Intro and Diagnosis Flashcards
Positive Symptoms
reflect an excess or distortion of ‘normal’ functioning. Includes hallucinations and delusions.
Negative Symptoms
reflecting a reduction or loss of ‘normal’ functioning. Includes avolition and speech
poverty.
Positive Symptoms: Hallucinations
are bizarre, unreal perceptions of the environment that are usually auditory (hearing voices) but may also be visual (seeing lights, objects or faces), olfactory (smelling things) or tactile (e.g. feeling that bugs are crawling on or under the skin). Many schizophrenics report hearing a voices or voices telling them to do something (ie hurt themselves or others) or
commenting on their behaviour.
Positive Symptoms: Delusions
bizarre beliefs that seem real to the person with schizophrenia, but they are not real. Sometimes these delusions can be paranoid (i.e. persecutory) in nature. Delusions may also involve inflated beliefs about the
person’s power and importance. There may also be delusions of reference where it is believed that events in the environment are directly related to them eg special messages being relayed via TV.
Negative Symptoms: Speech poverty
lessening of speech fluency and productivity, reflecting slow or
blocked thoughts. May produce fewer words in a test of verbal fluency (eg name
as many animals as you can in one minute) due to a difficulty in spontaneously
producing the words. May also be reflected in less complex syntax eg fewer clauses, shorter utterances (associated with long illness and early onset of
illness).
Negative Symptoms: Avolition
the reduction of, or inability to initiate and persist in, goal-directed behaviour (e.g. sitting in the house for hours every day, doing nothing). Avolition is distinct from poor social function or disinterest, but is often confused with this.
Diagnosis
DSM-V – one positive symptom must be present
ICD-10 – two or more negative symptoms are sufficient for diagnosis
Subtype Changes
In 2013 the Diagnostic and Statistical Manual of Mental Disorders 5th edition
(DSM-V) changed the method of classification to bring all these categories
under a single heading: schizophrenia.
According to the American Psychiatric Association (APA), the decision to
eliminate these various subtypes was based on the conclusion they had
“limited diagnostic stability, low reliability, and poor validity.” It was concluded that they did not help to provide better treatment or to predict how patients would respond to treatment.
Further Changes
Two other important changes were made to the diagnostic criteria in 2013.
One was the removal of the requirement for a person to experience bizarre delusions and to hear two or more voices talking during an auditory hallucination to receive a positive diagnosis.
The second was that, to receive a diagnosis, a person must have at least one of the following symptoms:
hallucinations
delusions
disorganized speech
Classification
CD-10 and DSM-5 cluster symptoms together to identify disorders and distinguish them from each other.
Diagnosis (2)
Classificiation then used to identify disorder in individuals with specific symptoms.
Positive symptoms (addition to usual experience)
Hallucinations: unreal or distorted sensory experiences, e.g. auditory (hearing voices), visual (distorted faces), etc.
Positive symptoms (addition to usual experience) (2)
Delusions: beliefs with no basis in reality, e.g. believing you are an important historical figure or that someone is persecuting you.
Negative symptoms (loss of usual experience)
Avolition: loss of or severely reduced motivation, low activity levels.
Negative symptoms (loss of usual experience) (2)
Speech poverty: reduced frequency or quality of speech, disorganisation.
