Lesson 1 – Classification of Schizophrenia

Question 1

What is Schizophrenia

Answer 1

Schizophrenia is a serious mental psychotic disorder characterised by a profound disruption of cognition and emotion. It is so severe, that it affects a person’s language, thought and perception, emotions and even their sense of self.

Question 2

Approximately how many people suffer from Schizophrenia

Answer 2

It is suffered by approximately 1% of the population. This means it affects about four in thousand people (Saha et al., 2005).

Question 3

What are the common ages for the onset of Schizophrenia

Answer 3

The onset of the disorder is between 15 and 35 years of age.

Question 4

What were the issues about how it was diagnosed in the past

Answer 4

In the past, it was more commonly diagnosed in:
* Men more than women
* Cities rather than the countryside
* Working class than middle class people

Question 5

What are the two classification systems used to diagnose Schizophrenia

Answer 5

DSM 5 and ICD 11

Question 6

What is DSM 5

Answer 6

The DSM 5 (The Diagnostic and Statistical Manual of Psychiatric Disorders) – devised by the American Psychological Association (APA) – the DSM is currently now in its 5th edition.

Question 7

What is ICD 11

Answer 7

The ICD 11 (The International Classification of Diseases) – devised by the World Health Organisation (WHO) - the ICD is currently in its 11th edition

Question 8

How does DSM 5 diagnose Schizophrenia

Answer 8

DSM 5 states that you need to show at least two or more positive symptoms such as hallucinations or delusions (or one positive and one negative) for a period of one month (as well as extreme social withdrawal for at least six months) to be diagnosed with schizophrenia

Question 9

How does ICD 11 diagnose Schizophrenia

Answer 9

ICD 11 states you need to show one positive and one negative symptom (or two negative symptoms) for at least one month to be diagnosed with schizophrenia.

Question 10

Why did both manuals delete subtypes of Schizophrenia

Answer 10

The ICD and DSM recognises that there are subtypes of schizophrenia (such as Catatonic Schizophrenia, Paranoid Schizophrenia) but both manuals have deleted these subtypes of schizophrenia as it made diagnosis more complex and had little effect on the treatments.

Question 11

What are the types of Schizophrenia

Answer 11

Crow (1980) made a distinction between two types of schizophrenia: Type 1 syndrome and type 2 syndrome.

Question 12

What is Type 1 Syndrome

Answer 12

Type 1 is characterised more by positive symptoms (those which are an addition to an individual’s behaviour) e.g. visual or auditory hallucinations or delusions of grandeur. Generally with this type of SZ, there are better prospects for recovery.

Question 13

What is Type 2 Syndrome

Answer 13

Type 2 is characterised more by negative symptoms e.g. loss of appropriate emotion of poverty of speech. Generally with this type of SZ, there are poorer prospects for recovery.

Question 14

What are positive symptoms (general)

Answer 14

Positive symptoms are those that appear to reflect an excess or distortion of normal functions.

Question 15

What are negative symptoms (general)

Answer 15

Negative symptoms of SZ are those that appear to reflect a reduction or loss of normal functions which often persist even during periods of low (or absent) positive symptoms.

Question 16

What are the 4 positive symptoms of Schizophrenia

Answer 16

Hallucinations, Delusions, Disorganised Speech, Grossly Disorganised or Catatonic behaviour

Question 17

What are hallucinations

Answer 17

Hallucinations are sensory experiences of stimuli that have either no basis in reality or are distorted perceptions of things that are there.

Question 18

What are the types of Hallucinations

Answer 18

Auditory, Visual, Olfactory and Textile

Question 19

What are Delusions

Answer 19

Delusions (also known as paranoia) are irrational, bizarre beliefs that seem real to the person with SZ. These can take a range of forms. Common delusions involve being an important historical, religious or political figure such as Jesus or Napoleon.

Question 20

What is Disorganised Speech

Answer 20

Disorganised Speech is where the individual has problems organising his or her thoughts and this shows up in their speech. They may slip from one topic to another (derailment), even in mid-sentence, and in extreme cases their speech may be so incoherent that it sounds like complete gibberish – this is often referred to as ‘word salad’.

Question 21

What is Grossly Disorganised or Catatonic Behaviour

Answer 21

This includes the inability or motivation to initiate or even complete a task – this can lead to problems of personal hygiene or the person could be over active and doing loads of different activities simultaneously.

Question 22

What are the 4 negative symptoms of Schizophrenia

Answer 22

Speech Poverty, Avolition, Affective Flattening and Anhedonia

Question 23

What is Speech Poverty

Answer 23

The reduction in the amount and quality of speech. This is sometimes accompanied by a delay in the sufferer’s verbal responses during conversation. Speech poverty may also be reflected in less complex syntax, e.g. fewer clauses, shorter utterances, etc.

Question 24

What is Avolition

Answer 24

Finding it difficult to begin or keep up with goal-directed activity, i.e. actions performed in order to achieve a result. Sufferers of SZ often have sharply reduced motivation to carry out a range of activities.

Question 25

What is Affective Flattening

Answer 25

A reduction in the range and intensity of emotional expression, including facial expression, voice tone, eye contact and body language. Individuals who are schizophrenic have fewer body and facial movements and smiles, and less co-verbal behaviour.

Question 26

What is Anhedonia

Answer 26

A loss of interest or pleasure in all or most activities, or a lack of reactivity to normally pleasurable stimuli. There are two types Physical Anhedonia and Social Anhedonia

Question 27

What are the 6 Issues Associated with the Classification and Diagnosis of Schizophrenia

Answer 27

Reliability, Validity, Co-morbidity, Symptom Overlap, Gender Bias and Cultural Bias

Question 28

Reliability in the Classification and Diagnosis of Schizophrenia

Answer 28

Whaley (2001) found the interrater reliability between diagnosticians as low as +0.11 (using the DSM). Another more recent study that also showed low inter-rater reliability amongst diagnosticians was carried out by Cheniaux et al (2009). In this study, they had two psychiatrists independently diagnose 100 schizophrenic patients using both ICD and DSM criteria. Inter-rater reliability was poor with one psychiatrist diagnosing 26 with SZ according to DSM and 44 according to ICD and the other psychiatrist diagnosing 13 according to DSM and 24 according to ICD. This poor reliability is a weakness of diagnosis of SZ

Question 29

Validity in the Classification and Diagnosis of Schizophrenia

Answer 29

According to Cheniaux’s study we can see the SZ is much more likely to be diagnosed using ICD than DSM suggesting that SZ is either over diagnosed in ICD and under diagnosed in DSM. Either way, this problem is a sign of poor validity

Question 30

Co-morbidity in the Classification and Diagnosis of Schizophrenia

Answer 30

The idea that two or more mental disorders (or conditions) occur together at the same time with the same person. If this is the case, then we can question the validity of diagnosis for schizophrenia. Infact, schizophrenia is commonly diagnosed with other conditions.

Buckley et al. (2009) 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.

Question 31

Symptom Overlap in the Classification and Diagnosis of Schizophrenia

Answer 31

This means that there is considerable overlap between the symptoms of SZ and other conditions such as depression and bipolar disorders. For example, a person can show a symptom of SZ and this symptom will also be in another disorder.

For example, Ellason and Ross (1995) point out that people with DID (Dissociative Identity Disorder) actually having more schizophrenic symptoms than people 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 (Read, 2004)

Question 32

Gender Bias in the Classification and Diagnosis of Schizophrenia

Answer 32

Longenecker et al (2010) reviewed SZ studies since the 1980s and found men more likely to be diagnosed than women. Is it because men more genetically vulnerable than women? There could be a gender bias in diagnosis as women seem to function better than men having good family relationships and more likely to work (Cotton 2009). Therefore it is less likely to be diagnosed with SZ because women showing better interpersonal function than men.

Question 33

Cultural Bias in the Classification and Diagnosis of Schizophrenia

Answer 33

It may be because positive symptoms of SZ such as auditory hallucinations may be acceptable in Africa because of cultural beliefs in communication with ancestors (e.g. hearing their dead ancestors talking to them) which are acceptable and not warranted to a diagnosis in Africa (as SZ rates low in Africa). However in the UK, this is more likely to be seen as a positive symptom of SZ.

Question 34

What are the 2 advantages of the Classification and Diagnosis of Schizophrenia

Answer 34

Communication Shorthand and Treatment

Question 35

Communication Shorthand in the Classification and Diagnosis of Schizophrenia

Answer 35

A patient with a mental disorder often has numerous symptoms. It is simpler to incorporate these symptoms into a single diagnosis and this makes communication between mental health professionals much easier

Question 36

Treatment in the Classification and Diagnosis of Schizophrenia

Answer 36

Treatments are often specific to certain disorders e.g. symptoms of schizophrenia respond well to certain anti-psychotic drugs but not anti-anxiety. A reliable diagnosis can point to a therapy that will alleviate symptoms.