Introduction To Schizophrenia

Question 1

What is Schizophrenia?

Answer 1

• a serious mental disorder experienced by 1% of the world population, more commonly diagnosed in men, city dwellers and lower socioeconomic groups
• can interfere severely with everyday tasks, so a lot end up homeless or hospitalised

Question 2

What is meant by diagnosis and classification of schizophrenia?

Answer 2

• the two are interlinked, in order to diagnose a specific disorder we need to distinguish one disorder from another by identifying clusters of symptoms that occur together and classifying it as one disorder
• diagnosis is then possible by identifying symptoms/deciding what disorder a person has
• two major systems for classification WHO’s ICD-10 and America’s DSM-5. Differ slightly in classification of schizophrenia
• DSM-5 states one positive symptoms must be present for diagnosis vs 2+ negative symptoms for ICD-10

Question 3

What are the positive symptoms of Schizophrenia?

Answer 3

• Hallucinations: sensory experiences, related to events in the environment whereas others bear no relationship e.g voices heard talking to/criticising patient. Can be experienced in relation to any sense
• Delusions: paranoia and irrational beliefs. Being an important historical/political figure, also being persecuted or having superpowers. Person may believe they are under external control

Question 4

What are the negative symptoms of schizophrenia?

Answer 4

• Speech Poverty: changes in patterns of speech, emphasis is on the reduction of quality/amount of speech in Sz, accompanied by delay in verbal responses during conversation. However, nowadays more emphasis on speech disorganisation in which speech is incoherent or speaker changes topic mid-sentence. DSM-5 as a positive symptom of schizophrenia, whilst speech poverty remains negative symptom.
• Avolition: ‘apathy’ can be described as finding it difficult to begin or keep up with goal-directed activity, reduced motivation to carry out a range of activities
• Andreasen (3 signs of avolition) : poor hygiene and grooming, lack of persistence in work or education and lack of energy

Question 5

How is the diagnosis of Schizophrenia Reliable?

Answer 5

• Osorio et al report excellent reliability for diagnosis of Sz in 180 individuals using DSM-5, pairs of interviewers achieved inter-rater reliability of +.97 a test-retest reliability of +.92

Question 6

How is the validity of diagnosis of Sz a limitation?

Answer 6

• Cheniaux has two psychiatrists independently assess the same 100 clients using ICD-10 and DSM-5 criteria and found 68 were diagnosed under ICD and 39 under DSM

Question 7

How is Co-morbidity an issue?

Answer 7

• if conditions occur together a lot this calls into question the validity of their diagnosis because they might be a single condition
• over half of those with Sz also had depression or substance abuse
• means Sz may not exist as a distinct condition (may just be an unusual case of depression)

Question 8

How is Schizophrenia gender biased?

Answer 8

• men diagnosed more than women (ratio of 1.4:1 - Fisher and Buchanan), women may be less vulnerable however, more likely women have closer relationships and get support (Cotten et al)
• women may not receive treatment

Question 9

How is Sz culturally biased?

Answer 9

• British people of African-Carribean origin are 9 times more likely to receive a diagnosis as white British people (Pinto and Jones)
• some symptoms e.g hearing voices have different meanings in other cultures e.g Haiti believes voices are communications from ancestors

Question 10

How do symptoms overlap in Schizophrenia?

Answer 10

• Both Sz and bipolar disorder involve positive symptoms (delusions) may not be distinct conditions but variations of the same condition