Diagnosis and Classification

Question 1

What is schizphrenia?

Answer 1

a severe mental illness where contact with reality and insight are impaired, an example of psychosis. It is a split between thinking and emotion and sufferers lack insight into their condition.

Question 2

What is psychosis?

Answer 2

Psychosis describes when an individual loses contact with reality.

Question 3

What is the prevalence of schizophrenia?

Answer 3

1% of the population.
More common in men, city dwellers and lower socio-economic groups.
Onset is typically in late adolescence and early adulthood.

Question 4

What is classification and diagnosis?

Answer 4

-In order to diagnose, we classify mental disorders by grouping clusters of symptoms together and labelling this as one disorder. Diagnosis then happens as we identify symptoms and compare with classified disorders.

Question 5

What are the two classification systems?

Answer 5

The ICD-10 and DSM-5 are the main classification systems.

Question 6

How does the ICD diagnose sz?

Answer 6

The ICD requires a one month presence of the clinical characteristics of schizophrenia.

Question 7

How does the DSM-5 diagnose sz?

Answer 7

The DSM requires one or more of the clinical characteristics to be present for at least 6 months.

Question 8

Why have the latest versions dropped the subtypes of schizophrenia?

Answer 8

The latest versions have dropped the subtypes of schizophrenia due to inconsistency.

Question 9

What are positive symptoms?

Answer 9

=Symptoms present in people with schizophrenia but not in the rest of the population.
-Delusions, hallucinations, echolalia.

Question 10

What are delusions?

Answer 10

irrational beliefs that have no basis in reality. It can come in many forms. Delusions can make sufferers behave in ways that seem bizarre to others.

Question 11

What types of delusions can be experienced?

Answer 11

Delusions of persecution, delusions of grandeur (importance), and they may believe a part of their body is under external control.

Question 12

What are hallucinations?

Answer 12

sensory experiences that have no basis in reality or a distorted perception of things that are there. Can be visual, audible or feeling.

Question 13

What is echolalia?

Answer 13

the repetition of other people’s words.

Question 14

What are negative symptoms?

Answer 14

=Symptoms present in the rest of the population but less so in people with schizophrenia.
-Avoliation, speech poverty.

Question 15

What is avolition?

Answer 15

a lack of drive and motivation. It is difficult to start or keep up with a goal-directed task. Andreason 1982 identified signs of avolition- poor hygiene and grooming, lack of persistence in work/education and lack of energy.

Question 16

What is speech poverty?

Answer 16

reduction in the quality and amount of speech. It also can mean a sufferer’s verbal response is delayed in conversation. This is a negative symptom in the ICD. The DSM considers speech disorganisation a positive symptom.

Question 17

What other negative symptoms are there?

Answer 17

Asociality- social withdrawal.
Anhedonia- loss of enjoyment in previously loved activities.
Blunted effect- lack of emotional response.

Question 18

What is diagnosis reliability?

Answer 18

Reliability refers to the consistency of diagnosis. Diagnosis is reliable when different clinicians reach the same diagnosis.

Question 19

What is inter rater reliability?

Answer 19

When two independent assessors give similar diagnosis.

Question 20

What is test retest reliability?

Answer 20

whether tests used to deliver diagnoses are consistent over time. The same clinician reaches the same conclusions on two occasions.

Question 21

Research for good reliability?

Answer 21

Reliability for schizophrenia diagnosis was low but has improved with the DSM-5. In Osario’s 2019 study, inter rater was 0.97 and test retest was 0.92 when 180 individuals used the DSM-5.

Question 22

Research for poor reliability?

Answer 22

Rosenhan 1973 study sent 8 confederates to a psychiatric hospital with one symptom (which was not an agreed symptom of schizophrenia). 7 confederates were diagnosed. When reporting the findings to the hospital, the hospital then suspected 41 more ‘fakes’. This highlights the previous unreliability of diagnostic practices.

Question 23

What is diagnosis validity?

Answer 23

Validity concerns whether we actually assess what we are aiming to assess.
We assess validity in psychiatric diagnosis with criterion validity

Question 24

What is criterion validity?

Answer 24

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

Question 25

Research into sz validity?

Answer 25

In Cheniaux’s 2009 study, two psychiatrists independently assessed the same 100 clients using the DSM-4 and ICD-10. Using the DSM they diagnosed 39 but under the ICD they diagnosed 68.
This suggests low criterion validity when using multiple systems.

Question 26

Why does cultural bias exist in diagnosis?

Answer 26

Some symptoms have different meanings in different cultures. For example, in Haiti, hearing voices is considered communications from ancestors.

Question 27

Cultural bias in sz diagnosis?

Answer 27

British people with African-caribbean background are 9 times more likely to be diagnosed than British white people, whereas those living in African- Caribbean countries are not. This suggests clinicians have a cultural bias in diagnosis of clients from different cultural backgrounds.

Question 28

Cultural bias in inter rater raliability?

Answer 28

There is also cultural bias in inter-rater reliability. Copeland 1971 gave descriptions of patients. In the US, 68% of psychiatrists diagnosed schizophrenia compared with 2% of british psychiatrists.

Question 29

Why is their gender bias in sz diagnosis?

Answer 29

Since the 1980s men have been more commonly diagnosed than women. One explanation for this is that women tend to have closer relationships and therefore get support. However this underdiagnosis means women may not be getting treatment and services that are needed.

Question 30

Broverman et al 1970 gender bias?

Answer 30

Broverman et al 1970 gave a sex role stereotype questions to 79 clinicians. Behaviours and characteristics judged of a ‘adult sex unspecified’ resembled behaviours of men not women. They supposedly represent the ideal standard of mental health. Women were perceived as being less mentally healthy.
There is clear gender bias in diagnostic systems.

Question 31

impact of overlapping symptoms on sz diagnosis?

Answer 31

A limitation of schizophrenia diagnosis is that symptoms overlap with other conditions. Both schizophrenia and bipolar disorder have positive and negative symptoms, which suggests they are two variations of the same disorder and means schizophrenia is hard to distinguish between bipolar.
-Schizophrenia may not be a distinct condition and is hard to diagnose.
-Are we treating the right disorder?

Question 32

Research support for overlapping symptoms?

Answer 32

Ellason and Ross 1995 pointed out people with dissociative personality disorder had more schizophrenia symptoms than people being diagnosed with schizophrenia symptoms.

Question 33

What is comorbidity?

Answer 33

The occurrence of two or more disorders together for example schizophrenia and depression.

Question 34

Why is comorbidity a limitation of sz diagnosis?

Answer 34

If two conditions are frequently diagnosed together it calls into question the validity of classifying them as separate conditions.

Question 35

Examples of sz comorbidity?

Answer 35

Common morbidities are substance abuse, anxiety and depression.
Buckley et al 2009 found a 50% comorbidity with depression and 47% for substance abuse. Swets et al 2014 found 12% of sz patients fulfilled the diagnostic requirements for OCD.
Schizophrenia may not be a distinct disorder, just an unusual variation of another.