Paper 3 - Schizophrenia - Diagnosis And Classifications Flashcards
What is the “split in schizophrenia”?
between as person’s processes and reality
What % of the population have schizophrenia?
1% of population have a diagnosis of schizophrenia
How many people have schizophrenia world wide?
Between 24 million and 55 million worldwide
What is a surprising fact about schizophrenia?
Schizophrenia is the most common psychosis mental disorder accounting for 50% of all mental health
What term is used to describe a “schizophrenia phase thingy”?
Psychosis
Define psychosis?
Psychosis - a term used to describe a severe mental health problem where the individual looses contact with reality
What do the stats say about people after experiencing psychosis?
About 25% of sufferers will get better after only 1 episode of the illness; 50-65% will improve but continue to. Have bouts of the illness. The reminder will have persistent difficulties. (Was suggested by a study)
What are the 2 classifications used with schizophrenia?
ICD 10
DSM V
What is the ICD 10?
This is the international classification of the cause of disease and death (WHO)
What is the DSM V?
Diagnostic and statistical manual of mental disorder (american psychiatric associations)
Which criteria has sub categories?
ICD
How many different sub categories are there in the ICD 10?
5
What are the different sub categories in the ICS?
………………………….Schizophrenia
Disorganised
Catatonic
Paranoid
Undifferentiated
Residual
Explain Disorganised Schizophrenia?
The patients behaviour is generally disorganised and not goal directed.
Symptoms include thoughts disturbances (including delusions and hallucinations), an absence of expressed emotion, incoherent speech, large mood swings and a loss in interest in life - social withdrawal
This type of schizophrenia is usually diagnosed in adolescent or young adulthood
Explain Catatonic Schizophrenia
The patient has sever motor abnormalities such as
unusual gestures or use of body language.
Sometimes patients gesture repeatable using complex sequences of fingers, hand and arm movements which appear to have some meaning for them.
This classification often involves doing opposite to what is being asked
repeating everything that is said.
The main feature is almost total immobility for hours at a time, with the patient simply staring blankly
It can be split into Echolalia or Echopraxia
Echolalia
The involuntary imitations or repetitions are parrot like echoing of words or phrases just spoken by another person
Echopraxia
The involuntary imitation or repetition is of body movements of another person
Explain Paranoid Schizophrenia?
This type involves delusions of various kinds (persecution and grandeur) however, the patient remains emotionally responsive. They are more alert than patients with other types of schizophrenia.
People who are diagnoses with paranoid schizophrenia tend to be argumentative
Explain Undifferentiated Schizophrenia
This is a broad category which includes patients who don’t clearly belong within any other category. They show symptoms of schizophrenia but don’t fit into any of the other categories
Explain Residual Schizophrenia?
This is the category that 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 their own category. This type consists of patients who are experiencing mild symptoms.
What are the symptoms of disorganised schizophrenia?
Symptoms include thoughts disturbances (including delusions and hallucinations), an absence of expressed emotion, incoherent speech, large mood swings and a loss in interest in life - social withdrawal
What are the main symptoms of Catatonic Schizophrenia?
Sever motor abnormalities such as unusual gestures or use of body language. Sometimes patients gesture repeatable using complex sequences of fingers, hand and arm movements which appear to have some meaning for them.
The main feature is almost total immobility for hours at a time, with the patient simply staring blankly
What is the main feature of Residual Schizophrenia?
Had an episode of psychosis in the last 6 months but is otherwise fine
What are the 2 sub categories of Catatonic Schizophrenia?
Echolalia
Echopraxia
What is Echolalia?
A sub category of Catatonic Schizophrenia where the involuntary imitations or repetitions are parrot like echoing of words or phrases just spoken by another person
What is Echopraxia?
A sub category of Catatonic Schizophrenia where the involuntary imitation or repetition is of body movements of their own invention or mirroring of another person
What do the different criteria of the DSM V look for?
Criterion A - Symptoms
Criterion B - Social/Occupational Dysfunction
Criterion C - Duration
Explain Criterion A for the DSM V?
Two (or more) of the following symptoms:
a) Delusions
b) Hallucinations
c) Disorganised Speech (e.g. frequent derailment or incoherence)
d) Grossly disorganised or catatonic behaviour
e) Negative symptoms i.e. affective flattening, alogia or avolition.
Note: Only one criterion A symptom is required if delusions are bizarre or hallucinations consist of a voice keeping up a running commentary on the person’s behaviour or thoughts, or two or more voices conversing with each other.
Explain Criterion B of the DSM V?
For a significant portion of the time since onset, one or more major areas of functioning such as work, interpersonal relations or self-care are markedly below the level achieved prior to onset.
Explain Criterion C in the DSM V?
Continuous signs of disturbance persist for at least 6 months.
This 6-month period must include at least 1 month of symptoms (or less if successfully treated) that meet Criterion A.
During non-active periods, disturbance may be limited to negative symptoms or two or more symptoms in Criterion A in attenuated form (e.g. odd beliefs, unusual perceptual experiences).
What are positive symptoms?
Less frequent symptoms of Schizophrenia?
What are negative symptoms of Schizophrenia?
More common symptoms
What are secondary symptoms of Schizophrenia?
Symptoms that are a result of the Schizophrenia
Are positive, negative and secondary symptoms to do with the ICD 10 ir the DSM V?
Both
When was the mental health act
1983
What does the mental health act allow to happen?
Why?
Forced admission to hospital (sectioning) and forced medication (with no consent) if their health is at risk or if they are a danger to themselves or others
Why: Someone with schizophrenia may not realise that they are ill and refuse treatment
What are the negative evaluations of the Classifications of Schizophrenia?
Lack of validity
Comorbidity affects reliability and validity
Symptom overlap
Explain the evaluation of the Classifications of Schizophrenia: Lack of Validity
• The diagnosis of schizophrenia lacks validity, as psychiatrists cannot distinguish between real and pseudo-patients. (Being sane in insane places)
• Being diagnosed with schizophrenia is a ‘sticky label’ – difficult to remove, with serious consequences – and yet it is manufactured by psychiatrists with low degrees of accuracy.
Being sane in insane places was a study where participants went into psychiatric hospitals pretending to be insane to show how patients were being mistreated
Explain the evaluation of the Classifications of Schizophrenia: Comorbidity
Comorbidity is the occurrence of 2 illnesses or conditions occurring simultaneously
This can create a problem with reliability of diagnosis as there may b confusion over which disorder to diagnose
There are stats on a different FC
Comorbidity raises the issue of descriptive validity as having simultaneous diagnosis suggests that schizophrenia may not be a distinct disorder
Explain the evaluation of the Classifications of Schizophrenia: Symptom Overlap
There is a considerable overlap of symptoms of schizophrenia
For example both schizophrenia and bi polar disorder
This questions the validity of many diagnosis
Symptoms of bi polar:
Agitation or iritation
Elevated mood
Racing thoughts
Low mood
Withdrawal
What are the stats to do with Comorbidity?
Given that the patient has a diagnosis of schizophrenia:
50% also had a diagnosis of depression
47% substance abuse
29% PTSD
23% OCD
What are the negative evaluations of the Diagnosis of Schizophrenia?
Reliability and Consistency of Schizophrenia
Accuracy of Diagnosis
Gender Bias
Cultural Bias
What are the positive evaluations of Diagnosing Schizophrenia?
Reliability and the consistency of Diagnosis’
Explain the negative evaluation of Diagnosing Schizophrenia: Reliability and the Consistency of Diagnosis’
• An important measure of reliability is inter-rater reliability
• In relation to diagnosis, this means that different clinicians
make identical, independent diagnosis of the same patient
• Cheniaux et al. (2009) had two psychiatrists independently
diagnose 100 patients using both DSM and ICD criteria.
They found poor inter-rater reliability with psychiatrist 2 diagnosis only half of what psychiatrist diagnosed. They also found that psychiatrists diagnosed more often when using the ICD criteria rather than the DSM criteria
Explain the positive evaluation of Diagnosing Schizophrenia: Reliability and the Consistency of Diagnosis’
• Even if reliability of diagnosis based on classification systems is not perfect, they do provide practitioners with a common language, permitting communication of research ideas and findings, which may ultimately lead to a better understanding of the disorder and the development of better treatments
• Evidence does generally suggest that reliability of diagnoses has improved as classifications systems have been updated
Explain the negative evaluation of the Diagnosis of Schizophrenia: Accuracy of Diagnosis’?
• Evidence from the Cheniaux et al. (2009) study suggests that it is much more likely to be diagnosed using ICD rather than DSM
• This suggests that schizophrenia is either over-diagnosed in ICD or under diagnosed in DSM
So it lacks Criterion validity
What is criterion validity?
• An important measure of validity for criteria is criterion (concrete) validity: which is the fact that different criteria should have the same diagnosis rates or arive at the same conclusions
Explain the negative evaluation for Schizophrenia: Gender Bias
• Longenecker et al. (2010)- since 1980 men have been diagnosed with schizophrenia more often than women.
• Men are more genetically vulnerable to developing the disorder
• Gender bias: Loring and Powell (1988) – 290 psychiatrists were asked to diagnosis two patients with the same symptoms
• Cotton et al. (2009) – female patients typically function better than male patients. (better interpersonal functioning)
If women are under-diagnosed then this suggests that the validity of the diagnosis of schizophrenia is poor, because the procedures for diagnosis work well only on patients of one gender.
Explain the negative evaluation for Schizophrenia: Cultural Bias
• African Americans and English people of Afro-Caribbean origin are several times more likely than white people to be diagnosed with schizophrenia
• This suggests that the validity of the diagnosis is poor because either it is confounded by cultural beliefs and behaviours in patients, or by a racist distrust of black patients on the part of mental health practitioners (Escobar, 2012).
• Whaley (2004) believes the main reason for the incidence of schizophrenia among black Americans (2.1%) being greater than among white Americans (1.4%) is cultural bias, where ethnic differences in symptom expression are overlooked or misinterpreted by practitioners.
• Copeland et al. (1971) – 69% of American psychiatrists diagnosed a patient as having schizophrenia compared with 2% of British psychiatrists.
What are the positive symptoms of schizophrenia?
Hallucinations
Delusions
Disorganised speech or catatonic behaviour
What are the secondary symptoms of schizophrenia?
Depression
Loss of employment
Breakdown of relationships
What are the negative symptoms of schizophrenia?
Speech poverty
Avolition - putting of tasks
Andivonia - lack of motivation and pleasure
Poor self care eg sleep and eating schedule
