Schizophrenia Flashcards
What is schizophrenia?
A type of psychosis, a severe mental disorder characterised by a profound disruption of cognition and emotion so that contact with external reality and insight are impaired.
How common is schizophrenia?
It is the most common psychotic disorder, affecting 1% of the population at some point in their lifetime.
Who is most commonly diagnosed with schziophrenia?
Mostly commonly diagnosed in males, city-dwellers and lower socio-economic groups.
When does schizophrenia usually occur?
Can occur at any time in life, but usually occurs late in adolescence or early in adulthood. The peak of incidence onset is 25-30 years.
How many people recover?
Its been estimated that no more than 1 in 5 individuals recover completely, even with treatments available that can relieve many symptoms.
What is classification?
Organising symptoms into categories based on which symptoms cluster together in sufferers i.e. what are the symptoms of schizophrenia?
What is diagnosis?
Deciding whether someone has a particular mental illness using the classifications.
How can the characteristics schizophrenia affect someone?
Can affect a person’s langauge, thought, perception, emotions and even their sense of self.
What are the types of symptoms of schizophrenia?
Positive and negative symptoms
What are positive symptoms?
Atypical symptoms experinced in addition to normal experiences (an excess of normal functioning). These include hallucinations and delusions.
What are negative symptoms?
Atypical experiences that represent the loss of usual experience (a diminution or loss of normal functioning). These include avolition and speech poverty.
What are hallucinations?
Disturbances to perceptions in any of the senses. They are false sensory perceptions that either have no basis in reality or are distorted perceptions of things that are.
What are the most common type of hallucinations?
The most common are auditory hallucinations (hearing voices). Many schizophrenics report hearing voices or seeing people, telling them to do something (e.g. harm themselves or others) or commenting on their behaviour.
What are delusions?
Firmly held irrational beliefs that have no basis in reality.
What is a common type of delusions?
Delusions of control- the belief that their body is under external control e.g. being controlled by aliens or the government (e.g. have implanted radio transmitters)
What is avolition?
A lack of purposeful willed behaviour. It is the reduction, difficulty or inability to start and continue with goal-directed behaviour i.e. actions performed to achieve a result. People with schizophrenia often have a sharply reduced motivation to carry out a range of activities and results in lowered activity levels. E.g. no longer being interested in going out and meeting friends, poor hygiene and grooming, lack of persistence in work or education, siting in the house every day doing nothing.
What is speech poverty?
Limited speech output with limited, often repetitive content. It involves reduced frequency (amount) and quality of speech. This is sometimes accompanied by the delay in sufferer’s verbal responses during conversation. It’s not that they don’t know the words, but that they have difficulty in spontaneously producing them.
What are the two major systems for classifying schizophrenia and where are they used?
The World Health Organisation’s International Classification of Disease edition 10 (ICD-10) and the American Psychiatric Association’s Diagnostic and Stastical Manual edition 5 (DSM-5).
The ICD-10 is mainly used in Europe and the DSM-5 is mostly used in the USA.
According to the DSM-5 system, what symptoms does someone need to have to be diagnosed with schizophrenia?
Two of the positive symptoms must be present for diagnosis, but only if the delusions are bizarre or hallucinations consist if a voice keeping up a running commentary on the person’s behaviour or thoughts, or two or more voices conversing together. There must be continuous signs of disturbance for at least 1 month. For a significant portion of time, one or more major areas of functioning such as work, interpersonal relations or self-care must be markedly below the level achieved prior to onset.
According to the ICD-10 system, what symptoms does someone need to have to be diagnosed with schizophrenia?
Two or more negative symptoms are sufficient for diagnosis or one positive symptom.
Why are there no longer subtypes of schizophrenia recognised in classification systems?
The ICD-10 and DSM have both dropped subtypes of schizophrenia (e.g. paranoid schizophrenia, which is characterised by powerful hallucinations and delusions but relatively few other symptoms) because they tended to be inconscient.
What is reliability (in terms of diagnosis of schizophrenia)?
Reliability is the level of agreement (consistency) on the diagnosis of schizophrenia by different psychiatrists (inter-rate reliability) across time (test-retest reliability) and cultures. It is also the stability of diagnosis over time given no changes in symptoms.
What did Osario et al (2019) find about the reliability of diagnosis of schizophrenia?
Found that inter-rater reliability of +0.97 and test-retest reliability of +0.92 for the DSM5 suggesting the diagnosis of schziophrenia is consistency applied.
What is validity in terms of diagnosis and classifications of schizophrenia?
The extent to which schizophrenia is a unqiue syndrome with unique charateristics, signs and symptoms.
Classification- Are the symptoms of schizophrenia unqiue enough that we can distinguish them from other mental health problems?
Diagnosis- If we diagnosis someone with schizophrenia, do they actually have it?
What is symptom overlap?
When there is an overlap between symptoms of schziophrenia and other conditions. For example, schziophrenia and bipolar disorder share positive symptoms like hallucinations and delusions. The lack of distinction calls into question the validity of the classification and diagnosis of schizophrenia as a unique syndrome with its own charateristics, signs and symptoms.
Evaluation: Symptom overlap: What did Ketter (2005) point out?
Points out that misdiagnosis due to symptom overlap can lead to years of delay in recieving relevant treatment, during which time suffering and further degeneration can occur, as well as high levels of suicide- so symptom overlap can have serious consqeunces. Focusing on this issue could save money and lives.
Evaluation: Symptom overlap: What does Ketter’s point suggest about the validity of classification and/or diagnosis of schizophrenia?
This calls into question the validity of classification and diagnosis of schizophrenia. In terms of classification, if a number of mental illnesses share many symptoms, schizophrenia does not have enough unqiue characteristics, signs and symptoms to be easily distinguished from other mental health problems, and so it may lack external validity as a seperate condition. This then impacts the validity of diagnosis as if clinicals cannot easily distinguish between schizophrenia and other mental illnesses, people may be misdiagnosed with other conditions when they have schizophrenia. This then has serious consquences for patients with schziophrenia and so suggests symptom overlap is a significant issue impacting the validity of classification and diagnosis of schizophrenia.
Evaluation: Symptom overlap: What did Serper et al (1999) do?
Assessed pateints with co-morbid schizophrenia and cocaine abuse, cocaine intoxication on its own and schizophrenia on its own. They found that despite there being a considerable symptom overlap in pateints with schizophrenia and cocaine abuse, it was actually possible to make accurate diagnoses.
Evaluation: Symptom overlap: What does Serper et al’s findings suggest about the validity of classification and/or diagnosis of schizophrenia?
This suggests that symptom overlap did not affect the validity of the diagnosis and clinicians can tell the differnece between the illnesses. Therefore this suggests that symptom overlap may not be as significant an issue as previously thought because schizophrenia has enough unique characteristics, signs and symptoms to be valid as a seperate condition and so be accurately diagnosed.
What is co-morbidity?
Refers to the extent that two or more conditions occur together. Co-morbidities are common among patients with schizophrenia e.g. substance abuse, anxiety and depression. Where two conditions are frequently diagnosed together, it calls into question the validity of the classification and diagnosis of both illnesses.
How does co-morbidity affect classification and diagnosis?
In terms of diagnosis, if many pateints are diagnosed with both conditions, psychiatrists may not be able to tell the difference between the two conditions. In terms of classification, it may be that if one illness (e.g. serve depression) looks a lot like schizophrenia and vice versa, they might be better seen as a single condition.
Evaluation: Co-morbidity: What did Buckley et al. (2019) conclude?
They concluded around half of patients with a diagnosis of schizophrenia also have a diagnosis of depression (50%) or substance abuse (47%). PTSD also occured in 29% of cases and OCD in 23%.
Evaluation: Co-morbidity: What did Buckley et al.’s conclusion suggest about the validity of classification and/or diagnosis of schizophrenia?
This calls into question the validity of classification and diagnosis of both illnesses. In terms of diagnosis, if many pateints are diagnosed with both conditions, psychiatrists may not be able to tell the difference between the two conditions. This suggests that schizophrenia may not be a syndroyme with unqiue symptoms and charcteristics and so it may be that if one illness (e.g. severe depression) looks a lot like schziophrenia and vice versa, they might be better seen as a single condition, implying that they lack validity as seperate conditions. This could have implications such as patients being diagnosed with schizophrenia when they have depression leading to inappropriate treatments, as well as patients being stigmatised due to being labelled as schizophrenic. This may even impact their job prospects and relationships, exacerbating their depression (self-fufilling prophecy).
What is cultural bias?
The tendency to interpret all phenomena through the lens of one’s own culture, ignoring the effects that cultural differences might have on behaviour.
Why is cultural bias an issue for diagnosis?
Cultural bias is an issue for diagnosing schizophrenia, because psychiatrists may ignore cultural differences between them and their patient, and only consider the symptoms through their own culture. This is a problem for the validity of diagnosing schizophrenia, because they may not be diagnosing people who have schizophrenia correctly.
Evaluation: Cultural bias: What did Escobar (2012) point out?
Pointed out that White psychiatrists may tend to over-interpret the symptoms of Black people during diagnosis. Such factors as cultural differences in language and mannerisms, difficulties in relating between black pateints and white therapists, and the myth that black people rarely suffer from affective disorders may be causing this problem. Therefore clinicians and researchers must pay more attention to the effects of cultural differences on diagnosis.
Evaluation: Cultural bias: What does Escobar’s point suggest about the relaibility of classification and/or diagnosis of schizophrenia?
This calls into question the reliability of the diagnoses of schziophrenia as there doesn’t seen to be agreement on the diagnosis of schizophrenia by psychiatrists across cultures as there isn’t consistent diagnoses. Additionaly, it questions the validity of diagnoses of schziophrenia as it suggests psychiatrists may be imposing their own cultural standards for schziophrenia when diagnosing patients and so they may be misinterpreting symptoms and mislabelling behaviour as symptoms of schizophrenia.
What is gender bias?
A tendency to treat one individual or group in a different way from others (it may not present the experince or behaviour of one of the genders).
When does gender bias occur in the diagnosis of schizophrenia?
Said to occur when the accuracy of diagnosis is dependent on the gender of the individual. This may be due to gender-biased diagnostic criteria or clinicians basing their judgements on stereotypical beliefs held about gender.
Evaluation: Gender bias: What did Loring and Powell (1988) do?
Randomly selected 290 male and female psychiatrists to read two case articles of patients’ behaviour and the asked them to offer their judgement on these individuals using standard diagnostic criteria. When patients were described as ‘male’ or no information was given about gender, 56% were given a diagnosis of schziophrenia. However, when patients were described as being ‘female’, only 20% were given a diagnosis of schziophrenia. This suggests that there is a gender bias in the diagnosis of schizophrenia which calls into question its validity. This gender bias did not appear to be evident amongst female psychiatrists.
Evaluation: Gender bias: What did Loring and Powell’s findings suggest about the reliability and validity of diagnosis of schizophrenia?
Suggests that the diagnosis is influenced not only by gender of the patient but also the gender of the clinician. This calls into question the reliability of the diagnosis of schizophrenia because if patients are seen by different clinicians, they may recieve differnet diagnoses and therefore the diagnoses lack inter-rater reliability. It also questions the validity of the diagnoses of schizophrenia as it suggests that schizophrenia may not accurately be diagnosed when gender bias is present.
What do biological explanations emphasise?
The role of inherited factors and dysfunction of brain activity in the development of schizophrenia.
What are the two main biological explanations of schizophrenia?
Genetics and neural correlates
Biological explanations: Genetics: What is there considerable evidence of?
That schizophrenia runs in families and is in part genetic (inherited- as genes are transmitted from parent to child).
Biological explanations: Genetics: What is an example of schizophrenia being genetic?
For example, Gottesman (1991) conducted a large-scale study and found much higher concordence rates in MZ twins (48%) in comparsion to DZ twins (17%). This suggests that individuals with identical genetic make-up (MZ twins) have an increased chance if developing schizophrenia comapred to those sharing fewer genes, suggesting that there is an association between the degree of genetic similarity and shared risk of schizophrenia.
Biological explanations: Genetics: What is schizophrenia thought to be?
Polygenic (it requires a number of different genes to work in combination) and so different combinations of genes can lead to the condition. The most likely genes are those coding for neurotransmitters such as dopamine.
Biological explanations: Genetics: How many different genetic variations are associated with the increased risk of schizophrenia?
Reserach suggests 108
Biological explanations: Genetics: How else can schizophrenia also have a genetic origin?
Through the mutation of parental DNA by radiation, poison or viral infection.
