Schizophrenia Flashcards
what is schizophrenia?
schizophrenia involves hallucinations and delusions and is a type of psychosis.
what are the positive symptoms of schizophrenia?
positive symptoms means excess of normal functions.
delusions: unrealistic beliefs that appear real. they can be paranoid, involve inflated beliefs about the individuals power and importance. the schizophrenic individual will believe that the behaviour and comments of others is directed solely at them.
hallucinations: these can be auditory, visual, olfactory (smelling things) or tactile (something crawling under their skin).
what are the negative symptoms of schizophrenia?
loss of normal functions
speech poverty (alogia): poor speech which is thought to reflect slow or blocked thoughts. individuals with this will produce fewer words on a verbal fluency task because they have difficulty spontaneously producing them. speech poverty is also shown through less complex syntax, fewer clauses etc.
avolition: a lack of focused behaviour, instead the individual will appear disinterested in doing things and may simply sit doing nothing for hours sat at a time. they show no initiation or persistence with tasks.
what are the social/occupational dysfunctions of schizophrenia?
work, personal, social relationships below the quality of what they were prior to onset.
duration of schizophrenia
continuous signs of disturbance for at least six months, including one month of symptoms that meet criterion A. during non-active periods, disturbance may be limited to negative symptoms or two or more symptoms in criterion A.
define reliability in schizophrenia
the consistency of the classification system such as the DSM or a measuring instrument to assess particular symptoms of schizophrenia.
define validity in schizophrenia
the extent that a diagnosis represents something that is real and distinct from other disorders and the extent that a classification system such as the DSM measures what it claims to.
reliability: cultural differences in diagnosis
research suggests that when it comes to diagnosing schizophrenia there are significant variations between culture so culture has an influence on the diagnostic process. Copeland (1971) gave 134 US and 194 British psychiatrists a description of a patient. 69% of the US psychiatrists diagnosed schizophrenia compared to only 2% of British psychiatrists. one of the main characteristics of hearing voices also appears to be influenced by cultural environment. Luhrmann (2015) interviewed 60 adults diagnosed with schizophrenia, 20 each in India, Ghana, and the US. each was asked about what voices they heard, many of the African and Indian subjects reported positive experiences with their voices, describing them as playful and offering advice. no US PPs reported positive experiences, they were more likely to report the voices they heard as violent and hateful. Luhrmann suggests that the harsh, violent voices that are so common in the West may not be an inevitable feature of schizophrenia.
Evaluation of reliability
inter-rater reliability and unreliable symptoms: despite claims for increased reliability in the DSM, there is still little evidence that the DSM is routinely used with high reliability by mental health clinicians. Whaley (2001) found inter-rater reliability correlations in the diagnosis of schizophrenia of 0.11. Rosenhan’s (1973) study demonstrated the unreliability of the diagnosis of schizophrenia. ‘normal’ people presented themselves at a psychiatric hospital in the US. they all claimed to hear voices and were subsequently diagnosed and admitted to the hospital. during their stay, no staff recognised that they were not symptomatic.
culture: research has established cultural and racial differences in the diagnosis of schizophrenia. however, the prognosis for members of ethnic minority groups may be actually more positive than for majority group members. the ethnic culture hypothesis predicts that ethnic minority groups experience less distress associated with mental disorders because of the protective characteristics and social structures that exist in most ethnic minority cultures. Brekke and Berrio found evidence to support this hypothesis in a study of 184 individuals diagnosed with schizophrenia or a schizophrenia-spectrum disorder. this sample was drawn from 2 non-white minority groups and a white majority group. they found that non-minority group members were consistently more symptomatic than members of the 2 ethnic minority groups, findings which were supported by the ethnic cultural hypothesis.
validity: gender bias in diagnosis
this occurs when the accuracy of diagnosis is dependent on the gender of the individual. the accuracy of the diagnostic judgements can vary for several reasons, including gender-biased diagnostic criteria or clinicians basing their judgements on stereotypical beliefs held about gender. for example, the critics of the DSM diagnostic argue that some diagnostic categories are biased towards pathologising one gender rather than the other. Broverman (1970) found that clinicians in the US equated mentally healthy adult behaviour with mentally healthy male behaviour. As a result, there was a tendency for women to be perceived as less mentally healthy.
validity: gender bias in diagnosis evaluation
Loring and Powell (1988) randomly selected 290 male and female psychiatrists to read two case study of patient behaviour. they were then asked to give their judgement on these individuals, using the standard diagnostic criteria. when the patients were described as male or no information was given about their gender, 56% of the psychiatrists gave a diagnosis of schizophrenia. however, when the patients were described as female only, 20% were given a diagnosis of schizophrenia. this gender bias was not as evident among the female psychiatrists, suggesting that diagnosis is influenced not only by the gender of the patient but also the gender of the clinician.
validity: symptom overlap
it is believed that identifying positive and negative symptoms of schizophrenia would help to create a more valid diagnosis of schizophrenia. however, many of these symptoms are found in other disorders. Schneider (1959) listed 1st rank symptoms (the most common), which he believed distinguished schizophrenia from other psychotic disorders. these symptoms included delusions of being controlled by external forces, beliefs that the individuals thoughts are being broadcast to others, hearing hallucinatory voices commenting on their thoughts or actions. this made diagnosis more reliable.
validity: co-morbidity
this refers to the extent to which two or more symptoms can co-occur. psychiatric co-morbidities are common among patients with schizophrenia. these include substance abuse, anxiety, and symptoms of depression. for example, Buckley (2009) estimated that co-morbid depression occurs in 50% of patients and 47% of patients also have a lifetime diagnosis of co-morbid substance abuse. schizophrenia and OCD are 2 distinct psychiatric conditions. roughly 1% of the population develop schizophrenia and roughly 2-3% develop OCD. s evidence suggests that the two conditions appear together more than chance would suggest. Swets (2014) conducted a meta-analysis and found that at least 12% of patients with schizophrenia also fulfilled the diagnostic criteria for OCD and about 25% displayed significant obsessive-compulsive symptoms.
validity: co-morbidity evaluation
Several studies have examined single co-morbidities with schizophrenia. One example is Weber (2009) who studied just under 6 million hospital discharge records to calculate co-morbidity rates. pPsychiatricand behaviour-related diagnosis accounted for 45% of co-morbidity. However, the study also found evidence of many co-morbid non-psychiatric diagnoses. Many patients with a primary diagnosis of schizophrenia were also diagnosed with medical problems including asthma and type 2 diabetes. It was concluded that the nature of a diagnosis of a psychiatric disorder is that patients tend to receive a lower standard of care, which in turn adversely affects the prognosis for patients with schizophrenia.
validity: prognosis evaluation
just as people with schizophrenia may not share the same symptoms, there is no evidence to suggest that they share the same outcomes (prognosis). the prognosis for patients diagnosed with schizophrenia varies between 20% recovering their previous level of functioning, 10% achieving significant and lasting improvement and about 30% showing some improvement with intermittent relapse. a diagnosis of schizophrenia has little predictive validity, some people never appear to recover form the disorder but some do. what does appear to influence the outcome is more to do with gender and psycho-social factors such as social skills, academic achievements, and family tolerance of schizophrenic behaviour.
