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Schizophrenia Flashcards

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1
Q

Schizophrenia

A

Schizophrenia is a severe mental disorder characterised by a profound disconnection from reality, involving a disruption of cognition and emotion.

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2
Q

What aspects of functioning are affected by schizophrenia? (x4)

A
  • Language
  • Thought
  • Perception
  • Sense of self
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3
Q

At what age is schizophrenia typically diagnosed?

A

Between 15 and 35.

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4
Q

Who is more commonly affected by schizophrenia?

A

It is more commonly diagnosed in men, in cities, and in the working-class population.

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5
Q

How prevalent is schizophrenia?

A

Schizophrenia ranks among the top 10 causes of disability worldwide, and affects about 1% of the population at some point in their lives (Mathers et al, 1996).

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6
Q

What are positive symptoms?

A

Atypical symptoms experienced in addition to normal experiences.

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7
Q

What are negative symptoms?

A

Atypical symptoms that represent a loss to normal experiences.

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8
Q

What are the positive symptoms of schizophrenia? (x2)

A
  • Hallucinations
  • Delusions
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9
Q

What are the negative symptoms of schizophrenia? (x2)

A
  • Avolition
  • Speech poverty
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10
Q

What are hallucinations?

A
  • Unusual sensory perceptual experiences.
  • May or may not be related to events in the environment.
  • Voices heard either talking to or commenting on the sufferer, often criticising them.
  • Hallucinations can be experienced in relation to any sense (hearing, seeing, feeling, taste or touch).
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11
Q

What are delusions?

A

Irrational, bizarre beliefs that seem real to the person with schizophrenia.

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12
Q

What are the different forms of delusions? (x3)

A
  • Delusions of grandeur (e.g involve being an important historical, political or religious figure, such as Jesus or Napoleon).
  • Paranoid / persecutory delusions (being persecuted, perhaps by government or aliens or of having superpowers).
  • Delusions of reference (may believe they are under external control, or that the events in the environment are directly related to them, e.g personal messages through the TV).
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13
Q

What are the negative symptoms of schizophrenia? (x2)

A
  • Avolition
  • Speech poverty
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14
Q

What is avolition?

A

(Sometimes called apathy)
- Finding it difficult to begin or keep up with goal-directed activity (I.e actions performed in order to achieve a result).
- Andreason (1982) identified 3 identifying signs of avolition: poor hygiene and grooming, lack of persistence in work or education, lack of energy.

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15
Q

What is speech poverty (alogia)? (x4)

A
  • Lessening of speech fluency and productivity, reflecting slow or blocked thoughts.
  • Sometimes accompanied by a delay in the sufferer’s verbal responses during conversation.
  • In DSM-5 it is a positive symptom.
  • In ICD-10 it is a negative symptom.
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16
Q

What is a classification system?

A

A classification system collects the symptoms of a disorder.

17
Q

Which symptoms are required for an ICD-10 based diagnosis of schizophrenia and for how long?

A

2 or more negative symptoms for one month.

18
Q

Are positive symptoms required for an ICD-10 diagnosis?

A

Positive symptoms are not required.

19
Q

What are the ICD-10 subtypes of schizophrenia?

A
  • Paranoid (powerful delusions and hallucinations but few other symptoms).
  • Hebrephrenic (involved primarily negative symptoms).
  • Catatonic (involves disturbance to movement).
    (The ICD-11 no longer recognises subtypes).
20
Q

Which symptoms are required for a diagnosis of schizophrenia using DSM-5 and for how long?

A

2 or more of the following for at least one month, and at least one of them must be a positive symptom (1, 2 or 3).
1. Delusions
2. Hallucinations
3. Disorganised speech
4. Grossly disorganised or catatonic behaviour
5. Negative symptoms, such as diminished emotional expression

21
Q

What are the additional criteria for a schizophrenia diagnosis?

A
  1. Impairment in one of the main areas of functioning for a significant period of time since the onset of disturbance (work, interpersonal relations or self-care).
  2. Some signs of the disorder must last for a continuous period of at least 6 months.
  3. Schizoaffective disorder and bipolar or depressive disorder must be ruled out:
    - No major depressive or manic episodes occurred concurrently with active phase symptoms.
    - If mood episodes (depressive or manic) have occurred during active phase symptoms, they have been present for a minority of the total duration of the active and residual phases of the illness.
    - If there is a history of autism spectrum disorder, delusions or hallucinations (along with other symptoms) should be present for at least one month for a diagnosis to be made.
22
Q

What are the main differences between ICD-10 and DSM-5? (x2)

A
  • DSM-5 states that some signs must be present for 6 months, but ICD-10 states that one month is enough.
  • DSM-5 states that there must be one positive symptom, but ICD-10 states that 2 negative symptoms are enough.
23
Q

What is the impact of the differences in the classification systems?

A

This poses challenges with reliability and validity.

24
Q

What is reliability in relation to schizophrenia?

A

The extent to which the diagnosis of schizophrenia is consistent - the level of agreement between psychiatrists and diagnostic tools over time.

25
Q

What is inter-rater reliability in relation to schizophrenia?

A

The extent to which psychiatrists can agree on the same diagnosis when independently assessing patients.

26
Q

What is test-retest reliability in relation to schizophrenia?

A

The same diagnostic tool should assess patients with the same diagnosis over a period of time.

27
Q

What is validity in relation to schizophrenia?

A

The extent to which a diagnosis represents something that is real and distinct from other disorders, and the extent that a classification system such as ICD-10 or DSM-5 measures what it claims to measure.

28
Q

What is criterion validity in relation to schizophrenia?

A

Relationship to other measures (do different assessment systems arrive at the same diagnosis?).

29
Q

What is concurrent validity in relation to schizophrenia?

A

Does it relate to an existing or similar measure?

30
Q

What is predictive validity in relation to schizophrenia?

A

Does the test predict later performance on a related criterion?

31
Q

How are reliability and validity linked in relation to diagnosis?

A

A diagnosis cannot be valid if it is not reliable.
If the diagnoses are inconsistent, you cannot be sure of the validity of the classification.

32
Q

Cheniaux et al (2009) - procedure

A

Had 2 psychiatrists independently diagnose 100 patients using the ICD and DSM criteria.

33
Q

Cheniaux et al (2009) - findings

A
  • 1st psychiatrist diagnosed 26 using DSM, and 44 using ICD.
  • 2nd psychiatrist diagnosed 13 using DSM, and 24 using ICD.
34
Q

Cheniaux et al (2009) - conclusion (x2)

A
  • Presents an issue with inter-rather reliability because 2 or more psychiatrists do not distinguish between types of symptoms consistent.
  • Shows that the diagnosis of schizophrenia is not reliable because diagnosis and treatment depends on the psychiatrist you see, rather than the symptoms you present.
35
Q

Rosenhan (1973) - aims - diagnosis and classification

A
  • Distinguishing the ‘sane’ from the ‘insane’ - being sane in insane places.
  • Investigate psychiatric labels.
36
Q

Rosenhan (1973) - procedure - diagnosis and classification

A
  • Field experiment
  • 8 confederates acted as pseudopatients, going to 12 different hospitals in 5 different states in the USA (old, new, overstaffed and understaffed).
  • Complained of hearing voices prior to admission, but then stopped pretending to have symptoms once admitted.
37
Q

Rosenhan (1973) - findings - diagnosis and classification

A
  • Staff diagnosed 11/12 with schizophrenia, and 1 with manic depression.
  • Average hospital stay was 90 days.
  • 35 patients detected sanity in pseudopatients; staff misinterpreted normal behaviour as evidence of psychopathology.
38
Q

Richard Benthall - diagnosis and classification

A

Advocated a symptom-based approach (rather than a disease-based approach) to diagnosing schizophrenia (does not require any assumption that there is an underlying disease).

Psychology (14 decks)

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