diagnosis & classification of schizophrenia

Question 1

schizophrenia: definition

Answer 1

a severe mental illness where contact with reality and insight are impaired

Question 2

schizophrenia

Answer 2

• an example of psychosis
• experienced by 1% of the world
• more commonly diagnosed in men, city-dwellers & lower socio-economic groups
• symptoms can interfere severely and many can end up homeless or hospitalised

Question 3

Diagnosis & classification

Answer 3

• has a cluster of symptoms
• classified by the World Health Organisation’s International Classification Of Disease (ICD-10) & American Psychiatric Association’s Diagnostic and Statistical Manual Edition (DSM-5)

Question 4

DSM diagnosis & classification

Answer 4

more than one positive symptom must be present

Question 5

ICD diagnosis & classification

Answer 5

2 or more negative symptoms must be present

Question 6

Positive symptoms

Answer 6

additional experiences beyond those of ordinary experience

Question 7

Positive symptoms: hallucinations

Answer 7

• unusual sensory experiences
• some relate to events in the environment being picked up by the senses
  
  • some have no relationship to the environment
• e.g: voices criticising the sufferer
• can come from any of the sense (visual)

Question 8

Positive symptoms: delusions

Answer 8

• irrational beliefs: known as paranoia
• can take a range of forms ( having superpowers / being an important figure)
• others can concern the body and make sufferers believe that they or part of them is being controlled by external forces
• can make people behave in ways that are sensible to them but bizarre to others
• some can lead to aggression (most aren’t and some are more likely to be victims of crimes)

Question 9

Negative symptoms

Answer 9

involve the loss of usual abilities & experiences

Question 10

Negative symptoms:avolition

Answer 10

• sometimes called apathy
• find it difficult to begin or keep up with goal-directed activity
• reduced motivation to carry out a range of activities
• Andreason (1982): recognised three identifying signs of avolition
  
  • poor hygiene & grooming
  • lack of persistence in work/ education
  • lack of energy

Question 11

Negative symptoms: speech poverty

Answer 11

• changes in patterns of speech
• reduction in the amount & quality of speech
• can be accompanied by a delay in verbal responses during a conversation
• DSM places emphasis on speech disorganization: incoherent speech or changing topic mid-sentence
  
  • classified as a positive symptom

Question 12

AO3 - Reliability: consistency (S)

Answer 12

• inter-rater reliability: extent to which 2 or more mental health professionals arrive at the same diagnosis for the same patient
• test-retest: when the same professional reaches the same diagnosis for the same individual on two occasions
• Osorio et al (2019): found excellent reliability
  
  • 180 individuals using the DSM
  • pairs of interviewers achieve inter-observer reliability of .97 & test-retest of .92
• shows the diagnosis of schizophrenia has good reliability

Question 13

AO3 - Validity: extent to which we are measuring what we are intending to measure (W)

Answer 13

• one way to assess the validity of a diagnosis is criterion validity: do different assessment systems arrive at the same diagnosis for the same patient
• seems that schizophrenia is much more likely to diagnosed using ICD (68 people) than DSM (39)
• suggests that schizophrenia is either over-diagnosed in the ICD or under- diagnosed in the DSM
• shows poor criterion validity

Question 14

AO3 - Co-morbidity (W)

Answer 14

• 2 or more conditions occurring together
• it conditions occur together a lot of the time this questions the validity of diagnosis & classification as they could actually be a single condition
• commonly diagnosed with other conditions
• Buckley et al (2009): 50% of patients also had depression
  
  • 47% also had substance abuse
  • 23% of patients also OCD
  • problem as some may have unusual cases of conditions like depression

Question 15

AO3 - symptom overlap (W)

Answer 15

• considerable overlap between symptoms of schizophrenia & other conditions
• schizophrenia & bipolar have positive symptoms like delusions & negative symptoms like avolition
• using the ICD they may be diagnosed as schizophrenic but with the DSM they may have bipolar (due to the overlap of symptoms)
• suggests that schizophrenia & bipolar may be one condition

Question 16

AO3 - gender bias (W)

Answer 16

• since the 80s men have been diagnosed more often - ratio of 1:4:1
• may be because men are more genetically vulnerable than women
• more likely that women are under-diagnosed as they have better support systems due to closer relationships
• can function better : continue to work and have good family relationships as symptoms are masked
• underdiagnosis is a form of gender bias meaning that women may not get the treatment they require

Question 17

AO3 - cultural bias (W)

Answer 17

• some symptoms include hearing voices, have different meanings in different cultures ( voices are communications from ancestors)
• British people of African Carribean origin are up to 9x more likely to be diagnosed
• given that rates in Africa & West indies aren’t high this isn’t due to genetics
• leads to the conclusion of gender bias by psychiatrists from a different culture background & lead to over interpretation of symptoms in black people
• causes discrimination by using culturally biases diagnostic system