Classifying Schizophrenia Flashcards
What is Schizophrenia?
a serious mental psychotic disorder characterised by a profound disruption of cognition and emotion
What percentage of the population has schizophrenia?
0.01
What age is the onset of schizophrenia?
15 and 45
where is schizophrenia more commonly diagnosed?
Men, Cities, Working class
What does a psychotic disorder refer to?
Serious mental issues causing abnormal thinking, perceptions and losing touch with reality or sense of self.
What are the two classification systems of schizophrenia?
DSM-5 and ICD-11
DSM-5
Diagnostic and Statistical Manual of Psychiatric Disorders from the APA
APA
American Psychological Association
ICD-11
International Classification of Diseases, from WHO
WHO
World Health Organization
Where is the DSM used?
America
Where is the ICD used?
Europe and other parts of the world
How is schizophrenia diagnosed in the DSM?
At least two or more positive symptoms (or one of each) for a month and social withdrawal for six months
How is schizophrenia diagnosed in the ICD?
At least two negative symptoms (or one of each) for a month
What are the possible subtypes of schizophrenia?
Catatonic/Paranoid Schizophrenia
What did Crow (1980) make a distinction between?
Two subtypes of schizophrenia; type one and two
type one schizophrenia, Crow (1980)
characterised by positive symptoms more and better prospects for recovery
type two schizophrenia, Crow (1980)
characterised by negative symptoms more and poorer prospects for recovery
What are symptoms of schizophrenia divided into?
positive and negative
What are the positive symptoms of schizophrenia like?
Those that appear to reflect an excess or distortion of normal functions
What are the types of positive symptoms in schizophrenia?
Hallucinations, Delusions, Disorganised speech, Grossly disorganised/catatonic behaviour
What are the types of hallucinations that can occur with schizophrenia?
Auditory, Visual, Olfactory, Tactile
Hallucinations
Sensory experiences of stimuli that have either no basis in reality or are distorted perceptions of things that are there
delusions
Paranoia, irrational bizarre beliefs that seem real to the person with SZ. May involves the sufferers believing they are under external control
Disorganised speech
The result of abnormal thought processes where the individual has problems organising their thoughts which show up in speech. They slip from one topic to another (derailment) or be so incoherent it sounds like gibberish (called ‘word salad’)
grossly disorganized or catatonic behavior
Includes the inability or motivation to initiate or even complete a task - this can lead to problems of personal hygiene
Catatonia
Adopting rigid postures or aimless repetition of the same behaviour.
What is a negative symptom?
Those that appear to reflect a reduction or loss of normal functions which often persist even during periods of low positive symptoms
What are the negative symptoms of schizophrenia?
Speech poverty (Alogia) , avolition, affective flattening, anhedonia
What is speech poverty? (Alogia)
Reduction in the amount and quality of speech. May occur with a delay in responses during conversation.
Avolition (apathy)
Finding it difficult to begin or keep up with goal directed activity.
Who identifies signs of avolition?
Andreason (1982)
Andreason (1982)
Proposed signs of avolition: poor hygiene and grooming, lack of energy and lack of persistence in work
Affective flattening
reduction in range and intensity of emotional expressions and a deficit in prosody
Prosody
(Intonation, tempo, loudness and pausing) Aspects of speech that give queues to emotional content of a conversation.
Anhedonia
A loss of interest or pleasure in all or most activities or a lack of reactivity to normally pleasurable things
What are the 5 issues with classifying and diagnosing Schizophrenia?
Reliability, Validity, Co-morbidity, Symptom overlap, Gender bias and cultural bias
How do co-morbidity, symptom overlap, gender and cultural bias impact the reliability and validity of classifying and diagnosing SZ?
They have a negative effect on it
In which ways is reliability an issue in diagnosing schizophrenia?
(Consistency of a measuring instrument) Inter-rater reliability and test-retest reliability
What is inter-rater reliability in diagnosing schizophrenia?
When two or more diagnosticians agree with the same diagnosis for the same individual after it is done separately
What aspects of diagnosing schizophrenia cause issues for inter-rater reliability?
The different manuals (DSM and ICD) and different subjective ideas from psychiatrists.
Who looked at inter-rater reliability?
Whaley (2001) and Cheniaux et al (2009)
What did Whaley (2001) find about inter-rater reliability?
It was as low as +0.11 (DSM)
How was Cheniax et al’s (2009) study into inter-rater reliability carried out?
Two psychiatrists independently diagnosed 100 schizophrenic patients using the ICD and DSM criteria
What was found in Cheniaux et al’s (2009) study?
Inter-rater reliability was poor with one psychiatrist diagnosing 26 with SZ according to the DSM and 44 according to the ICD. The other had 13 from the DSM and 24 from the ICD
What is test-retest reliability in diagnosing schizophrenia?
When a clinician makes the same diagnosis on separate occasions from the same information
What aspects of diagnosing schizophrenia cause issues with test retest reliability?
The fact that the symptoms can fluctuate over time and the fact that ways of identifying the illness varies throughout time
Who looked at test-retest reliability in diagnosing schizophrenia?
Read et al (2004)
What did Read et al (2004) find about test-retest reliability?
It only had a 37% concordance rate and in a 1970 study with 194 UK and 134 US psychiatrists provided a diagnosis on the basis of a case description where 69% of US were diagnosed but only 2% of UK
What study proved that there aren’t issues with the reliability of diagnosing schizophrenia?
Osario et al (2019)
Osario et al (2019)
(DSM) Found inter-rater reliability was +0.97 and test retest was +0.92
How is validity an issue in diagnosing schizophrenia?
Are we diagnosing sz correctly based on the symptoms used in the manuals?
How can the validity of a schizophrenia diagnosis be assessed?
Criterion validity
What is criterion validity in diagnosing schizophrenia?
When different assessment systems arrive at the same diagnosis for the same patient (DSM and ICD)
How can Cheniaux et al’s study be applied to validity in terms of diagnosing schizophrenia?
SZ is much more likely to be diagnosed using ICD than DSM suggesting that SZ is either over diagnosed in ICD and under diagnosed in DSM
Who conducted research into validity to prove that it is low?
Rosenhan (1973) “on being sane in insane places”
What are the studies into the validity of diagnosing schizophrenia?
Rosenhan (1973), Birchwood and Jackson (2001)
What was the aim of Rosenhan’s (1973) study?
To test validity of SZ diagnosis using the DSM (2nd) classification.
What was the procedure of Rosenhan (1973)?
8 volunteers who didn’t suffer with mental illness presented themselves to different mental hospitals claiming they could hear voices (‘hollow, empty, thud’). All were admitted and acted normally and the time taken to be released and reactions to them were recorded.
What were the findings of Rosenhan (1973)?
The volunteers took 7-52 to be released diagnosed as SZ in remission and normal behaviours were interpreted as symptoms of SZ. 35/118 patients suspected that the volunteers were sane
What was the second part of the Rosenhan (1973) study?
A hospital was informed that an unspecified number of pseudo-patients would attempt to enter over 3 months and the number of suspected imposters were recorded. (No actual pseudo-patient attempted admission)
What were the findings of the second part of the Rosenhan (1973) study?
193 patients admitted and 83 had suspicion of being false patients
What do the Rosenhan study highlight?
The reason why diagnosis of SZ lacks validity as psychiatrists are unable to distinguish between real and pseudo-patients
What did Birchwood and Jackson (2001) find?
Of schizophrenics, 20% recovered, 10% have significant improvement, 30% some improvement, 40% never recover and of these 10% commit suicide
What did Birchwood and Jackson (2001)’s study suggest?
The variation in prognosis suggests very poor predictive validity
Co-morbidity?
The idea that two or more mental disorders occur together at the same time with the same person
Who looked at co-morbidity?
Buckley et al (2009)
What did Buckley et al (2009) find?
50% of SZ patients have depression, 47% have substance abuse, 29% have PTSD and 23% have OCD
Why is co-morbidity a problem when diagnosing schizophrenia?
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.
Symptom overlap
there is considerable overlap between the symptoms of SZ and other conditions.
Who looked at symptom overlap?
Ellason and Ross (1995), Read (2004)
What did Ellason and Ross (1995) find?
People with DID may have more schizophrenia symptoms than people with SZ
What did Read (2004) find in regards to Ellason and Ross (1995) study?
Most people diagnosed with SZ have sufficient symptoms of other disorders that they could also receive at least one other diagnosis
How is there gender bias in diagnosing SZ?
Since the 1980s men have been diagnosed with SZ more commonly than women
Who looked at gender bias in diagnosing schizophrenia?
Fischer and Buchanan (2017), Cotton (2009)
What did Fischer and Buchanan (2017) find about gender bias in diagnosing schizophrenia?
It was a ratio of 1.4:1 between men and women diagnosed
What reason did Cotton (2009) find for men being diagnosed with schizophrenia more than women?
Women seem to function better than men, having good family relationships and more likely to work. Better interpersonal function.
How is there a cultural bias in diagnosing schizophrenia?
(Pinto and Jones (2008) African American and English people of African Caribbean origin are 9 times more likely to be diagnosed with SZ
Who looked at cultural bias in diagnosing schizophrenia?
Pinto and Jones (2008), Escobar (2012)
Pinto and Jones (2008)
African American and English people of African Caribbean origin are 9 times more likely to be diagnosed with SZ
Why may there be a cultural bias in diagnosing schizophrenia?
+ve symptoms may be acceptable in africa due to cultural beliefs in communication with ancestors.
What did Escobar (2012) find?
In western cultures we may doubt the honesty of black people causing cultural bias.
What are the advantages of classification and diagnosis?
Communication shorthand, Treatment, Understanding
What is communication shorthand as an advantage of the diagnosis of schizophrenia?
Patients with mental disorders may have numerous symptoms so it is easier to put this into a single diagnosis to easily communicate between professionals
What is treatment as an advantage of the diagnosis of schizophrenia?
Treatments are often specific to certain disorders so a reliable diagnosis can point to a therapy that will help
What is understanding as an advantage of the diagnosis of schizophrenia?
although there are variations there are many underlying biological abnormalities in people with schizophrenia so understanding this can help provide an effective treatment
