Introduction To Schizophrenia

Question 1

What is schizophrenia?

Answer 1

A severe mental illness where contact with reality and insight are impaired; an example of psychosis suffered by 1% of the population more commonly diagnosed in men rather than women

Question 2

Explain why schizophrenia is difficult to diagnose

Answer 2

• schizophrenia does not have a single defining characteristic- it is a cluster of symptoms that seem to be unrelated
• in fact, the two major systems DSM-5 and ICD-10 differ in their approach to the diagnosis of schizophrenia

Question 3

Explain how the DSM-5 and ICD-10 differ in their classification of schizophrenia

Answer 3

• DSM-5 states that one so called ‘positive symptom’ of schizophrenia must be present for a diagnosis of schizophrenia (hallucinations, delusions or speech disorganisation)
• in contrast the ICD-10 states that two or more ‘negative symptoms’ of schizophrenia are sufficient for diagnosis (avolition and speech poverty)

Question 4

What is the DSM-5?

Answer 4

The Diagnostic and Statistical Manual of Mental Disorders is a classification system of mental disorders published by the American Psychiatric Association. It contains typical symptoms of each disorder and guidelines for clinicians to make a diagnosis (most recent version is DSM-5)

Question 5

What is the ICD-10?

Answer 5

The most recent version of the International Classification of Diseases, published by the WHO

Question 6

What are ‘positive symptoms’ of schizophrenia?

Answer 6

Additional experiences beyond those of everyday existence such as hallucinations and delusions

Question 7

What are hallucinations?

Answer 7

Sensory experiences of stimuli that either have no basis in reality or distorted perceptions of things that are there. For example auditory hallucinations (hearing voices) and visual hallucinations (e.g. seeing people who are not there)- hallucinations can however be experienced in relation to any sense

Question 8

What are delusions?

Answer 8

Beliefs that have no basis in reality, for example, that the sufferer is a very important person e.g. superhero or they are a victim of conspiracy- delusions can make people behave in ways that make sense to the sufferer but are perceived as bizarre to others

Question 9

What are ‘negative symptoms’ of schizophrenia?

Answer 9

Involve the loss of usual abilities and experiences such as avolition and speech poverty

Question 10

What is avolition?

Answer 10

Involves the loss of motivation to carry out tasks and results in lowered activity levels

Question 11

What is speech poverty?

Answer 11

Reduction in the frequency and quality of speech, and is often accompanied by a delay in verbal responses during conversations- the DSM-5 also emphasises speech disorganisation and incoherence

Question 12

What are some sub-types of schizophrenia?

Answer 12

• disorganised schizophrenia
• catatonic “
• paranoid”
• undifferentiated”
• residual”

Question 13

What is disorganised schizophrenia?

Answer 13

• person’s behaviour generally disorganised and not goal directed
• symptoms include thought disturbances (including delusions and hallucinations), absence of expressed speech, large mood swings and social withdrawal
• usually diagnosed in adolescence

Question 14

What is catatonic schizophrenia?

Answer 14

• diagnosed if the patient has severe motor abnormalities such as unusual gestures or use of body language- sometimes patients gesture repeatedly using complex sequences of finger, hand or arm movements, which appear to have some meaning for them
• main gesture is almost immobility for hours at a time, with the patient simply staring blankly

Question 15

What is paranoid schizophrenia?

Answer 15

• this type involves delusions of various kinds, however the patient remains emotionally responsive
• they are more alert than patients with other types of schizophrenia
• in some ways least-serious but most well-known
• often has a later onset than other types

Question 16

What is undifferentiated schizophrenia?

Answer 16

Broad ‘catch-all’ category that includes patients who do not clearly belong within any other category= show symptoms of schizophrenia but do not ‘fit’ into the other types

Question 17

What is residual schizophrenia?

Answer 17

• this category describes people who, although they have had an episode of schizophrenia during the past 6 months and still exhibit some symptoms, these are not strong enough to merit putting them in the other categories
• this type consists of patients who are experiencing mild symptoms

Question 18

What are the 4 most prevalent issues in the diagnosis of schizophrenia?

Answer 18

• reliability
• validity
• co-morbidity
• symptom overlap

Question 19

What is reliability? (Regarding schizophrenia diagnosis)

Answer 19

The extent to which diagnosis of schizophrenia is consistent I.e. different professionals give the same diagnosis

Question 20

What is validity? (Regarding schizophrenia diagnosis)

Answer 20

The extent to which diagnosis and classification techniques measure what they are designed to measure; in this case, schizophrenia

Question 21

What is co-morbidity? (Regarding schizophrenia diagnosis)

Answer 21

The occurrence of two illnesses together, which can confuse diagnosis and treatment = validity of diagnosis questioned as it may be a single condition

Question 22

What is symptom overlap? (Regarding schizophrenia diagnosis)

Answer 22

When two or more conditions share symptoms, questioning the validity of the classification

Question 23

What are the evaluation points for diagnosis of schizophrenia?

Answer 23

❌ reliability (Cheinaux et al,2009)
❌ validity (“) 
❌ co-morbidity (Buckley, 2009)
❌ symptom overlap
❌ cultural bias

Question 24

Discuss how Cheniaux et al (2009) showed poor reliability in diagnosis of schizophrenia

Answer 24

• Cheniaux et al (2009) had 2 psychiatrists independently diagnose 100 patients using both the DSM-5 and ICD-10 criteria
• inter-rater reliability was poor with one psychiatric diagnosing 26 with schizophrenia according to DSM and 44 according to ICD, and the other diagnosing 13 according to DSM and 24 according to ICD
• this inconsistency between mental health professionals and the different classification systems is a significant limitation of the diagnosis

Question 25

Discuss how another limitation of diagnosis of schizophrenia is validity

Answer 25

• one standard way to assess validity of diagnosis is criterion validity (a means of assessing validity by considering the extent to which people do well on a test do on other things you would expect to be associated with the test); do different assessment systems arrive at the same diagnosis for the same patient?
• Cheniaux et al’s (2009) study shows that schizophrenia is much more likely to be diagnosed using ICD than the DSM
• this suggest that schizophrenia is their over-diagnosed in ICD or under-diagnosed in DSM
• shows poor validity and so weakness of diagnosis

Question 26

Discuss how a further limitation of diagnosis of schizophrenia is co-morbidity? (Buckley, 2009)

Answer 26

• co-morbidity is when two or more conditions occur together
• if conditions occur together frequently, it might call into question whether they are actually a single condition
• Buckley et al (2009) concluded that around half of patients with diagnosis of schizophrenia, also have a diagnosis of depression (50%) or substance abuse (47%)
• in terms of classification, it may be that if very severe depression looks a lot like schizophrenia and vice versa, they may be seen as a single condition
• this confusing picture= limitation of diagnosis and classification as it’s clear that mental health tends to be a complex area not a simple one

Question 27

Discuss how symptom overlap is a limitation of diagnosis of schizophrenia

Answer 27

• there is a considerable overlap of symptoms of schizophrenia and other conditions- both schizophrenia and bipolar disorder for example, involve positive symptoms like delusions and negative symptoms like avolition
• this calls into question both the validity and classification of of diagnosis of schizophrenia
• under ICD, patient may be diagnosed as schizophrenic but many of same patients would receive diagnosis of bipolar disorder under DSM criteria = inconsistency in diagnosis

Question 28

Discuss how cultural bias is a limitation in the diagnosis of schizophrenia

Answer 28

• African Americans and English people of African origin are several times more likely to be diagnosed with schizophrenia
• given that the rates in the West Indies and Africa are not high, this almost certainly not due to genetic vulnerability
• one factor that may be at work here is that positive symptoms such as hearing voices (auditory hallucinations) are more acceptable in African cultures due to beliefs about communication with ancestors
• thus highlights and issue in the validity of diagnosis because it suggests individuals from some cultural backgrounds are more likely to be diagnosed than others, due to bias