Schizophrenia Flashcards
What type of disorder is Schizophrenia?
Psychotic
Positive symptoms of schizophrenia
Hallucinations: unusual sensory experiences; can be auditory, visual etc.
Delusions: irrational beliefs, including paranoia, delusions of persecution, delusions of grandeur
Speech disorganisation: incoherent speech, changes of topic mid sentence.
Negative symptoms of schizophrenia
Avolition: difficulty in beginning or keeping up with goal-directed activity, reduced motivation.
Speech poverty: reduced amount and quality of speech, delay in response during conversation.
Validity of diagnosis
the extent to which we are measuring what we intend to measure, in the context of schizophrenia, can we correctly diagnose it when it occurs
Reliability of diagnosis
refers to consistency, if two clinicians saw the same patient, would they draw the same conclusion and give the same diagnosis
Rosenhan: Aim
investigate whether the sane can be distinguished from the insane
Rosenhan Sample: study one
8 pseudopatients, age 20+, included Rosenhan.
Variety of professions, 3F, 5M.
Used false names and professions
Rosenhan’s involvement was known only to the hospital administrator and chief psychologist.
Rosenhan method: study one
Pseudopatients sought admission to a hospital, claiming to hear unfamiliar voices of their sex saying words like ‘empty’ and ‘hollow’. They had to convince staff they were sane. They behaved ‘normally’, indicated no symptoms, and were co-operative. In four hospitals, they observed staff responses to ‘when am I likely to be discharged?’
Rosenhan results: study one
All were successfully admitted, and not detected by staff in the hospitals. All but one received diagnoses of schizophrenia, and were discharged with a diagnosis of ‘schizophrenia in remission’. Experience was negative and unpleasant. Hospital staff avoided interaction with patients. Most individuals experienced depersonalisation and powerlessness
Rosenhan sample: study two
Psychiatric staff at a teaching hospital, judgements were made on 193 patients
Rosenhan method: study two
Staff were told that over 3 months, one or more pseudopatients would attempt to gain admission. Each staff member rated each patient, on a 10 point scale according to the likelihood that the patient was an imposter
Rosenhan results: study two
41 patients were rated with high confidence to be pseudopatients by at least one member of the staff. No pseudopatients actually presented themselves to the hospital.
Cheniaux et al (2009)
Two psychiatrists independently diagnosed 100 patients using both the DSM and the ICD criteria
Psychiatrist one diagnosed 26 under the DSM and 44 under the ICD
Psychiatrist two diagnosed 13 under the DSM and 24 under the ICD
This implies that diagnosis is not reliable, between clinicians or between systems
Implies that the systems are not valid, either the DSM is underdiagnosing or the ICD is overdiagnosing
They’re reviewed as we gain knowledge, helps clinicians to have clarity and accuracy in diagnosis
Jacobson et al (2005)
100 Danish patients with a history of psychosis were assessed using the criteria in the ICD-10; 98% concordance rate was found between clinicians.
Soderberg et al (2005)
81 raters from various psychiatric outpatient clinics rated eight case vignettes using the DSM-IV; 81% concordance rate was found.
