Introduction to Schizophrenia Flashcards
What is Schizophrenia?
- a severe mental disorder where contact with reality and insight are impaired - psychosis
- more commonly diagnoses in men
Diagnosis and Classification
- interlinked
- identify clusters of symptoms that occur together and then classifying this as one disorder
2 major systems
- The World Health Organisations International Classification of Disease (ICD-10 VERSION 11)
- 2 or more negative symptoms to be diagnosed - DSM-5
- 1 positive symptoms
What are positive symptoms?
- something that is added to someone
Examples of positive symptoms
- Hallucinations
= unusual sensory experiences - hearing voices that aren’t there or seeing things that aren’t there
- can be related to any sense
- Delusions
= irrational beliefs - important historical figures, being persecuted, the body (under external control)
- their behaviour makes sense to them but to others it is seen as bizarre
What are negative symptoms?
- take away a norm from someone
Examples of negative symptoms
- Speech poverty
= patterns of speech and reduction of speech - disorganisation
- DSM-5
- Avolition (apathy)
= finding it hard to keep up with a goal or a directed activity - reduced motivation (to clean, shower, work etc)
- poor hygiene, lack o work, lack of energy (Andreason)
How is the DSM-5 tested for reliability?
- inter rater reliability
- a kappa score of 1 = perfect agreement, 0 = no agreement
- DSM-5 = 0.46
Luhrmann
- interviewed 60 adults diagnosed with schizophrenia - 20 fro ghana, 20 from india and 20 from usa
Found:
- many african and indian subjects reported positive experiences with the voices they heard
- us patients were more likely to report these voices as being violent and hateful
Concludes:
- the harsh and violent voice is common in the west, may not be an inevitable feature of schizophrenia
Rosenhan’s Study
Aim:
- investigate psychiatric labels
- what was it like to be hospitalised as a mentally ill patient?
Method:
- 12 hospitals
- 5 different states
- 8 sane people
Findings:
- no one was detected by the doctors
- doctors could not distinguish healthy people from people with mental illness
- findings provided convincing evidence against accuracy and validity of psychiatric diagnoses
Conclusion:
- it is very difficult to distinguish sanity and insanity in a hospital setting
So What?
- Demonstrates concerns of validity and how patients are diagnosed
What does Rosenhan’s study tell us about the problems of reliability of diagnosis?
- findings may be questioned in respect to reliability and validity
- demonstrates that psychiatrists cannot reliably tell the difference between people who are sane and insane
- definitions need to be operationalised and more rigid and structured diagnosis
- it is invalid - admitted when they didn’t have schizophrenia but pretended they did - hospitals are more likely to say better to be safe than sorry
Define reliability in the context of schizophrenia
- reliability is the consistency of results
- clinicians must be able to reach the same conclusion at 2 different points (test-retest reliability)
- different clinicians must reach the same conclusions (inter-rater reliability)
Identify and explain one way the reliability of the diagnosis of schizophrenia can be tested
- test-retest reliability
- clinician diagnosing the same patient 2 or more times - 2 week interval
- kappa score of 0.8 or above we can say it had reliability
Validity
- the extent to which a diagnosis reflects the actual disorder and that is real and distinct from other disorders
How can gender bias impact diagnosis?
- gender bases diagnostic criteria or clinicians basing judgements on stereotypical beliefs about gender
