paper 3- schizophrenia

Question 1

what is schizophrenia?

Answer 1

schizophrenia is a serve long term health condition and causes a wide range of different psychological symptoms.

Question 2

name some facts about schizophrenia

Answer 2

> Doctors often describe schizophrenia(SZ) as a type of psychosis(out of reality)
Stigma, discrimination and violation of human rights of people with sz is common.
Men and women are equally likely to get Sz, but men tend to get it more earlier.

Question 3

Define both positive and negative symptoms ( in terms of Sz)

Answer 3

Positives symptoms reflect an excess of normal function ( e.g hallucinations, delusions) and negative symptoms refer a absence of normal behavior to motivate or interest (e.g avolition , speech poverty)

Question 4

What are the positive symptoms of Schizophrenia

Answer 4

-Hallucinations- experiencing something that isn’t real, this can be visual or auditory
-Delusions- irrational thoughts/ beliefs

Question 5

What are the negative symptoms of schizophrenia?

Answer 5

-Avolition,lack of motivation and unable to complete tasks or activities
-Speech poverty, changes in speech, often lack conservation.
↳ Can include other symptoms such as echolalia( repetitive words ), neologism( creating new words) and word salads(disorganized speech).

Question 6

Outline the diagnosis of the schizophrenia

Answer 6

Schizophrenia does not have one defining characteristic. It is a cluster of symptoms and such as can be very difficult to diagnose. BUT there are two main ways that SZ is classified, which is the DSM and ICD.

Question 7

Outline the DSM

Answer 7

DSM- APA’s diagnostic and statistical Manual of mental health disorders.
The DSM only includes mental disorders and tends to be in Australia and USA. The latest version has been removed subtypes. To be classified the patient should at least one positive symptom.

Question 8

Outline the ICD

Answer 8

ICD-Who’s the international classification of diseases.
The ICD includes all medical disorders and tends to be in Europe. ICD mainly focuses on the use of subtypes to classify and patients needs only present 2 negative symptoms to be classified with Sz

Question 9

What are the problems with classification and diagnosis of schizophrenia?

Answer 9

Reliability and Validity

Question 10

Define reliability and reliability in context of Sz

Answer 10

Reliability refers to how consistent the finding from a investigation or measuring device are.
Reliability in context of Sz, refers to the consistency of diagnosis, between patient and between the making the diagnosis.

Question 11

Chieniaux Et Al (2009)- reliability

Answer 11

Chieniaux et al (2009) investigated the reliability of Sz diagnosis.
100 patients were diagnosed by different psychiatrists using both DSM and ICD.

the results: results shows poor reliability.
One psychiatrist diagnosed 26 Patients according to the DSM and 44 according to the ICD, while other psychiatrists diagnosed 13 from the DSM and 24 from ICD.

This shows low reliability because there is no consistency of the diagnosis of Sz made by the psychiatrist. One set of results is significantly higher than the other diagnosis, this means if the results were reliable, the results of diagnosis would be similar in numbers. But clearly seen here, this is not the case as the sets of results are very different due to a big gap in the numbers of diagnosis

Question 12

Define validity and define validity in context of Sz

Answer 12

Validity is the extent to which we are measuring what we intent to do.
Validity in context of Sz is a psychiatrist accurately diagnosing Sz or mistaking it with another (similar) illness?

Question 13

What is criterion validity?

Answer 13

The extent to which different assessment systems arrive the same diagnosis for the same patient.

Question 14

What are the 4 validity issues?

Answer 14

Firstly, the diagnosis of Sz suffers from numbers of validity issues, including:
-co-morbidity
-symptoms overlap
-gender bias
-cultural bias

Question 15

Co-morbidity

Answer 15

Co- morbidity is the extent to which two or more conditions occur together, calling into questioning the validity of diagnosis.
The phenomenon (occurrence) that two or more conditions occur together
As there might be a singular condition.

Question 16

Buckley et al (2009) - co morbidity

Answer 16

Buckley et al (2009)found that around half of all patients diagnosed with Schizophrenia also had a diagnosis of depression. This factor called into question the ability to tell the difference between the two conditions and diagnose accurately.
It could be that very serve depression can present as Sz because it looks like it.

Question 17

Symptom overlap

Answer 17

Symptom overlap refers to the extent to which the symptoms of one disorder are also presented in a different disorder. A misdiagnosis is possible from this.
For example, schizophrenia and bipolar disorder both include symptoms such as delusions and avolition.
Also this calls into question the ability to accurately diagnose specific conditions as doctors may not agree with one disorder.
Under ICD, a patient may be diagnosed with schizophrenia, while under the DSM, the might be classified with bipolar disorder. This might even mean that two are actually the same disorder.

Question 18

Gender bias

Answer 18

Men and women not being treated equally.
Gender bias in the diagnosis of schizophrenia is said to occur when the accuracy of diagnosis on the gender of the individuals. This may be due to the gender biased diagnostic criteria of clinicians basing their judgements on stereotypical beliefs held about gender.

Question 19

Longenecker et al (2010) - gender bias

Answer 19

According to longnecker et al (2009), schizophrenia diagnosis might suffer from gender bias because of the disproportionate number of men is diagnosed with disorders in comparison to women.

Question 20

Cotten et al (2009)

Answer 20

While it could be more than men are diagnosed because they are generally vulnerable, it could also be because women are able to function better with the disorder than men.
According to Cotten et al (2009), female patients appear to continue with work and have a good family relationships. This is better interpersonal functioning might have lead to practitioners under diagnosing schizophrenia in women.

Question 21

Culture bias

Answer 21

Culture bias in diagnosis is when patients can display the same symptoms but receive different diagnoses because of their ethic background - difference in cultures.
For instance, African and AA more likely to develop Sz as they keep in contact with ancestors because it’s the ‘norm’ in their culture.
White psychologists may over interpret the symptoms.
Positive symptoms such as hearing voices are more acceptable in African and Indian cultures because of cultural beliefs in communicating with ancestors.
When reporting to a psychiatrist from a different cultural tradition, this may be seen as bizarre and irrational.

Question 22

Escobar (2012) supporting study for culture bias

Answer 22

Escobar (2012) has suggested that, because the physiatrics profession is dominated by white people, psychiatrists might over-interpret symptoms and distrusting the honesty of black people during diagnosis.

Question 23

Pinto et al (2017) - cultural bias

Answer 23

Pinto et al (2017) studied schizophrenia and other psychotic disorders in black Caribbean- born migrants and their descendants.
Research aim: To investigate the increased risk of sz in black Caribbean people and their descendants.
Research method: a mete analysis of database from 1930-2013.

Results: statistically significant elevated incident rates (rate of new cases) in the black Caribbean group were found, presented across all major psychotic disorders, including schizophrenia and bipolar disorder.
Conclusion: in the uk, black Caribbeans are more likely to be diagnosed with mental health illness than their white parts.

Evaluation:
Strengths- large sample, reliable evidence
Limitations- does not explain why, evidence of rasical bias in diagnosis

Question 24

Copeland et al (1971)- cultural bias

Answer 24

Copeland et al (1971) studied American psychologist diagnoses Vs British. The researchers wanted to investigate cultural variations on the diagnosis of Sz.

Method- in an experiment, Copeland gave 134 US and 194 British psychiatrists a description of a patient.
Results- 69% of the US psychiatrists diagnosed schizophrenia,but only 2% of the British psychiatrists gave the same diagnosis.
Conclusion- diagnosis of Sz is not very reliable between cultures.

Evaluation:
Strengths: shows that mental illness can be cultural construct.
Limitation: lacks ecological validity, giving diagnosis for, a description is different to seeing a patient in real life.

Question 25

Rosehan (1973)- study on pseudo patients, reliability

Answer 25

The aim of this study was to test the hypothesis that psychiatrists cannot reliably tell the difference between people who are mentally ill and those who are not.
The main study is an example of a field experiment( real word settings). The manipulation ( independent variable) was the made up symptoms of 8 pseudo patients( fake patients) and dependent variable was the psychiatrist admission and diagnostic label of the pseudo patient.
The study also involved participant observation, since, one admitted, the pseudo patients written records of how ward operated as well as how they personally treated. They telephoned hospitals for appointments and all reported the same symptoms, ‘ I hear a voice saying thud, empty or hollow.’

Question 26

What was Rosehan (1973) study on pseudo patients results?

Answer 26

All were admitted and all except one give a diagnosis of Sz. They remained in the hospital for 7-52 days ( average 19 days) . Visitors to the pseudo patients observed “no serious behavior consequences”. Although they were not detected by staff, many other patients suspected their sanity ( ability to think and behave in a normal manner) - 35 out of 118 patients voiced their suspections.
- Some patients voiced their suspicions very vigorously for example ‘ You’re not crazy. You’re a journalist or a professor. You’re checking up on the hospital’

Question 27

What were Rosehan (1973) study on pseudo patients conclusion and evaluation?

Answer 27

Conclusion:
-The study demonstrates both limitations of classification and importantly, the appalling conditions in many psychiatric hospitals. This has stimulated much further research and has lead to many institutions improving their philosophy care.

Evaluation:
Strengths- ecological validity, objective evidence from pseudo patients, qualitative and quantitative data, practical applications
Limitations- ethics, the pseudo patients experiences could differ from real patients as they know they were not mentally ill.

Question 28

Explain Psychological explanations

Answer 28

Psychological explanations focus on the psychological environment and abnormal cognition such as family relations, communication patterns and thought processes involve in the experience of Sz.

Question 29

Explain family dysfunction

Answer 29

Family dysfunction studies investigates the link between schizophrenia and childhood and adulthood experiences of living in a dysfunctional family.

Question 30

Name three prominent theories seek to expand on family dysfunction and the psychological explanations for schizophrenia.

Answer 30

• The schizophrenic mother
• The double bind theory
• Expressed emotion (EE)

Question 31

Family based explanations- Theory of expressed emotion (EE)

Answer 31

The theory of expressed emotions(EE) highlights the impact of negative enviroments ( hostile or critical) on schizophrenic patients.
This is a primary explanation of a relapse in Sz patients.
If family carers direct high level of negative express emotion towards the patient, this can place the patient in a great deal of stress.

Extra:
This refers to the amount of (usually negative) emotion expressed towards a patient by their carer.
-Verbal criticism of their patient, sometimes accompanied by violence.
- Hostility towards the patient including anger and rejection.
-Emotional over-involvement in the life of the patient including needless self sacrifice.

High levels are a serious source of stress for the patient. Although high levels sometimes triggers onset, it is more likely to be a cause for a relapse.

Question 32

EE- Vaughn and Leff (1967)

Answer 32

Households with high levels of expressed emotions significantly increase relapse rates in the hospitalisation of schizophrenic patients. This situation correlate to relapse in Sz patients after discharge. But stress might be a contributory factor in the initial onset of Sz.

Question 33

Family based explanations- the schizophrenic mother proposed by Reichmann(1948)

Answer 33

Reichmann (1948) proposed the theory of the schizophrenic mother.
This theory is based on reports from her own patients about their childhood and their relationship with their mothers.
Results: many of Reichmann patients spoke of COLD, REJECTING OR CONTROLLING mothers and a family climate characterized by tension and secrecy.
She referred to these mothers as schizophrenic, meaning schizophrenia causing.
Schizophrenic mothers leads to distrust that can later develop into PARANOID DELUSIONS and ultimately schizophrenia.

Question 34

Family based explanations- double bind theory proposed by Bateson et al (1972)

Answer 34

Bateson et al (1972) proposed the double blind theory.
They agreed with Reichmann (1948) that the family climate was a factor in the development of schizophrenia. But they placed greather emphasis on the role of communication patterns.

Bateson et al (1972) emphasis the role of communication style in families. The developing child receives mixed signals/ messages about what is they are doing wrong, ur are not able to communicate this and therefore feel trapped in this explanation.