Introduction to schizophrenia

Question 1

definition of classification of mental disorder

Answer 1

process of organising symptoms into categories based on which symptoms frequently cluster together

Question 2

definition of schizophrenia

Answer 2

severe mental disorder where contact with reality and insight are impaired, an example is psychosis

Question 3

definition of positive symptoms of schizophrenia

Answer 3

atypical symptoms experienced in addiction to normal experiences. they include hallucinations and delusions

Question 4

hallucinations definition

Answer 4

positive symptom of schizophrenia. they are sensory experiences that have either no basis in reality or a distorted perceptions of things that are there

Question 5

delusions definition

Answer 5

positive symptom of schizophrenia. they involve beliefs that have no basis in reality, for example a person believes they are someone else or that they are a victim of a conspiracy

Question 6

negative symptoms of schizophrenia definition

Answer 6

Atypical experiences that represent the loss of a usual experience such as a loss of clear thinking or a loss of motivation

Question 7

speech poverty definition

Answer 7

negative symptom of schizophrenia - involves reduced frequency and quality of speech

Question 8

co-morbidity defintion

Answer 8

occurrence of the two disorders or conditions together, for example when someone has schizophrenia and a personality disorder. where two conditions are frequently diagnosed together it calls a question into the validity of classifying the two disorders separately

Question 9

symptom overlap defintion

Answer 9

occurs when two or more conditions share symptoms, where conditions share many symptoms this calls into question the validity of classifying the two disorders separately

Question 10

how much os the world has schizophrenia

Answer 10

1%

Question 11

who is schizophrenia commonly diagnosed in

Answer 11

men, city dwellers and lower socio-economic groups.

Question 12

how can schizophrenia symptoms interfere

Answer 12

can interfere with everyday life leasing to many ending up homeless or hospitalised

Question 13

how do we diagnose according to the medical approach

Answer 13

to diagnose a specific disorder, we need to distinguish one disorder from another. we do this by identifying clusters of symptoms that occur together and classifying this as one disorder. diagnosis is possible by identifying the symptoms and deciding what disorder the person has

Question 14

what are the 2 major systems for diagnosis

Answer 14

international classification of disease (ICD) which is the world health organisations, the diagnostic and statistical manual (DSM) which is the American Psychiatric association’s

Question 15

what does ICD stand for

Answer 15

international classification of disease

Question 16

what does DSM stand for

Answer 16

diagnostic and statistical manual

Question 17

what are differences in ICD and DSM in diagnosis of schizophrenia

Answer 17

DSM-5 needs one positive system and the ICD needs two or more negative symptoms

Question 18

what have ICD and DSM previously done

Answer 18

recognised subtypes of schizophrenia involved mainly powerful hallucinations and delusions. Bithe the DSM-5 and ICD-10 have dropped subtypes as tend to be inconsistent with diagnosis of paranoid schizophrenia would not necessarily show the same symptoms a few years later

Question 19

what are positive symptoms schizophrenia

Answer 19

additional experiences beyond those of ordinary existence

Question 20

what are the 2 positive symptoms of schizophrenia

Answer 20

-hallucinations
-delusions

Question 21

what are hallucinations (positive symptom)

Answer 21

unusual sensory experiences. some are relevant to the events in the environment whereas others bear no relationship into the environment. can be experienced in relation to any sense

Question 22

example of a hallucination

Answer 22

voices heard wither talking to or commenting on a person, often criticising them

Question 23

what are delusions (positive symptom)

Answer 23

(also known as paranoia) are irrational beliefs. can take a range of form. common delusions uinvolves being and important historical, political or religious figure, such as jesus. commonly involved being persecuted such as by the government. another class of delusions concern the body. a person may believe that they are under external control. delusions can make people behave in a way that makes sense to them bizarre to others

Question 24

what are negative symptoms of schizophrenia

Answer 24

involve the loss of usual abilities and expereinces

Question 25

what are the 2 negative symptoms of schizophrenia

Answer 25

-speech poverty - avolition

Question 26

what is speech poverty (negative symptom)

Answer 26

-changes in patterns of speech -negative as emphasise on reduction in amount and quality of speech in schizophrenia. sometimes accompanied by a delay in peron's verbal response during conversation -nowadays, more emphasis is placed in speech disorganisation in which speech becomes incoherent or the speaker changes topic mid sentence -classified in DSM-5 as a positive symptom (speech disorganisation) but speech poverty is a negative symptom

Question 27

what is avolition (negative symptom)

Answer 27

-sometimes called 'apathy' which can be described as finding it difficult to begin or keep up with goal-directed activity (ie actions performed in order to achieve a result) -people with schizophrenia often have sharply reduced motivation to carry out a range of activities -Andreasen identifies 3 signs of avolition--> poor hygiene and grooming, lack of persistence in work or education, lack of energy

Question 28

issues in diagnosis and classification of schizophrenia --> good reliability

Answer 28

-reliability means consistency -a psychiatric diagnosis is said to be reliable when different diagnosing clinicians reach the same diagnosis for the same individual (inter-rater reliability) and when the same clinician reaches the same diagnosis for the same individual on two occasions (test-retest reliability). prior to DSM-5, reliability for schizophrenia diagnosis was low but this has improved. Osoria et al report excellent reliability for the diagnosis of schizophrenia in 180 individuals unring the DSM-5. pairs of interviewers achieved inter-rater reliability of +.97 and test-retest reliability of +.92

Question 29

issues in diagnosis and classification of schizophrenia --> low validity

Answer 29

-validity generally concerns whether we assess what we are trying to assess. one way to assess validity of psychiatric diagnosis is criterion validity -Cheniaux et al had 2 psychiatrists independently assess the same 100 clients using the ICD-10 and the DSM-IV criteria and found 68 were diagnosed with schizophrenia under ICD and 39 under DSM suggests schizophrenia is either over or under diagnosed according to the diagnostic system, wither way criterion validity is low

Question 30

issues in diagnosis and classification of schizophrenia counterpoint to low validity

Answer 30

-in Osorio et al study there was excellent agreement between clinicians when they used two measures to diagnose schizophrenia both derived from DSM system. this means the criterion validity for diagnosing schizophrenia is actually good provided it takes place within a single diagnostic system

Question 31

issues in diagnosis and classification of schizophrenia --> co-morbidity

Answer 31

-co-morbidity with other conditions -if conditions occur together a lot of the time them is calls question into validity of their diagnosis and classification because they might be a single condition. -schizophrenia is commonly diagnosed with other conditions. for example, one review found that about half of those diagnosed with schizophrenia also ahd diagnosis of depression or substance abuse (Buckley et al) -this is a problem for classification because it means schizophrenia may not exists as a distinct condition, and is a problem for diagnosis as at least some people diagnosed with schizophrenia may have unusual cases of other conditions such as depression

Question 32

issues in diagnosis and classification of schizophrenia --> gender bias in diagnosis

Answer 32

-since the 1980s men have been diagnosed with schizophrenia more commonly than women (1.4:1 Fisher and Buchanan). one possible explanation is that women are less vulnerable than man, possibily due to genetic factors. however, it seems more likely that women are underdiagnosed because they have closer relationships so get more support (cotton et al). this leads to women with schizophrenia functioning better than men -this underdiagnosis is a gender bias and means women may not therefore be receiving treatment and services that might benefit them

Question 33

issues in diagnosis and classification of schizophrenia --> cultural bias in diagnosis

Answer 33

-some symptoms such as hearing voices have different meanings in different cultures -for example, hearing voices in Haiti some people believe that voices are communications from ancestors -British people of African-Caribbean origin are 9 times more likely to be diagnosed as white British people (pinto and Jones), although people living in African-Caribbean countries are not, ruling out a genetic vulnerability. the most likely explanation is culture bias in diagnosis of clients by psychiatrists form a different cultural background. this appears to an overinterpretation of symptoms in black British people (Escobar) -means British African-Caribbean people may be discriminated against by a culturally-biased diagnostic system

Question 34

issues in diagnosis and classification of schizophrenia --> symptom overlap

Answer 34

-considerable symptom overlap with schizophrenia and other conditions -eg both schizophrenia and bipolar involve positive symptoms (such as delusions) and negative symptoms (such as avolition). in terms of classification this suggests that schizophrenia and bipolar may not be 2 different conditions but variations of a single condition in terms of diagnosis it means schizophrenia is hard to distinguish forms bipolar -as with co-morbidity, symptom overlap mean that schizophrenia may not exist as a distinct condition and that even if it does it is hard to diagnose. both its classification and diagnosis are flawed

Question 35

Buckley et al findings into co-morbidity of schizophrenia

Answer 35

-50% with schizophrenia have depression -47% have co-morbidity with substance abuse -23% have OCD

Question 36

Rosenhan- sane in insane places study procedure

Answer 36

-12 hospitals -participants set up appointment with fake name, occupation and employment -participants complained about hearing unfamiliar voices which came from someone of their own sex and said empty, hollow and thud where participants provide truthful information on matters other than name, occupation and employment with changes to fit -once admitted they stopped simulating psychiatric symptoms -in psychiatric wards, participants engaged with patients and staff as they would normally with colleagues in everyday life. when asked how they were feeling, participants indicated that they were fine but no longer experienced symptoms. received but did not take prescription medicine (typically) -recorded observations regarding staff, ward and patients -discharged when the hospital thought fit

Question 37

Rosenhan- sane in insane places study findings

Answer 37

- in 11/12 participants were admitted on a diagnosis of schizophrenia and discharged with schizophrenia in remission --the other instance the person was admitted on diagnosis of manic-depressive psychosis where discharge diagnosis was not reported -stays ranged from 7-52 days with a mean of 19 days

Question 38

Rosenhan- sane in insane places study non-existent imposter study

Answer 38

-informed that one or more people previously instructed to stimulate at least one symptom of a psychiatric disorder (pseudopatient) in the next 3 months - staff were asked to rate each patient seeking admission on a 10 point scale, from most likely to be pseudopatient to least likely -no patients were actually sent

Question 39

Rosenhan- sane in insane places study non-existent imposter findings

Answer 39

-of the 193 scores obtained 41 were judges as highly likely to be a pseudo patient by at least 1 member of staff -23 by at least one psychiatrist -19 by one psychiatrist and one other member of staff

Question 40

avolition definition

Answer 40

negative symptom of schizophrenia. involves the loss if motivation to carry out tasks and results in lowered activity levels