Schizophrenia

Question 1

Schizophrenia

Answer 1

Schizophrenia is a serious mental psychotic disorder characterised by a profound disruption of cognition and emotion. It is so severe, that it affects a person’s language, thought and perception, emotions and even their sense of self. It is suffered by approximately 1% of the population. The onset of the disorder is between 15 and 45 years of age. In the past, it was more commonly diagnosed in:
• Men more than women
• Cities rather than the countryside
• Working class than middle class people

More of a psychotic than neurotic disorder

Question 2

Psychotic

Answer 2

the term psychotic refers to serious mental issues causing abnormal thinking and perceptions and also the fact that people lose touch with reality and even their sense of self. Many people who suffer from schizophrenia end up homeless or hospitalised. It is not uncommon for a person suffering with SZ to commit or attempt suicide.

Question 3

Type 1 schizophrenia

Answer 3

characterised more by positive symptoms (those which are an addition to an individual’s behaviour) e.g. visual or auditory hallucinations or delusions of grandeur.
Generally with this type of SZ, there are better prospects for recovery.

Question 4

Type 2 schizophrenia

Answer 4

characterised more by negative symptoms e.g. loss of appropriate emotion of poverty of speech. Generally with this type of SZ, there are poorer prospects for recovery.

Question 5

Positive symptoms

Answer 5

Hallucinations- sensory experiences of a stimuli that have either no basis in reality or are distorted perception of things which are there
Delusions (paranoia)- irrational, bizarre beliefs that seem real to the person with schizophrenia
Disorganised speech- this is the result of abnormal thought processes, where the individual has problems organising his or her thoughts and this shows up in their speech, in form of derailment, word salad (speech so incoherent that it sounds like complete gibberish)
Catatonic behaviour- includes the inability or motivation to initiate or even complete a task, catatonia refers to adopting rigid postures or aimless repetitions of the same behaviour

Question 6

Negative symptoms

Answer 6

Appear to reflect a reduction or loss of normal functions which often persist even during periods of low positive symptoms.

Speech poverty (alogia)
Avolition- finding it difficult to begin or keep up with a goal directed activity
Affective flattening- reduction in the range and intensity of emotional expression including facial expressions
Anhedonia- a loss of interest or pleasure in all or most activities, or a lack of reactivity to normally pleasurable stimuli

Question 7

Classifying schizophrenia- DSM-v

Answer 7

Need 2 or more of the following criteria: delusions, hallucinations, disorganised speech, catatonic behaviour, avolition

Social/ occupational dysfunctions
Duration: for 6 months or more, symptoms from criteria A must be present for more than a month

Question 8

ICD-11

Answer 8

Produced by the WHO, updated every few years, focuses on clusters of symptoms needed to classify a psychiatric illness, mainly used in Europe, focuses on subtypes of schizophrenia

Question 9

DSM-V

Answer 9

200 mental disorder which are grouped together in terms of features, produced in the USA, updated every few years, used to have subtype of schizophrenia but removed from updated version

Question 10

Issues In diagnosis of schizophrenia

Answer 10

Comobidity, symptom overlap, gender bias and culture bias

Question 11

Comorbidity

Answer 11

This refers to the extent that two or more conditions occur simultaneously/coexist in the same individual at the same time (co-exist alongside each other.) Therefore a person with schizophrenia might also be suffering from another condition such as depression.
This is an important issue when considering the validity in diagnosing and classifying schizophrenia. Swets (2014)_stated that 1% of the population will suffer from schizophrenia and 2.5% from OCD. However, 12% of schizophrenic patients meet the diagnostic criteria to also be suffering from OCD (co-morbid). This causes the problem of classifying the illness as schizophrenia, and not OCD.
The boundaries between schizophrenia and mood disorders are blurred, and both types of illnesses share many symptoms.
There is the problem that depression (a mood disorder) is co-morbid (occurs alongside) schizophrenia. This means that full consultation using the DSM and ICD must be used in order to get the correct and valid diagnosis of the illness.

Question 12

Comorbidity evaluation

Answer 12

• dms and icd can be seen as lacking validity, there is too much of an overlap between sz and depression, sometimes clinicians might classify the patient as having both to avoid making a decision, second opinion is important
  -invalid and unreliable- 32% of 142 hospitalised schizophrenia patients had additional mental disorders
• has been found through research that SZ patients before being diagnosed suffered from alcohol, cannabis, cocaine substance abuse, unreliable because some symptoms are from drug abuse
  -schizophrenic patients with Comorbidity illness are often excluded from research when in reality majority suffer from this. Can not be generalised

Question 13

Culture bias

Answer 13

Culture has an influence on the diagnosis and classification of schizophrenia. For example, “hearing voices” (auditory hallucinations) can be influenced by culture. Luhrmann (2015) interviewed 60 adults with schizophrenia, (20 from Ghana, 20 from India and 20 from USA), all of the patients reported that they heard voices, but the patients from the USA reported the most negative experiences associated with the voices, e.g. the voices were violent and hateful.
Therefore culture has an influence on the reliability of diagnosing schizophrenia.

b) Davison and Neale (1994) _explain that in Asian cultures, some people are praised if they do not show that they are suffering from an emotional/psychological problem, therefore people from Asian cultures might be unlikely to seek psychological help if they have schizophrenia (and therefore these people will not appear in any stats). In Arabic cultures, people are encouraged to show emotions, and therefore this culture might be more likely to seek help for schizophrenia if they have it and there might be more stats and data available for this group. Therefore there is a cultural bias.

Question 14

Evaluation of culture bias

Answer 14

negative point about diagnosing and classifying schizophrenia is cultural relativism. The psychologist might not be able to understand the patient’s symptoms correctly due to not fully understanding the patient’s cultural background, and might misdiagnose schizophrenia. The psychologist might also wrongly label the patient as schizophrenic if the psychologist makes incorrect judgements about the patient in terms of their cultural background.Also some people from an African background might be wrongly diagnosed with schizophrenia due to the fact that they might claim that they can hear the voice of God (due to religion). In the African culture, these people would be seen as gifted; however in the western world this could be interpreted as a hallucination (auditory), and could be judged as being a symptom of schizophrenia, which could lead to an incorrect and invalid diagnosis. (-)

Afro Caribbean people have little immunity to file and children born to the mothers which had flu in the second trimester, have an 88% increase chance of developing schizophrenia

3) Barnes (2004) suggested there is supporting research evidence for cultural differences when diagnosing and classifying schizophrenia. The Ethnic Culture hypothesis predicts that ethnic minorities experience less distress if they suffer with the illness of schizophrenia, because they have protective characteristics and social structures that exist in their culture. 184 individuals with schizophrenia were investigated from African American, Latino or White American cultures. It was found that Americans had more symptoms than the other 2 cultures because they had less protective and supportive features in their culture (social support).

Question 15

Gender bias

Answer 15

The accuracy of diagnosing schizophrenia can be dependent on the gender of the patient which leads to a gender bias occurring. Male sufferers of schizophrenia tend to show more negative symptoms than women, and also seem to suffer from more substance abuse. Males have an earlier onset (aged 18-25 years) of schizophrenia than females (25-35 years).
There seems to be great disagreement amongst clinicians when diagnosing schizophrenia, especially when the factor of gender is taken into account. The accuracy of diagnosis can vary due to clinicians having stereotypical beliefs about gender. Critics of the DSM argue that healthy adult behaviour is linked more to healthy males rather than healthy females. Therefore the DSM could be viewed as being gender biased, especially when trying to classify and diagnose the symptoms of schizophrenia, which might be invalid.

Question 16

Evaluation of gender bias

Answer 16

There is a problem of gender bias occurring when diagnosing schizophrenia and research support comes from Loring
(1985). He gave 290 male and female psychologists case studies of patients to read (one male and one female).
Psychologists had to judge the patients using diagnostic criteria. When the patient was described as male, or no information was given about gender, 56% of psychologists diagnosed the patient as schizophrenic. When the patient was described as female, 20% of the psychologists diagnosed schizophrenia. Therefore there is a gender bias when diagnosing schizophrenia, and this was especially prominent when the psychologist was male. (-)

2) The validity of the diagnosis of schizophrenia can be questioned, especially as it seems that females develop schizophrenia 4-10 years later than males do. There are different types of schizophrenia that males and females are vulnerable to, so this must be taken into account when diagnosing and classifying the illness. (-)
3) Research evidence by Kulkarni (2001) has found supporting data to suggest that females might be less vulnerable than males to schizophrenia. He found the female sex hormone estradiol can help treat schizophrenia in females, especially when added to anti-psychotic drugs. It seems that estradiol might be a protective factor present in females that might lower their chances of getting schizophrenia compared to males. Clinicians must take this into account when diagnosing schizophrenia, especially in females, in order to ensure the diagnosis is valid. (+)

Question 17

Symptoms overlap

Answer 17

The positive and negative symptoms of schizophrenia are a valid diagnosis of schizophrenia, however some of the symptoms of schizophrenia can also be found in the other disorders such as depression and bipolar disorder, and this is called symptom overlap which means that shared symptoms could lead to an incorrect and invalid of diagnosis.
Ross (1995) found that patients who had Dissociative Identity Disorder had many symptoms which overlapped with schizophrenia, so much so, that they could have been diagnosed with schizophrenia!
Other illnesses that seem to show symptom overlap with schizophrenia include:
• Bipolar depression (depressed mood, episodes of mania/energy, unpredictable, hallucinations delusions)
• Depression (hallucinations)
• Schizotypal personality disorder (similar symptoms of schizophrenia, but milder)
The person may exhibit a symptom typical of schizophrenia (e g. delusions) but they could instead have another condition with the same symptom (e.g. bipolar disorder).

Question 18

Evaluation of bipolar depression

Answer 18

1) To support a correct diagnose of schizophrenia in a valid way, clinicians should conduct a brain scan or EEG. This can examine the brain in detail and especially check the grey matter in the brain (where intelligence is held). Schizophrenic patients tend to suffer from a deterioration of grey matter, and this can be checked by conducting a brain scan. Patients who have bipolar depression do not have a reduction in grey matter. (+)
2) A problem of symptom overlap is that it can cause misdiagnosis of schizophrenia. Ketter (2005) found evidence of schizophrenia being misdiagnosed as another illness, because of symptom overlap. This causes years of delays, whereby schizophrenia patients do not receive the necessary treatment that they actually need, and their illness gets worse. This can increase rates of suicide and deterioration. Therefore it is important than patients get a valid and accurate diagnosis in the first place. (-)
3) Research evidence has supported the idea that inter rater reliability is actually quite low, especially when asking psychologists to agree on diagnosing schizophrenia and not another illness. Beck (1961) studied 154 patients who met with two different psychiatrists. It was found that inter rater reliability was 54%, which means that there was 54% agreement between the two psychiatrists in terms of diagnosis of the illness schizophrenia. This therefore suggests that different psychiatrists might give different diagnosis to the same patient who display the same symptoms of schizophrenia (-)

Question 19

Rosenham- study on validity of schizophrenia

Answer 19

Psychiatrist cannot reliably distinguish schizophrenics from non schizophrenics, he questioned the validity of classification and diagnosis of schizophrenia, he conducted a field experiment in the USA (8 sane patients sought admission to 12 separate hospitals ), they lied about having auditory hallucinations, all but one was given the diagnosis of schizophrenia, remained in hospital for 7-52 days, 35 out of 118 genuine patients suspected the pseudo patients to be sane.

Hospital staff were informed by rosenham that pseudo patients might see, admittance in the next 3 months, out of 193, 41 were confident, and 23 as suspect, no pseudo patients were sent at all

Question 20

Evaluation of rosenham

Answer 20

• lacks temporal validity, now more procedures have been added like consulting a second psychiatrist before making decision
  + could we argue that the psychologists made correct decision to keep the patient in hospital for help, otherwise can be seen as negligence