health
2-environmental factors
3-global assessment of functioning
What are the 2 ways of assessing reliability in schizophrenia diagnosis?
1- test-retest method
2- inter-rater method
2 pieces of research on reliability of diagnosis
Read et al 2004 (against)- American vs UK diagnosis (69% vs 2%)
Jakobsen et al 2005 (for) - Danish patients
What are the 4 ways of assessing validity?
1-reliability
2-predicitive validity
3-descriptive validity
4-aetiological validity
what do the following mean?
1-internal validity
2-external validity
3-ecological validity
4-population validity
5-temporal validity
1-does it measure what it claims to?
2-the extent to which the results can be generalised
3-can the findings be generalised to other settings?
4-can the findings be generalised to other people?
5-can the findings be generalised over time?
What are the 4 further questions to assess validity?
1-face validity - does it measure what it claims to?
2-concurrent validity - is there a good correlation between the scores of this and those we know to be valid?
3-predictive validity - does it accurately predict future behaviour?
4-temporal - will the findings remain over time?
Briefly describe Rosenhan’s classic research on validity
used the DSM-5 system, 8 participants without mental illness went to psych hospitals claiming to hear voices, took between 7-52 days to be released, normal behaviours were interpreted as abnormal, sh0ws the diagnosis system lacks validity (1973)
2 pieces of research on the validity of schizophrenia diagnosis
Birchwood + Jackson 2001 - predictive validity is low, 20% fully recover but 10% commit suicide
Kendell + Jablensky 2007 - diagnostic criteria give an agreed framework which can lead to developing effective therapies
How does symptom overlap relate to schizophrenia?
makes it difficult for clinicians to decide what disorder someone has
can occur with autism, cocaine abuse and bipolar disorder
2 pieces of research on symptom overlap
Serper et al 1999 - considerable overlap with cocaine abuse, but its possible to make an accurate diagnosis
Ophoff et al 2011 - assessed genetic material from 50k participants, found 3/7 gene locations for schizophrenia overlapped with bipolar disorder
What is Co-morbidity and how does it relate to schizophrenia?
when 2 or more diseases occur simultaneously
it creates problems wit reliability of diagnosis (what are you diagnosing?) and validity (is schizophrenia a separate lone disorder?)
2 pieces of research on co-morbidity in relation to schizophrenia
Sim et al 2006 - 32% of hospitalised patients had another disorder too
Jeste et al 1996 - people with additional disorders are often excluded from research yet make up most of schizophrenia patients, which effects generalisation and treatment
How does culture bias relate to schizophrenia?
in Britain, afro-Caribbean people are more likely to be diagnosed and securely hospitalised (probably because of racism as most psychiatrists are white)
could be because racism/poverty increases stress levels, triggering the onset
Cochrane - 7x more likely (1977)
what was Fernando’s 1988 evaluative point on culture bias? how did Cochrane 1983 differ?
Fernando said ethnic minorities experience more racism which could trigger the onset
Cochrane said all ethnic minorities experience racism, but only afro-Caribbean are over diagnosed. could be because they have little immunity to the flu (Murray 1996 flu research)
2 pieces of research on culture bias in relation to schizophrenia
Whaley 2004 - ethnic differences in symptom expression are overlooked/misinterpreted
Rack 1982 - cultural differences in behaviour expectations, e.g. in some cultures its normal to hear voices
How does gender bias relate to schizophrenia?
its possible men are up to 50% more vulnerable, and yet women are over-diagnosed
men suffer more negative symptoms
females have better recovery rates
difference in age onset; men = 18-25, females = 25-35
men have 2 age peaks, women have 3
2 pieces of research on gender bias in relation to schizophrenia
Lewin et al 1984 - when a clearer diagnosis criteria was applies, female diagnosis was much lower
Kulkarni et al 2001 - female sex hormone, estradiol, was effective in treating schizophrenia in women when combined with antipsychotic therapy
