Introduction to Schizophrenia

Question 1

What is schizophrenia?

Answer 1

• A severe mental disorder where contact with reality & insight are impaired
• An example of a psychosis

Question 2

What are the type 1 (positive symptoms) of schizophrenia?

Answer 2

• Delusions
• Hallucinations
• Catatonia

Question 3

What are hallucinations?

Answer 3

• Unusual sensory experiences that either have no basis in reality or are distorted perceptions of things that are there.
• Hallucinations can be experienced in relation to any sense

Question 4

What are delusions?

Answer 4

• Also known as paranoia, delusions are irrational beliefs
• Delusions can make a person behave in ways in ways that make sense to them but seem bizarre to others
• Vast majority dont, but some delusions can lead to aggression

Common delusions invlove being an important historical, political or religious figure

Question 5

What are some of the negative symptoms of schizophrenia?

Answer 5

• Speech Poverty
• Avolition

Question 6

What is speech poverty?

Answer 6

• Involves a reduction in the amount & quality of speech in schizophrenia
• Sometimes accompanied by a delay in the persons verbal responses during conversation

Question 7

What is avolition?

Answer 7

• Involves loss of motivarion to carry out tasks & results in lowered activity levels

Nancy Andreasen (1982)
- Identified 3 signs of avolition: poor hygeine & grooming, lack of persistence in work or education & lack of energy

Question 8

How do you diagnose a mental disorder?

Answer 8

• In order to diagnose a specific disorder, we need to distinguish one disorder from another
• We do this by identifying clusters of symptoms that occur together & classifying this as one disorder
• Diagnosis is then possible by identifying symptoms& deciding what disorder a person has e.g OCD, Schizophrenia

Question 9

What are the two major systems for classification of mental disorder?

Answer 9

• ICD-10/11
• DSM-5
• These differ slightly in their classification of schizophrenia
  -e.g. in the DSM-5 two positive or negative symptoms must be present for diagnosis whereas two or more negative symptoms are sufficient under ICD

Question 10

How long should symptoms last before making a diagnosis?

Answer 10

• Both ICD-11 & DSM-5 state that psychotic symptoms shld be present in th patient for at least one month for a diagnosis of schizophrenia to be made
• With DSM-5 requiring that these symptoms continue for up to 6 months

Question 11

What are the two types of reliability?

Answer 11

• Test-retest- Check diagnosis by completing a test, wait a short while (e.g. a few weeks), run same test again to see if it is consistent
• Inter-rater- Ask another doctor to diagnose the same patient & compare diagnosis

Question 12

Give on strength of the diagnosis of schizophrenia.

Answer 12

• Diagnosis have good reliability
• Prior to DSM-5, reliability for schizophrenia diagnosis was low but this has now improved
• Flavia Osorio et al (2019) reported excellent reliability for diagnosis of schizophrenia in 180 individuals using the DSM-5
• Pairs of interviewers achieved inter-rater reliability of +.97 & test retest reliability of +.92

This means that we can be reasonably sure that the diagnosis of schizophrenia is consistently applied

Question 13

Define co-morbidity.

Answer 13

• When you have two disorders- People diagnosed w schizophrenia are also diagnosed with other disorders
• Buckley et al - 50% of individuals with a diagnosis of schiz also have depression, 47% have co-morbidity w a substance abuse & for OCD it is 23%

Question 14

What are the issues with reliability & diagnosing schizophrenia?

Answer 14

• Elie Cheniaux et al (2009)
• Had 2 psychiatrists independantly diagnose 100 patients using both DSM (4) & ICD (10)
  Found:
• Psychiatrist 1 diagnosed 26 patients w schiz & 44 with the ICD
• Psychiatrist 2 diagnosed 13 w the DSM & 24 with the ICD
• Suggests using 2 different systems leads to unreliable diagnoses which may lead to false positives or false negatives of diagnoses of schiz, potentially affecting the lives of patients who may be incorrectly diagnosed or labelled

Question 15

What is the issue with the co-morbidity when diagnosing schizophrenia?

Answer 15

• Its co-morbidity with other conditions
• If conditions occur together a lot of the time then this calls into question the validity of their diagnosis & classification because they might actually be a single condition
• Schiz is often diagnosed w other conditions
• According to Buckley et al 50% of individuals w a diagnosis of schizophrenia also have depression, 47% have a co-morbidity w substance abuse & for OCD it is 23%
• This is problem for classification as it means schizophrenia may not exist as a distinct condition & is a problem for diagnosis as at least some people diagnosed w schizophrenia may have unusual cases of conditions like depression.

Question 16

What is the issue with gender bias in schizophrenia?

Answer 16

• The existence of gender bias.
• Since 1980s men have been more commonly diagnosed w schizophrenia than women (a ratio of 1.4:1)- Fischer & Buchanan
• One possible explanation for this is that women are less vulnerable than men, perhaps because of genetic factors
• However it seems more likely that women are underdiagnosed because they have closer relationships, hence get support (Cotton et al 2009)
• This leads to women functioning better than men
• This underdiagnosis is a gender bias & means women may not therefore be recieving treatment & services that benefit them

Question 17

What is the issue with culture bias when diagnosing schizophrenia?

Answer 17

• Some symptoms of schiz, particularly hearing voices have different meanings in different cultures
• For example in some Afro-Caribbean societies voices may be attributed to communication from ancestors
• Afro Carribeans living in the UK are up to ten times more likely to recieve a diagnosis as white British people
• Although people living in Afro-Carribean countries are not, ruling out a genetic vulnerability,
• The most likely explanation for this is culture bia, in diagnosis of clients by psychitrists from a different cultural backround.
• This appears to lead to an overinterpretation of symptoms in black British people
• This means that Afro-Caribbean people may be discriminated against by a culturally-biased diagnostic

Question 18

How has symptom overlap got to do with schizophrenia diagnosis?

Answer 18

• There is considerable overlap between the symptoms of schizophrenia & the symptoms of other conditions
• E.g. both schizophrenia & bipolar disorder involve positive symptoms (delusions) & negative symptoms (avolition)
• In terms of classification this suggests that schiz & bipolar disorder may not be two different conditions but variations of a single condition
• In terms of diagnosis it means schiz is hard to distinguish from bipolar disorder

As w co-morbidity, symptom overlap means that schizophrenia may not exist as a distinct condition & that even if it does it is hard to diagnose
So its both its classification & diagnosis are flawed