Diagnosis and classification Flashcards
What is a positive symptom?
An additional experience that go beyond those of ordinary existence and is not desirable.
What are the 3 positive symptoms?
- Hallucinations
- Delusions
- Disorganised speech/ thought
What is a hallucination?
They’re an unusual sensory experience and can be in relation to any sense:
- Auditory - hearing things
- Visual - seeing things that aren’t there or seeing distortions of things
- Olfactory- smelling odours that don’t exist
- Tactile - feeling of being touched by something
- Gustatory - tasting something that isn’t there
What is a delusion?
They are irrational beliefs that are held firmly despite them being completely illogical with no evidence
There are delusions of:
Persecution - others want to harm you
Grandeur- you’re an important individual
control - under control of an alternative force
What is disorganised speech/ thought ?
Where the individual struggles to think and or speak fluently. As thoughts can’t be measured scientifically so it’s often measured using speech.
For example
- the person may respond to questions with unrelated answers or making up new words (neologisms)
- Change topics frequently (derailment)
- Repeating words/ phrases (Perseverations)
- Using meaningless rhyming words (Clang)
Still is often grammatically correct
What is a negative symptom?
Involves the loss of usual abilities and experiences so is the loss of ordinary experiences
What are the 4 negative symptoms ?
- Speech Poverty
- Avolition
- Diminished emotional expression
- Catatonic behaviour
What is speech poverty ?
Refers to the reduction of amount and quality of speech which is sometimes accompanied by a delay in their verbal responses in a conversation
What is avolition?
Where the individual finds it difficult to begin or keep up with goal oriented activities. They also tend to have a lack of motivation to carry out a lot of activities
Andreasen - identified 3 signs of avolition:
- Poor hygiene and grooming
- Lack of persistence in work or education
- Lack of energy
What is diminished emotional expression?
Characterised by showing a lack of emotion categorised by an apathetic and unchanging facial expression and little to no change in strength, tone or pitch of voice
What is catatonic behaviour? -
Repetitive behaviour / stimming
or staying in uncomfortable positions for long periods of time
What is co-morbidity ?
When a person has more that one condition at the same time. When more than one condition exist alongside each other
What is symptom overlap
When there is an overlap between symptoms of schizophrenia and and other conditions such as bipolar disorder
What are the 2 tools used to diagnose schizophrenia?
DSM- 5 ( Main one)
ICD - 10
What’s the criteria to get a diagnosis of schizophrenia using the DSM -5
- 2 or more of a positive or negative symptoms for a significant portion of time in a 1 month period. One of them must be one of the positive sympotms (disorganised speech, hallucinations, delusions)
- Ruled out schizoaffective disorder, depressive or bipolar disorder
- Check for a history of Autism
- Check its not drug-induced psychosis
outline Rosenhan’s first study ‘being sane in insane places’
8 pseudo patients presented themselves at 12 psychiatric hospitals in 5 states in attempts to get a schizophrenia diagnosis. They reported hearing voices saying ‘hollow’ ‘thud’ and ‘empty’
After they were admitted to the psychiatric ward, They acted completely normal which were seen to just be symptoms of their disorder and the average stay was 19 days. 35 of the other patients suspected that they weren’t real patients and said things like ‘you’re not crazy’
- Type 1 error - false positive- psychiatrists were over cautious
Outline Rosenhan’s second study
He informed the hospitals of his previous study and said over the next 3 months one or more pseudo patients would be attempted to admitted into the hospital. None were actually admitted
The staff members than had to rate how confident on a 10 point scale where 1 and 2 was very confident that they were a pseudo patient
In that time 193 patients were admitted for treatment :
The number judged to be a pseudo patient was
41 by at least one member of staff
23 by one psychiatrist
19 by one psychiatrist and one staff member
- Type 2 error - false negative - the staff were under cautious due to the results from the previous study
What did Rosenhan’s study show us about diagnosis ?
Diagnosis was not valid but it was fairly reliable
What is the relationship between schizophrenia and culture bias ?
The diagnosis of Sz is culturally biased meaning it’s ethnocentric.
This is because the symptoms have different interpretations from other cultures
Eg. in Haiti, hallucinations are seen as a form of communication with ancestors
Pinto and Jones found that African Caribbean’s are 9x more likely to be diagnosed with schizophrenia.
What is the relationship between gender and the diagnosis and classification of schizophrenia ?
Men are more likely to be diagnosed with Sz.
Fisher and Buchanan - found a ratio of 1.4:1 where men are diagnosed more with Sz than women.
Clinicians ignore that there are different risk factors and predispositions between men and women which may make them more vulnerable to Sz
Gender bias also occurs as clinicians tend to ignore that men suffer from more negative symptoms than women and women have lower relapse rates
Cotten et al - Women have more support than men so could be under diagnosed
AO3 - Issues of diagnosis -
comorbidity
Buckley et al -
classification lacks validity :
50% of individuals with a diagnosis of schizophrenia also have depression, 47% have substance abuse, and 23% have OCD
AO3 - Strength - reliable
P- One strength is that it is reliable
E- Osorio et al - excellent reliability of diagnosis of Sz in 180 Ps using the DSM. interviewers achieved inter-rater reliability of +0.97 and test retest reliability of +0.92.
E - This shows that there’s excellent agreement between clinicians when they use the same single-diagnostic system of the DSM 5
L - Therefore, its a reliable system as there is consistency with the diagnosis
HOWEVER
P- Lacks reliability
E - Cheniaux et al - had 2 psychiatrists independently assess the same 100 clients using the ICD 10 and the DSM 5 and found that 68 were diagnosed using the ICD 10 as opposed to only 39 when using the DSM
E- Lacks reliability across the 2 classification systems
AO3- Issues of diagnosis -
ethnicity
- Pinto and Jones - African Caribbean origin are 9x more likely to be diagnosed with schizophrenia than white British people
- Some symptoms have a different interpretation in different cultures
e.g in Hati hallucinations are seen to be communication from ancestors
P - Ethnocentric
E - the classification systems of DSM 5 and ICD 10 do not take into account other countries beliefs
E - EG in Haiti hallucinations are seen to be a form of communication with ancestors meaning they are seen as positive where as here they are not. This leads to the over diagnosis of those from different ethnic backgrounds as pinto and jones found that African carribeans are 9x more likely to be diagnosed with schizophrenia
L - Therefore, Its ethnocentric as it doesn’t take into account other cultures beliefs/ traditions which leads to the over diagnosis of them.
AO3- Issues of diagnosis -
gender
Fischer and Buchanan - round a ratio of 1.4:1 where men are diagnosed more with schizophrenia than women
Cotten et al - Women could be under diagnosed because of closer relationships and therefore getting more support
AO3 - Issues of diagnosis -
Bipolar disorder
Symptoms of bipolar -
- manic episodes
- depressive episodes
- mixed affective episode and hypomania episode
