Diagnosis and Classification Flashcards
What is schizophrenia?
A severe mental disorder where contact with reality and insight is impaired. It is one of the most chronic and disabling mental illnesses. It is a type of psychosis.
What is psychosis?
A severe mental problem where an individual loses contact with reality and isn’t aware of the problems they have, unlike neurosis.
What percentage of the world experience schizophrenia?
1%
Are there any groups in society where schizophrenia is more commonly diagnosed?
In males rather than females.
In cities rather than rural areas.
In working classes rather than middle classes.
How severe can schizophrenia be?
The symptoms can be so severe that it can interfere drastically with everyday tasks, which can cause sufferers to end up homeless or in hospital.
What is an episode of psychosis?
The period of time where people experience psychotic symptoms.
How long does an episode of psychosis last?
Some people only experience a few episodes of psychosis or a brief episode that lasts a few days or weeks.
Can people with schizophrenia get better?
Stirling and Hellewell argue…
Around 25% of sufferers will get better after only one episode of the illness.
Around 50-65% will improve but continue to have episodes of the illness.
The remainder will have persistent difficulties.
What is classification?
This refers to our ability to identify and distinguish a disorder as different to all other disorders, based upon the symptoms it presents.
What is classification of mental disorder?
The process of organising symptoms into categories based on which symptoms frequently cluster together.
Why can there be issues with classifying schizophrenia?
There isn’t one, unique defining symptom. In fact, the symptoms are often like other disorder’s symptoms.
What is diagnosis?
This refers to our ability to reliably identify symptoms and decide what a person is suffering with. It allows us to actually diagnose schizophrenia as schizophrenia.
Why can there be issues with diagnosing schizophrenia?
Doctors not agreeing on who has schizophrenia because they use different criterias.
What are the two major classification systems?
ICD-10
DSM-5
What is the ICD-10?
The World Health Organisations International Classification of Disease.
It tends to be used in Europe.
What is the DSM-5?
American Psychiatric Association’s Diagnostic and Statistical Manual
What are differences between the ICD-10 and the DSM-5?
They slightly differ in classifications.
- In the DSM-5, one positive symptom must be present for a diagnosis whereas in the ICD-10 two or more negative symptoms are sufficient.
-In the DSM-5, signs of disturbance should be apparent for at least 6 months whereas in the ICD-10 signs should be apparent for at least 1 month.
How have the DSM-5 and ICD-10 changed?
Both previous editions recognised subtypes of schizophrenia, such as paranoid schizophrenia and simple schizophrenia.
However, they have both dropped the subtypes as they tended to be inconsistent. This is because someone could be diagnosed with paranoid schizophrenia may not show the same symptoms years later.
In general, how are diagnoses made?
In order for a diagnosis to be made, two or more symptoms must be present for more than one month along with reduced social functioning.
How are symptoms of disorders categorised?
Positive and negative categories.
What are positive symptoms?
Additional experiences beyond those of ordinary existence. They include hallucinations and delusions.
What are hallucinations?
They are a positive symptom of schizophrenia and are classed as unusual sensory experiences.
They occur when a person has a perception which doesn’t exist in reality.
Some are related to events in the environment whereas some are random and have no relation to our environment.
What are the types of hallucinations?
Hallucinations can be experienced in relation to any sense.
An example of an auditory hallucination is hearing voices talking to or commenting on a person. This often includes criticising.
What are delusions?
They are a positive symptom of schizophrenia and are classed as beliefs that have no basis in reality.
Delusions involve paranoia and irrational beliefs.
What are the types of delusions?
Delusions of control - belief that other people are controlling our thoughts
Nihilistic delusions - belief in things that don’t exist
Delusions of grandeur - belief that they have special powers, talents or abilities. For example, the belief that they are an important historical, political or religious figure
Persecutory delusions - belief that they are being tormented, followed, tricked, spied or ridiculed. For example, the government or aliens were after them
What are negative symptoms?
Loss of usual abilities and experiences. They include speech poverty and avolition.
What are misconceptions about delusions?
Though delusions can make a person behave in ways that make sense to them but seem bizarre to others, the majority of people with delusions aren’t aggressive and are more likely to be victims than perpetrators but some can lead to aggression.
What is speech poverty?
This is a negative symptom of depression which is classed as changes in patterns of speech.
It is a negative symptom because of the reduction in the quantity and quality of speech. They may be accompanied by a delay in verbal responses during a conversation.
How has speech poverty been adapted?
Nowadays, there is more emphasis placed on speech disorganisation in which speech becomes incoherent or the speaker changes topic mid-sentence.
How does speech poverty differ from the DSM-5 to the ICD-10?
In the DSM-5 it is classed as a positive symptom whereas in the ICD-10 it is a negative symptom.
What is avolition?
This is sometimes refereed to as apathy and finding it difficult to begin or keep up with goal-directed activity.
People with scizophrenia often have sharply reduced motivation to carry out a range of activities.
What are signs of avolition?
Anderson identified three signs of avolition.
- Poor hygiene
- Grooming
- Lack of persistence in work or education and lack of energy
What is validity?
Whether or not there is a real difference between illnesses. If so such illnesses should exhibit symptoms that distinguish themselves from one another.
What does a classification mean if it has low validity?
That suggests it is not a real disorder.
What is reliability?
Concerned with the fact that if we do find a real difference between illnesses, and so the diagnosis is valid, then we should be able to consistently distinguish between the illnesses based upon such differences.
What is a strength of the diagnosis of schizophrenia?
P - One strength of the diagnosis of schizophrenia is its reliability due to its consistency.
E - A psychiatric diagnosis is reliable when different clinicians conclude the same diagnosis for the same individual. This can be done through inter-rater reliability. A diagnosis can also be made when the same clinician reaches the same diagnosis for the same individual on two occasions, which can be done through test-retest reliability.
E - Before the DSM-5, reliability for schizophrenia diagnosis was low but has now improved.
Osorio et al, report excellent reliability for the diagnosis of schizophrenia in 180 individuals using the DSM-5. Pairs of interviewers achieved inter-rater reliability of +.97 and test-retest reliability of +.92
L - This means that we can be reasonably sure that the diagnosis of schizophrenia is consistently applied.
What is the first limitation for diagnosis of schizophrenia?
P - One limitation of schizophrenia diagnosis is that it may be influenced by cultural bias.
E - Some symptoms of schizophrenia, particularly hearing voices, have different meanings in different cultures. For example in Haiti some people believe that voices actually are communications from ancestors.
E - British people of African-Caribbean origin are up to nine times more likely to be diagnosed than white British people, according to Pinto and Jones.
Whilst this may suggest genetic vulnerability, the most likely explanation for this is cultural bias in diagnosis of clients by psychiatrists from a different cultural background.
Escobar states that it seems there is an over-interpretation of symptoms in black British people.
L - This suggests that British African-Caribbean people may be discriminated against by a culturally-biased diagnostic system.
What is the second limitation of diagnosis of schizophrenia?
P - A limitation of the diagnosis of schizophrenia is that there is low validity.
E - Validity concerns whether we assess what we are trying to assess.
E - Criterion validity is used to assess the validity of psychiatric diagnosis. Cheniaux et al had two psychiatrists independently assess the same 100 clients using ICD-10 and DSM-4 criteria and found that 68 were diagnosed under the ICD and 39 under the DSM.
L - This suggests that schizophrenia is either over or underdiagnosed according to the diagnostic system, which makes the criterion validity low.
What is a counterpoint to the low validity in the diagnosis of schizophrenia?
P - However, the diagnostic issue of low validity of schizophrenia can be overcome.
E - Osario et al reported there was an excellent agreement between clinicians when they used two measures to diagnose schizophrenia both derived from the same DSM system.
L - This means that criterion validity for diagnosing schizophrenia is high, only if it uses a single diagnostic system.
What is another limitation of diagnosis for schizophrenia?
P - Another limitation of schizophrenia diagnosis is its co-morbidity and similarity with other conditions may decrease the validity of classification.
E - If conditions occur together too often, then this questions the validity of their diagnosis and classification because they might actually be a single condition.
One review by Buckley et al, found that about 1/2 of those diagnosed with schizophrenia also had a diagnosis of depression or substance abuse.
E - This is a problem for classification because it means schizophrenia may not exist as a distinct condition, and is a problem for diagnosis as at least some people diagnosed with schizophrenia may have unusual cases of conditions like depression.
L - This therefore decreases the validity of classification of schizophrenia, which in turn also affects that diagnosis.
What is a further limitation for the diagnosis of schizophrenia?
P - A further limitation of schizophrenia diagnosis is that it may be influenced by gender bias
E - Since the 1980s men have been diagnosed with schizophrenia more commonly than women. There was a ratio of 1.4:1 according to Fischer and Buchanan. This is because of genetic factors.
E - However Cotton et al believes it is more likely that women are undiagnosed because they have closer relationships which allows them to get support.
L - This under-diagnosis is a gender and means women may not therefore be receiving treatment and services might benefit them.
What is a final limitation for the diagnosis of schizophrenia ?
P - A final limitation of schizophrenia diagnosis is symptom overlap with other conditions.
E - This is because there is a considerable overlap between the symptoms of schizophrenia and the symptoms of other conditions. For example, schizophrenia and bipolar disorder both involve positive symptoms and negative symptoms.
E - In terms of classification this suggests that schizophrenia and bipolar disorder may not be two different conditions but variations of a single condition. In terms of diagnosis it means that schizophrenia is hard to distinguish from bipolar.
L - This means that schizophrenia may not exist as a distinct condition and that even if it does, it is hard to diagnose. Therefore this makes classification and diagnosis are flawed.
What is the difference between co morbidity and symptom overlap?
Co-morbidity is the occurrence of two disorders or conditions together, whereas symptom overlap is when two or more conditions share symptoms.
