Schizophrenia Flashcards
What is schizophrenia?
A form of psychosis (where people loose some or all contact with reality). It is a splitting of the mind and the patient has fragmented thinking. Illness of the thought process.
What does the DSM say about the diagnosis of Schizophrenia?
Two or more of the following symptoms must be displayed during a month period:
-Delusions
-Hallucinations
-Disorganised speech
-Grossly disorganised or catatonic behaviour
-Negative symptoms
What are the positive symptoms of Schizophrenia?
Hallucinations and delusions
What are the negative symptoms of schizophrenia?
Speech poverty and avolition
What are hallucinations?
Unusual sensory experiences. False perceptions with no basis in reality eg hearing voices
What are delusions?
False beliefs that are firmly held despite being illogical eg beliefs about being a victim of conspiracy
What is speech poverty?
Where there are changes in patterns of speech. Reduction in the amount or quality of speech and delay of responses.
What is avolition?
Finding it difficult to begin or keep up with goal directed activities.
What are positive symptoms?
Behaviours/ experiences added on to behaviour.
What are negative symptoms?
Behaviours that are absent/ lacking eg hygiene, loss of emotion and social withdrawl
What is co-morbidity?
When a person has two disorders eg schizophrenia and depression
What is symptoms overlap?
When two or more conditions share the same symptoms, which may affect whether you get the correct diagnosis.
What was the aim of Rosenhan’s study?
To investigate how situational factors affect a diagnosis of schizophrenia.
Method of Rosenhan’s study
8 confederates acted as pseudopps going to 12 diff hospitals. Real pps was hospital staff. Pseudopp called hospital for appointment and when arrived they complained of hearing voices which were unclear, unfamiliar and of the same sex as them. Pseudopps gave false names and symptoms but real life histories. Once on the ward, pseudopps stopped pretending symptoms, behaved normally and wrote observations. They were discharged only when they convinced staff they were sane.
Conclusion of Rosenhan’s study
Psychiatrists cannot reliably tell the difference between an insane and sane person, calling into question the reliability of a Sz diagnosis. Normal behaviour was interpreted as abnormal to support their idea that pseudopatients had a mental illness. This suggests that validity of psychiatric diagnoses was low and the DSM was flawed.
Results of Rosenhan’s study
On admission, staff diagnosed 7 pseudopatients with Schizophrenia, and one with manic- depression. Staff never detected their sanity. Nurses reported their behaviour as showing „no abnormal indications” but did interpret their behaviour in the context of their diagnosis. Avg hospital stay was 19 days. All pseudopatients were discharged with diagnosis of Sz in remission. 35 real patients detected sanity.
What did Rosenhan’s find the issues were with diagnosis?
Not accurate as did not detect 8 patients were fake patients.
1 out of 8 patients were diagnosed with bipolar even though same symptoms given to doctor.
What impact did Rosenhan have on diagnosis?
Made changes to DSM so it has better accuracy and consistency
Better attitude towards mental health in society
What is an reliability (strength surrounding diagnosis of Sz)?
Reliability which means how consistent the diagnosis is between clinicians and diagnostic systems. Rosenhan found all 8 pseudopatients were diagnosed with a mental illness which shows there is consistency within clinicians. This is a strength in diagnosis of Sz because it shows inter rater reliability in diagnosis. This is supported by Osorio et al who reported excellent reliability for Sz diagnosis, using the DSM 5. They found inter rater agreement of +0.97 and test retest reliability was +0.92. Diagnosis of Sz is consistent when using DSM.
Cultural bias in diagnosis
Some cultures do not see hearing voices as a negative experience. In Afro Caribbean societies they hear voices from their ancestors and this would not be regarded as Sz. They see it as a gift from God. This is supported by Afro Caribbean British Men are up to ten times more likely to receive a diagnosis as white British Men, probably due to over interpretation of symptoms of Uk psychiatrists. This means Afro Caribbean men living in the UK appear to be discriminated against in a culturally- biased diagnostic system.
Validity in diagnosis of Sz
Whether diagnosis is accurate or not. Criterion validity involves seeing whether diff procedures used to assess the same individual’s arrive at the same diagnosis. Cheniaux et al shows diagnosis of Sz has low validity. Two psychiatrists independently assessed the same 100 clients using ICD and DSM. 68 were diagnosed w Sz with ICD and 39 with the DSM, which shows 29 where diagnosed differently. Sz is either over or under diagnosed, because there diff diagnosis rates between the two diagnostic tools, which suggests criterion validity is low.
Symptom overlap in diagnosis
There is an overlap between symptoms of Sz and other conditions. This makes diagnosis tricky as Sz may not exist as a singular condition and if it does it is hard to diagnose.
Tienari et al study (genes)
Adopted children of biological mothers with Sz were more likely to develop Sz then adopted children with mothers who did not have Sz. Supports genetic link to Sz
Percentage of developing Sz if parents have it?
6%
Percentage of Sz if your biological siblings have Sz?
9%
% of developing Sz if your identical twin has it?
48%
Schizophrenia is polygenic?
There is not a candidate gene. There is a number of genes which code for dopamine involved. 108 variations of genes associated with Sz.
Sz is aetiologically heterogenous?
Different combinations of factors including genetic factors can lead to the condition.
