L1 - Classification of Schizophrenia

Question 1

define schizophrenia

Answer 1

sz is defined as a mental psychotic disorder marked by a profound disruption of cognition and emotion, its so severe it affects a persons language, thought, perception, emotions and even sense of self

Question 2

sz onset age and percent of population with it

Answer 2

it is suffered by approximately 1% of the population, onset of the disorder is between 15 and 35 years of age

Question 3

why is sz regarded as a psychotic rather than neurotic disorder?

Answer 3

sz is referred to as a psychotic rather than neurotic disorder because the term psychotic refers to serious mental issues causing abnormal thinking and perceptions and also the fact that people lose touch with reality

Question 4

what are the two classification systems for sz?

Answer 4

1) DSM 5 - used in america

2) ICD 10 - used in europe and other parts of the world

Question 5

how is sz diagnosed?

Answer 5

based on how many positive and negative symptoms a patient is suffering from, but the numbers depend on which classification system is used

Question 6

DSM diagnosis

Answer 6

DSM states that you need to show at least two or more positive symptoms (or one positive and negative) such as hallucinations or delusions for a period of one month as well as extreme social withdrawal for at least 6 months in order to be diagnosed with sz

Question 7

icd diagnosis

Answer 7

the ICD 10 states that you need to show at least one positive and one negative symptom (or two negative) symptoms for at least one month to be diagnosed with sz

Question 8

ICD has subtypes

Answer 8

the ICD also recognises that there are subtypes of schizophrenia (catatonic, paranoid sz) whereas the DSM does not

Question 9

types of sz established by CROW?

Answer 9

Type 1: characterised by more positive symptoms (those which are an addition to an individuals behaviour) e.g delusions, hallucinations - better prospects of recovery

Type 2: characterised by more negative symtoms e.g loss of emotion, speech poverty - generally poorer propsects for recovery

Question 10

what are the positive symptoms of sz?

Answer 10

1) hallucinations - auditory, visual, olfactory, tactile - seeing or hearing things that arent actually happening in reality
2) delusions - sets of beliefs that have no basis in reality
3) disorganised speech - this is the result of abnormal thought processes, individual has problems organising their thoughts and this shows in their speech, they may slip from one topic to another (derailment) and their speech sounds incoherent

Question 11

what are the negative symptoms of sz?

Answer 11

1) speech poverty (ALOGIA) - characterised by changes in patterns of speech, individual speaks less and the quality of their speech is reduced (bare in mind this a negative symptom) - sometimes accompanied by a delay in the sufferer’s verbal responses during conversation
2) AVOLITION - finding it difficult to keep up with goals, sharply reduced motivation, poor hygiene and grooming, lack of persistence in work or education and lack of energy
3) AFFECTIVE FLATTENING - reduction in the range and intensity of emotional expression including facial expression and tone, body language etc. They give away less non verbal emotional cues
4) ANHEDONIA - loss of interest or pleasure in all or most activities or a lack of reactivity ro normally pleasurable stimuli . PHYSICAL ANHEDONIA - inability to experience pleasure from things like food, body contact. SOCIAL ANHEDONIA - inability to experience pleasure from interactions with other people

Question 12

what are the issues associated with classification and diagnosis of sz?

Answer 12

1) reliability
2) validity
3) co morbidity
4) symptom overlap
5) gender bias
6) cultural bias

Question 13

reliability issues

Answer 13

reliability refers to the CONSISTENCY OF A MEASURING INSTRUMENT (e.g the DSM or ICD) and an example of this is INTER RATER RELIABILITY.

WHALEY found that inter rater reliability between diagnosticians was as low as +0.11 using DSM. Another study conducted by CHENIEUX ET AL showed that when diagnosticians tried to diagnose 100 patients using DSM and ICD criteria the inter rater reliability between the two systems was very low. The low reliability is a weakness of diagnosis of SZ

Question 14

issues of validity

Answer 14

validity is the extent to which we are measuring what we intend to measure. In other words, are we diagnosing SZ correctly based on the SYMPTOMS USED IN THE MANUALS. This can be assessed using CRITERION VALIDITY which is when DIFFERENT ASSESSMENT SYSTEMS arrive at the SAME DIAGNOSIS for the SAME PATIENT.

According to CHENIAUX’s study, we can see that SZ is MUCH MORE LIKELY TO BE DIAGNOSED using ICD than DSM, suggesting that SZ is either OVER DIAGNOSED in ICD or UNDER DIAGNOSED in DSM - either way this problem is a SIGN OF POOR VALIDITY.

Question 15

validity issues - ROSENHAN’S STUDY

Answer 15

ROSENHAN’S STUDY supports the idea that the validity in the diagnosis of SZ is low since 8 PSEUDO PATIENTS (people who pretend to be ill to gain some benefit)were able to get themselves ADMITTED IN PSYCHIATRIC HOSPITALS by using the symptoms of HEARING VOICES.

It was found that ALL 8 PATIENTS STAYED IN FOR 7-52 DAYS. But it’s an OLD STUDY which means the DIAGNOSIS WAS MUCH POORER as the DSM (used in america) was NOT THAT RELIABLE AT THAT TIME - study LACKS TEMPORAL VALIDITY

Question 16

validity issues - BIRCHWOOD AND JACKSON

Answer 16

However, in a MORE RECENT STUDY, BIRCHWOOD AND JACKSON found ABOUT 20% of PATIENTS WITH SZ SHOW COMPLETE RECOVERY and NEVER HAVE ANOTHER SZ EPISODE, 10% show SIGNIFICANT IMPROVEMENT, 30% show SOME IMPROVEMENT. 40% NEVER REALLY RECOVER. 10% ARE SO AFFECTED THEY COMMIT SUICIDE.

This GREAT VARIATION in PROGNOSIS SUGGESTS VERY POOR PREDICTIVE VALIDITY.

Question 17

issues of co-morbidity

Answer 17

CO MORBIDITY is the idea that TWO OR MORE MENTAL DISORDERS OCCUR TOGETHER, If this is the case then we can QUESTION THE VALIDITY OF DIAGNOSIS FOR SZ. In fact, SZ is COMMONLY DIAGNOSED WITH OTHER CONDITIONS.

In one review by BUCKLEY ET AL, it was concluded that around HALF OF THE PATIENTS WITH SZ ALSO HAVE A DIAGNOSIS OF DEPRESSION (50%) OR SUBSTANCE ABUSE (47%). POST TRAUMATIC STRESS DISORDER also occurred in 29% of cases and OCD in 23% of cases

This poses a challenge for both CLASSIFICATION AND DIAGNOSIS OF SZ - it suggests that we AREN’T ABLE TO DISTINGUISH BETWEEN DISORDERS VERY WELL (especially with SZ and DEPRESSION). CO MORBIDITY IS THEREFORE A WEAKNESS OF DIAGNOSIS AND CLASSIFICATION

Question 18

issues of symptom overlap

Answer 18

symptom overlap means there is CONSIDERABLE OVERLAP BETWEEN THE SYMPTOMS OF SZ and the OTHER CONDITIONS such as DEPRESSION AND BIPOLAR DISORDERS. E.g ELLASON AND ROSS highlighted that people with DID actually have MORE SZ SYMPTOMS than PEOPLE ACTUALLY DIAGNOSED WITH SZ

In fact, most people diagnosed with SZ have SUFFICIENT SYMPTOMS OF OTHER DISORDERS that they COULD ALSO RECEIVE AT LEAST ONE OTHER DIAGNOSIS.

This OVERLAP questions the VALIDITY OF THE CLASSIFICATION AND DIAGNOSIS OF SZ.

Question 19

issues of gender bias in diagnosis

Answer 19

this issue refers to whether one gender is MORE/LESS likely to be diagnosed with SZ and if so, why?

LONGENECKER ET AL reviewed SZ STUDIES SINCE THE 1980s and found MEN MORE LIKELY TO TO BE DIAGNOSED THAN WOMEN. There could be a gender bias as women seem to FUNCTION BETTER THAN MEN, having GOOD FAMILY RELATIONSHIPS AND MORE LIKELY TO WORK.

Therefore its LESS LIKELY FOR WOMEN TO BE DIAGNOSED WITH SZ THAN IT IS FOR MEN because women are showing BETTER INTERPERSONAL FUNCTION THAN MEN. In conclusion there is a GENDER BIAS IN DIAGNOSIS with MORE MALES BEING DIAGNOSED THAN FEMALES

Question 20

issues of cultural bias in diagnosis

Answer 20

this issue refers to whether or not ONE PARTICULAR CULTURE is MORE OR LESS DIAGNOSED WITH SZ THAN OTHER CULTURES.

AFRICAN AMERICAN AND ENGLISH PEOPLE OF THE AFRO CARRIBEAN ORIGIN ARE 9X MORE LIKELY TO BE DIAGNOSED WITH SZ.

This may be because the positive symptoms of SZ such as AUDITORY HALLUCINATIONS may be ACCEPTABLE IN AFRICA because of CULTURAL BELIEFS in COMMUNICATION WITH ANCESTORS, and these don’t warrant a diagnosis in Africa (as SZ rates are low in Africa).

However, in the UK this is likely to be seen as a POSITIVE SYMPTOM OF SZ so they are likely to be diagnosed with SZ`

Question 21

+ shorthand

Answer 21

a patient with a mental disorder often has NUMEROUS SYMPTOMS. Its SIMPLER to INCORPORATE THESE SYMPTOMS INTO A SINGLE DIAGNOSIS and this makes COMMUNICATION BETWEEN MENTAL HEALTH PROFESSIONALS MUCH EASIER

Question 22

+ treatment

Answer 22

treatments are often SPECIFIC TO CERTAIN DISORDERS - e.g symptoms of SZ respond well to CERTAIN ANTIPSYCHOTIC DRUGS but NOT ANTI ANXIETY. A RELIABLE DIAGNOSIS can point to a therapy that will ALLEVIATE SYMPTOMS

Question 23

+ underlying biological abnormalities

Answer 23

although there is variation. there are many UNDERLYING BIOLOGICAL ABNORMALITIES SEEN IN PEOPLE WITH SZ. Its hoped that a GREATER UNDERSTANDING OF THESE ABNORMALITIES will lead to EVEN MORE EFFECTIVE TREATMENT