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Schizophrenia > Diagnosis and Classification > Flashcards

Diagnosis and Classification Flashcards

1
Q

what aspects of functioning are affected by schizophrenia

A

a person’s: language, thought, perception and sense of self

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2
Q

at what age is SZ typically diagnosed

A

between the ages 15-35

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3
Q

who is more commonly affected

A

males, people in cities, those in the working class

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4
Q

how prevalent is SZ

A
  • ranks among the top 10 causes of disabilty worldwide
  • affects about 1% of the population at some point in their life.
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5
Q

definition of a positive symptom of SZ

A

atypical symptoms experienced in addition to normal experiences
- e.g. hallucinations

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6
Q

definition of a negative symptom of SZ

A

atypical symptoms that represent a loss to normal experiences
- e.g. speech poverty

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7
Q

what is the difference between positive and negative symptoms of SZ

A

positive = in addition to normal experiences
negative = a loss to normal experiences

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8
Q

what are the positive symptoms of SZ

A
  • hallucinations
  • delusions
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9
Q

hallucinations

A
  • unusual sensory perceptual experiences
  • may or may not be related to events in the environment
  • voices heard talking or commenting on the sufferer (often criticism)
  • can be experienced in relation to any sense
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10
Q

delusions

A
  • irrational, bizarre, beliefs that seem real to the person with SZ
  • can take a range of forms: delusions of grandeur, paranoid delusions, delusions of reference
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11
Q

delusions of grandeur

A

e.g. involve being an important historical, political, or religious figure such as Jesus or Napoleon

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12
Q

paranoid/persecutory delusions

A

being persecuted, perhaps by government or aliens or of having superpowers

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13
Q

delusions of reference

A

may believe they are under external control, or that events in the environment are directly related to them
- e.g. personal messages through the TV

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14
Q

what are the negative symptoms of SZ

A
  • avolition
  • speech poverty (Alogia)
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15
Q

avolition

A
  • sometimes called apathy
  • finding it difficult to begin or to keep up with goal-directed activity
  • Andreason (1982) identified 3 signs of avolition
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16
Q

Andreason’s (1982) 3 signs of avolition

A
  • poor hygiene and grooming
  • lack of persistence in work or education
  • lack of energy
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17
Q

speech poverty (Alogia)

A
  • lessening of speech fluency and productivity reflecting slow or blocked thoughts
  • sometimes accompanied by a delay in the sufferer’s verbal responses during conversation
  • DSM-5 system places emphasis on speech disorganisation
  • ICD-10 says speech poverty is a negative symptom
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18
Q

how is SZ diagnosed

A

diagnosis is done through interveiw and observation and is therefore subjective
- e.g. blood tests, x-rays

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19
Q

why is diagnosing SZ problematic

A
  • it does not have 1 defining characteristic
  • no reliable diagnostic biomarkers of differential diagnosis or prognosis
  • in addition ICD-11 and DSM-5 differ in their diagnosis
20
Q

what is a classification system

A

a system that collects the symptoms of a disorder

21
Q

how are classification systems used in psychiatry

A

used to diagnose the disorder

22
Q

what are the 2 major systems for the classification of a mental disorder

A
  • World Health Organisation’s International Classification of Disease edition 10 (ICD-10)
  • the American Psychiatrists Association’s Diagnostic and Statistical Manual edition 5 (DSM-5)
23
Q

which symptoms are required for an ICD-10 based diagnosis of SZ and for how long

A
  • 2 or more negative symptoms
  • 1 month
24
Q

the ICD-10 also recognise a range of subtypes of SZ which are:

A
  • paranoid
  • hebrephrenic
  • catatonic
25
Q

are positive symptoms required for ICD-10

A

no

26
Q

which symptoms are required for a diagnosis of SZ in the DSM-5 and for how long

A

2 or more of the following for1 month (or longer) at least 1 of them MUST be positive
- delusions
- hallucinations
- disorganised speech
- grossly disorganised or catatonic behaviour
- negative symptoms such as diminished emotional expression

27
Q

additional criteria for DSM-5 diagnosis

A
  • impairment in one of the major areas of functioning for a significant amount of time since the onset of disturbance
  • some signs of the disorder must last for a continuous period at least 6 months
  • schizoaffective disorder and bipolar or depressive disorder with psychotic features have been ruled out
28
Q

what are the mai differences between DSM-5 and ICD-10

A

DSM = signs present for 6 months and one symptom MUST be positive
ICD = signs present for 1 month only and 2 negatives are enough

29
Q

what is the impact of the differences in the classification systems

A

poses challenges with reliability and validity

30
Q

AO3 - what is reliability

A

refers to the consistency of the diagnostic instrument to assess the severity of the SZ symptoms

31
Q

AO3 - what is validity

A

refers to the extent that a diagnosis represents something that is real and distinct from other disorders and the extent that a classification system measures what it claims to measure

32
Q

AO3 - how do the terms reliability and validity apply to SZ

A

R & V are linked. a diagnosis cannot be valid if it is not reliable

33
Q

AO3 - what issues are there with the reliability of the diagnosis of SZ

A
  • extent to which a psychiatrist can agree on the same diagnosis when independently assessing patients (inter-rater reliability)
  • for a classification system to be reliable, the same diagnosis should be made each time. Therefore different psychiatrists should reach the same decision when assessing a patient
  • same diagnostic tool should also assess patient with the same diagnosis over a period of time (test-retest reliability)
34
Q

AO3 - who and when did a study that investigated the reliability of diagnosis in SZ and what did they do

A
  • Cheniaux et al
  • 2009
  • had 2 psychiatrists independently diagnose 100 patients using the ICD and DSM criteria
35
Q

what were Cheniaux et al 2009 findings

A
  • 1st diagnosed 26 with DSM and 44 with ICD
    -2nd diagnosed 13 with DSM and 24 with ICD
36
Q

AO3 - what does Cheniaux et al’s findings present

A
  • an issue with inter-rater reliability
  • shows diagnosis os SZ is not reliable because diagnosis and treatment depends upon the psychiatrist that you see rather than the symptoms you present
37
Q

how is validity assessed in diagnosis

A

a standard way to assess validity of diagnosis is using criterion validity

38
Q

what is criterion validity

A

evaluates how accurately a test measures the outcome it was designed to measure

39
Q

AO3 - PEEL = explain how Rosenhan’s1973 study questions the validity of psychiatric diagnoses

A

p - situational factors have a diagnosis of SZ
e - 8 confederates acted as pseudopatients, going to 12 different hospitals
- complained of hearing voices prior to admission, then stopped pretending to have symptoms once admitted
- staff diagnosed 11/12 with SZ and 1 with manic depression
- average hospital stay = 19 days
- 35 patients detected sanity in pseudopatients
e - psychiatric staff cannot always distinguish sanity from insanity.
l - this suggests the validity of psychiatric diagnoses was low and DSM was flawed

40
Q

AO3 - what is predicitve validity and how does it relate to SZ diagnosis

A
  • people with SZ rarely share the same symptoms or outcomes
  • the prognosis for patients suffering with SZ varies wih about 20% recovering their previous level of functioning, 10% significant improvement and 30% come improvement
  • a diagnosis therefore has little predictive validity. gender and psycho-social factors do appear to influence outcome
41
Q

AO3 - How do issues with co-morbidity undermine the validity of SZ diagnoses

A
  • co-morbidity refers to the occurrence of 2 illnesses together
  • Buckley et al (2009) concluded that around half the patients with a diagnosis of SZ also have a diagnosis of depression (50%) or substance abuse (47%)
  • post traumatic stress occurred in 29% of SZ cases and OCD in 23%
42
Q

AO3 - how do issuses with regard to symptom and genetic overlap undermine diagnostic validity

A
  • symptom overlap is when 2 or more conditions share the same symptoms
  • Litenstein 2009 found that there are shared genes which cause bipolar and SZ. they overlap so much SZ might not actually be a distinct disease from bipolar. they have many shared symptoms including psychosis
43
Q

AO3 - how do issues with regard to gender bias undermine diagnostic validity

A
  • longenecker et al. (2010) reviewed literature and found since the 1980’s men are more likely to be diagnosed with SZ
  • cootton et al (2009) suggest this is because women are better at coping - i.e. “more highly functioning”
44
Q

AO3 - How do issues with regard to culture bias undermine diagnostic validity, and indicates a cultural bias?

A

research suggest there is a significant variation between countries when it comes to diagnosing SZ

45
Q

AO3 - How do issues with regard to culture bias undermine diagnostic validity, and indicates a cultural bias?
Harrison et al. 1971

A
  • suggested that those of West Indian origin were over diagnosed with SZ
  • specifically by white doctors in Bristol
  • due to ethnic background
46
Q

AO3 - How do issues with regard to culture bias undermine diagnostic validity, and indicates a cultural bias?
Escobar 2012

A
  • argues that psychiatrists may over interpret symptoms and distrust the honesty of black people during diagnosis
47
Q

AO3 - How do issues with regard to culture bias undermine diagnostic validity, and indicates a cultural bias?
Copeland et al 1971

A
  • gave a description of an american patient to 134 US and 194 British psychiatrists
  • 69% of US psychiatrists diagnosed SZ
  • 2% of British psychiatrists diagnosed SZ

Schizophrenia (6 decks)

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