Diagnosis and classification

Question 1

What is a positive symptom?

Answer 1

An additional experience that go beyond those of ordinary existence and is not desirable.

Question 2

What are the 3 positive symptoms?

Answer 2

1. Hallucinations
2. Delusions
3. Disorganised speech/ thought

Question 3

What is a hallucination?

Answer 3

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

Question 4

What is a delusion?

Answer 4

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

Question 5

What is disorganised speech/ thought ?

Answer 5

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

Question 6

What is a negative symptom?

Answer 6

Involves the loss of usual abilities and experiences so is the loss of ordinary experiences

Question 7

What are the 4 negative symptoms ?

Answer 7

1. Speech Poverty
2. Avolition
3. Diminished emotional expression
4. Catatonic behaviour

Question 8

What is speech poverty ?

Answer 8

Refers to the reduction of amount and quality of speech which is sometimes accompanied by a delay in their verbal responses in a conversation

Question 9

What is avolition?

Answer 9

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

Question 10

What is diminished emotional expression?

Answer 10

Characterised by showing a lack of emotion categorised by an apathetic and unchanging facial expression ad little to no change in strength, tone or pitch of voice

Question 11

What is catatonic behaviour? -

Answer 11

Repetitive behaviour / stimming
or staying in uncomfortable positions for long periods of time

Question 12

What is co-morbidity ?

Answer 12

When a person has more that one condition at the same time. When more than one condition exist alongside each other

Question 13

What is symptom overlap

Answer 13

When there is an overlap between symptoms of schizophrenia and and other conditions such as bipolar disorder

Question 14

What are the 2 tools used to diagnose schizophrenia?

Answer 14

DSM- 5 ( Main one)
ICD - 10

Question 15

What’s the criteria to get a diagnosis of schizophrenia using the DSM -5

Answer 15

• 2 or more of the following, each present for a significant portion of time during a 1 month period (or less if successfully treated) - at least 1 must be delusions, hallucinations or disorganised speech
  - delusions, hallucinations, disorganised speech, grossly disorganised or catatonic behaviour, negative symptoms
• schizoaffective disorder and depressive bipolar disorder with psychotic features have been ruled out.

Question 16

Outline Rosenhan’s second study

Answer 16

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

Question 17

outline Rosenhan’s first study ‘being sane in insane places’

Answer 17

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

Question 18

What did Rosenhan’s study show us about diagnosis ?

Answer 18

Diagnosis was not valid but it was fairly reliable

Question 19

AO3 - Issues of diagnosis -
comorbidity

Answer 19

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

Question 20

AO3- Issues of diagnosis -
ethnicity

Answer 20

• 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

Question 21

AO3- Issues of diagnosis -
gender

Answer 21

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

Question 22

AO3 - Issues of diagnosis -
Bipolar disorder

Answer 22

Symptoms of bipolar -
- manic episodes
- depressive episodes
- mixed affective episode and hypomania episode