Lesson 1 - Classification of Schizophrenia

Question 1

Which groups were more commonly diagnosed with Schizophrenia in the past?

Answer 1

Men more than women
Cities rather than the countryside
Working class rather than middle class.

Question 2

What is Schizophrenia?

Answer 2

Schizophrenia is a serious mental psychotic (serious mental issues that cause abnormal thinking) disorder that is characterised by a profound disruption of cognition and emotion. It affects a person’s language, thought and perception, emotions, and their sense of self.

Question 3

What are the 2 different classification systems used to diagnose Schizophrenia?

Answer 3

The DSM 5 which was devised by the American Psychological Association, and this is the classification that is used in the USA.

The ICD 11 which was devised by the World Health Organisation, and this is the classification that is used in the rest of the world.

Question 4

What is the DSM 5?

Answer 4

The DSM 5 is ‘The Diagnostic and Statistical Manual of Psychiatric Disorders’. It is used in America. The DSM states that you need to show at least 2 or more positive systems (or one positive and one negative) such as hallucinations or delusions for a period of one month (as well as extreme social withdrawal for at least 6 months) to be diagnosed with schizophrenia.

Question 5

What is the ICD 11?

Answer 5

The ICD 11 is ‘The International Classification of Diseases’. It is used all over the world. The ICD states that you need to show at least one positive and one negative (or two negatives) symptoms for at least one month to be diagnosed with Schizophrenia.

Question 6

What are the subtypes of Schizophrenia that were cut from the Diagnostic manuals?

Answer 6

Cataconic Schizophrenia, and Paranoid Schizophrenia.

Question 7

What are the 2 main types of Schizophrenia?

Answer 7

Type 1 Schizophrenia (acute schizophrenia): This is characterised by positive symptoms, and this is generally the type of SZ that has better prospects for recovery.
Type 2 Schizophrenia (Chronic Schizophrenia): This is characterised by negative symptoms, and generally is the type of SZ that has poorer prospects for recovery.

Question 8

What are positive symptoms of Schizophrenia?

Answer 8

Positive symptoms are those that appear to reflect an excess or distortion of normal functions. e.g Hallucinations, delusions, and disorganised speech.

Question 9

What are hallucinations?

Answer 9

Hallucinations: These are sensory experiences of stimuli that have ether no basis in reality, or are distorted perceptions of things that are not actually there.

Question 10

What are the types of hallucinations?

Answer 10

Auditory (hearing) hallucinations: these are when the person will experience hearing voices, that are making comments or talking to them in their head, and they are normally criticising the Schizophrenic.
Visual Hallucinations: This is when you see things which are not real e.g. distorted facial expressions, animals or people.
Olfactory Hallucinations: Smelling things which are not real e.g. they may smell disinfectant which is not real.
Tactile Hallucinations: Touching things which are not there e.g. bugs crawling on your skin.

Question 11

What are delusions?

Answer 11

This can also be known as paranoia. These are irrational and bizarre beliefs that seem real to the Schizophrenic. These can take a range of forms. Common delusions usually involve historical or religious figures. They also may involve that people are out to kill them, or other paranoid beliefs.

Question 12

What is disorganised speech?

Answer 12

This is the result of abnormal thought processes. This is where the Schizophrenic has problems organising his or her thoughts, and this shows up in their speech. They may experience derailment, which is when they switch topic very quickly, sometimes even mid sentence. This is because so much happens inside their head, that the conversation cannot keep up.

Question 13

What are the negative symptoms of Schizophrenia?

Answer 13

Negative symptoms of Schizophrenia are those that appear to reflect a reduction or loss of normal functions, which often occur even when there is a lack of positive symptoms. These consist of Speech Poverty (Alogia), Avolition, Affective flattening and Anhedonia.

Question 14

What is Alogia?

Answer 14

Alogia is speech poverty. This is when the sufferer has a significant reduction in the amount and quality of speech. This may also correlate with delays in the response speed during conversation. This type of speech is often associated with long illness and happens earlier in the onset of Schizophrenia.

Question 15

What is Avolition?

Answer 15

This may also be called apathy. This is essentially a lack of motivation to achieve anything. They do not want to keep up with any goal-directed activity, and they also allow their personal hygiene and grooming to take a hit. They also lose persistence when it comes to education, work and energy.

Question 16

What is affective flattening?

Answer 16

This is a reduction in the range and intensity of emotional expression, including facial expression, voice tone, eye contact and body language. Schizophrenics also have fewer body and facial movements and smiles. Alongside this, they also lack pronunciations, tempo, loudness and pausing when speaking, which are often indicative of emotion during a conversation.

Question 17

What is Anhedonia?

Answer 17

This is a loss of interest or pleasure in all or most activities, and just a lack of reactivity to normally pleasurable stimuli. Physical anhedonia is the inability to experience physical pleasures such as pleasure from food and physical touch. It is essentially an overall lack of pleasure.

Question 18

What are the 6 issues with the classification and diagnosis of Schizophrenia?

Answer 18

Reliability, validity, co-morbidity, symptom overlap, gender bias, cultural bias. These could all be referenced when discussing the reliability and validity of classification of schizophrenia.

Question 19

What are the issues of reliability with the classification of schizophrenia?

Answer 19

This concerns the consistency of a measuring instrument. Whaley (2001) found that the inter-rater reliability between diagnosticians was as low as +0.11. Cheniaux (2009) had 2 psychiatrists diagnose 100 patients using both DSM and ICD.
However, Oscario found that the DSM 5 has upped it’s inter rater reliability in 2019, and both pairs that Oscario used, had +0.97 and +0.92.

Question 20

What are the issues of validity with the classification of schizophrenia?

Answer 20

This the extent to which we are measuring what we intend to measure. The validity of diagnosis is measured via criterion validity. Schizophrenia is more likely to be diagnosed in the ICD than in the DSM. This is a problem, and a sign of poor validity. Rosenhan (1973) managed to get 8 pseudo patients to fake being schizophrenic, and all 8 patients managed to get diagnosed.

Question 21

What are the issues of co-morbidity with the classification of schizophrenia?

Answer 21

Co-morbidity is the idea that two or more mental disorders (or conditions) occur together. Buckley (2009) found that schizophrenia patients, 50% have depression, substance abuse 47%, PTSD 29%, OCD 23%. It may be that we are assuming that severe depression looks like SZ or vice versa. This is a weakness of diagnosis and classification as it is hard to differentiate.

Question 22

What are the issues of symptom overlap with the classification of schizophrenia?

Answer 22

This is when the symptoms for mental disorders overlap with one another. Ellason and Ross (1995), pointed out that people with DID (Dissociative Identity Disorder) actually having more schizophrenic symptoms than people diagnosed with Schizophrenia. This overlap questions the validity of the classification of schizophrenia.

Question 23

What are the issues of gender bias with the classification of schizophrenia?

Answer 23

Longenecker (2010) reviewed SZ studies since the 80s, and found that men were more likely to be diagnosed than women. There could be a gender bias in diagnosis as women seem to function better than men at having good family relationships. Therefore it is less likely to be diagnosed with Schizophrenia because women show better interpersonal function than men. Thus there is an issue as more men are being diagnosed than females.

Question 24

What are the issues of cultural bias with the classification of schizophrenia?

Answer 24

Pinto and Jones (2008) found that African Americans and English people of Afro Caribbean descent are nine times more likely to be diagnosed with Schizophrenia. This could be because positive symptoms ,such as auditory hallucinations, are accepted in African culture (ancestors speaking to you), and this may not be taken into account in the West. The west may also not believe black people’s honesty when diagnosing SZ.

Question 25

Advantages of classification and diagnosis of Schizophrenia: Communication between mental health professionals

Answer 25

A patient with a mental disorder often has numerous symptoms, and it is simpler to incorporate these into one diagnosis, which makes communicating between professionals easier.

Question 26

Advantages of classification and diagnosis of Schizophrenia: Treatment

Answer 26

Treatments of SZ are often specific to certain disorders, Most symptoms of schizophrenia can be declined by anti-psychotic drugs, rather than anti-anxiety drugs. This means that SZ can be reliably treated.

Question 27

Advantages of classification and diagnosis of Schizophrenia: Biological understanding

Answer 27

There are underlying biological abnormalities seen in Schizophrenics. Hopefully, by further understanding these predispositions, SZ can be treated more effectively.