Schizophrenia Flashcards
Outline Schizophrenia
Schizophrenia is a psychotic disorder, characterised by incoherent and illogical thoughts, behaviours and speech. Those who are experiencing psychosis endure a range of symptoms resulting in them having a loss of contact with reality.
Symptoms are most commonly onset between the ages of 15-35 and is most diagnosed in males.
Outline the positive symptoms of SZ
Positive symptoms are those which are additional to typical experiences an involve an excess of unusual functioning.
Hallucinations: additional sensory experiences, most typically auditory.
Delusions: fixed and false convictions that are irrational and not shared by others.
Grandiose, persecutory and referential are all forms of delusions. Delusions can cause an individual to believe the have remarkable qualities, that others are out to get them, or believe all ordinary events or behaviours from others is directed to them personally.
Disorganised speech
Abnormal motor movements: this can include agitation and catatonia. Catatonia refers to a lack of responsiveness to ones environment and may include the individual sitting in stage postures and carrying out repetitive movements.
Outline negative symptoms of schizophrenia
Negative symptoms refer to ones which refer to a loss of typical functioning.
Most commonly, individuals may experience a sense of avolition and a loss of any motivation towards goal directed behaviour. This can result in feelings of apathy, poor hygiene and a lack of persistence with work and social activities.
Speech poverty - reduction in quality and quantity of speech.
Discuss the reliability of SZ diagnosis/classification
When diagnosing SZ, clinicians will often use guidance from diagnostic manuals, most commonly the ICD-10 or DSM-V. However, different manuals vary in regards to the criteria outlined in order to receive a diagnosis. For example, the ICD-10 requires 2+ negative symptoms whereas the DSM-V only requires the presence of one positive symptom in order to receive a diagnosis. This could lead to practitioners arriving at different diagnoses’ depending on what classification system they are using, thus decreasing the reliability of SZ diagnosis’s’.
Cheniaux et al found when getting two psychiatrists to independently diagnose the same 100 patients using both the ICD and DSM-V, that they arrived at conflicting conclusions. One psychologist diagnosed 24 individuals using the ICD and 13 with the DSM-V. Whereas, the other diagnosed 44 using the ICD and 26 with the DSM-V. This limits the reliability of SZ diagnosis’s as the lack of inter-rater reliability indicates there is a lack of consistency in regards to the diagnosis of schizophrenia.
Discuss the validity of the diagnosis of SZ
Co-morbidity refers to the occurrence of 2+ disorder simultaneously. For example, Buckly found co-morbidity rates with SZ of 50% and 47% with depression and drug abuse respectively.
The issue of co-morbidity is coupled with the problem of symptom overlap, with SZ sharing symptoms with other disorders. For example, bipolar disorder and SZ both share similar positive symptoms such as delusions. Therefore, it could be possible that these two disorders are not distinct and in fact variations of the same condition.
These limitations make it increasingly difficult to distinguish SZ from other disorders. This can lead to a patient being diagnosed with one condition when they are in fact suffering with an other.
Discuss gender bias in reference to SZ
Men have been found to be more commonly diagnosed with SZ in contrast to women, however, research suggests that this is the result of diagnostic biases opposed to a real gender difference.
Loring and Powell found when having over 200 psychiatrists independently assess identical patient case studies but with varying descriptions of the patients race and/or gender, that there was an underdiagnosis of SZ in female patients and over diagnosis of SZ in black case studies.
As the exact same behaviour was concluded as schizophrenic in males but not in females, this indicates there is a gender bias in the diagnosis of schizophrenia and therefore some clinicians may be diagnosing the disorder based on biases opposed to factual evidence. This can result in female patients not receiving adequate treatment if their symptoms are being dismissed.
Discuss culture bias in reference to the diagnosis of SZ
Individuals of an Afro-Caribbean decent have been found to be 10x as more likely to be diagnosed with SZ in contrast to their white British counterparts. However, when looking at SZ rates in these countries of origin, they mirrored the same 1% as the rest of the general population.
This therefore indicates that this difference in diagnostic rates is not the result of a genetic vulnerability in black individuals but rather a culture bias.
Western clinicians may misinterpret the symptoms of individuals outside their culture as unusual or bizarre because they are not understanding them within their specific cultural context - cultural relativism. For example, Afro-Caribbean societies may attribute hearing voices to signs of a religious experience, whereas those outside this culture may view this as signs of schizophrenia.
The misinterpretation of symptoms in Black people may result in certain ethnic groups being discriminated against due to a culturally biased diagnostic system.
