Schizophrenia Flashcards
What are the two types of symptoms of schizophrenia?
Positive and negative
Define positive symptoms
Symptoms that the person did not have before the illness such as delusions and hallucinations
Define negative symptoms
Symptoms which have made the patient lose something such as loss of emotion, speech or motivation
What are the three symptoms that a person must have at least one of to be diagnosed?
Delusions, hallucinations, disorganized speech
What are the three types of delusions?
A delusion is an incorrect belief.
- Delusions of persecution (believing people are out to get you)
- Delusions of grandeur (believing you are someone great)
- Delusions of reference (believing everyday things such as songs on the radio have a personal significance)
What are the three types of hallucinations?
Hallucinations are sensing something that isn't there - Auditory hallucinations (hearing) - Visual hallucinations (Seeing) - Somatosensory hallucinations (feeling)
What are the two types of disorganized speech?
Loose association (jumping from topic to topic) Word salad (severe form of loose associations where the person's speech makes no sense at all)
What two other symptoms are there?
Grossly disorganized or catatonic behaviour and negative symptoms
What is grossly disorganized or catatonic behaviour?
Catatonia (maintaining the same rigid posture for a long period of time)
Stereotypy (engaging in repetitive, pointless movements)
What are the negative symptoms?
Lack of volition (withdrawal from social life) Flattened affect (no emotional expression)
What are the 5 stages of diagnosis?
Symptoms Areas affected Duration Rule out other disorders Rule out known causes
What are the three areas that a patient must have had lower levels of achievement in at least one of as a result of the illness?
Work , relationships , self care
What duration allows for diagnosis?
The patient must have shown continuous signs of disturbance for at least 6 months. During these 6 months the patient must have shown at least 1 month of symptoms.
What is involved in the process in ruling out other disorders?
There are similar psychotic disorders such as schizoaffective disorder and mood disorder with psychotic features which need to be ruled out.
What is involved in ruling out known causes?
Ensuring drug use or a separate medical condition isn’t the reason
What are the 5 categories that a patient can be diagnosed as?
Paranoid, disorganized, catatonic, undifferentiated, residual
What dominant feature leads to diagnosis of paranoid schizophrenia?
Delusions, auditory hallucinations
What dominant feature leads to diagnosis of disorganized schizophrenia?
Disorganized speech, disorganized behaviour, flattens or inappropriate affect
What dominant feature leads to diagnosis of catatonic schizophrenia?
Motor disturbances
What dominant feature leads to diagnosis of undifferentiated schizophrenia?
Where symptoms do not fit into paranoid, disorganized or catatonic
What dominant feature leads to diagnosis of residual schizophrenia?
Continuing evidence of the disorder but none of the active symptoms of the paranoid, disorganized or catatonic type
What is the classification system used in the UK?
DMS V
Is the diagnosis of schizophrenia subjective?
Yes although it is made less subjective by through the use of the DSM V.
What are the two issues of diagnosing schizophrenia?
Reliability and validity
What is reliability in terms of schizophrenia?
Reliability refers to how consistent something is. In the case of schizophrenia this is whether the diagnosis is consistent or not, in terms of over time and between doctors.
What did Kleitman say about reliability?
He identified 3 factors which might make diagnosis unreliable.
Difference between clinicians: classification systems may be interpreted differently. Furthermore, the culture of the clinician may affect the reliability.
Difference between patients: No two cases of schizophrenia are the same and so if the patients culture is different to the clinicians it may lead to false diagnosis. Also, a patient may show signs of schizophrenia on one day but not the next meaning diagnosis could be different on different days.
Differences in the procedures used to assess the patients: there are a number of classification systems e.g. the ICD 10 used in Europe identifies two extra subtypes of schizophrenia not listed in the DSM V.
What research studies do you need to know to support that diagnosing schizophrenia has low reliability?
Jones and Gray Stephens et al Mojtabi and Nicholson Copeland et al Harvey et al Pagsberg
Describe Jones and Gray’s study (reliability)
Noted that a large proportion of those diagnosed with schizophrenia in western countries are of Afro-Caribbean descent. They argue that this is may be symptoms being misinterpreted by psychiatrists. Many patients have a different speech style which could be misinterpreted for disorganised speech, it is also the norm to be visited by deceased relatives which may be misinterpreted as hallucinations and some mannerisms could be misinterpreted as motor disturbances. This supports that the cultural background of the psychiatrist can lower reliability.
Describe Stephens et al’s study (reliability)
Investigated the inter-rater reliability of nine different classification systems. Doctors were given the files of 283 patients and were asked to use the nine classification systems to diagnose the patients. They found that agreement between the classification systems was poor in that the same patient wasn’t given the same diagnosis by each system.
Describe Mojtabi and Nicholson’s study (reliability)
Investigated the subjective interpretation of psychiatrists. They based their study on the idea that the clinical characteristics are verbal descriptions that are open to interpretation. One such example is bizarre delusions. They gave 50 psychiatrists examples of delusions and they had to sort as either bizarre or non bizarre. They agreed only 40% of the time.
Describe Copeland et al’s study (reliability)
Investigated how the culture of the psychiatrist might lead to a difference in diagnosis. 134 US and 194 UK psychiatrists were given a description of a patient and asked to diagnose the patient using the same classification system. 69% of the US psychiatrists gave a diagnosis, compared to 2% of the UK psychiatrists. Although this research supports the lacking reliability it should be considered that this research used classification systems seen as outdated. More recent research shows the contrary.
Describe Harvey et al’s study (reliability)
Meta analysis on research that has been carried out to test reliability. They found that older classification systems led to unreliable diagnoses, however they argue that since the publication of the DSM V reliability in diagnosis has increased.
Describe Pagsberg’s study (reliability)
Considered the impact the DSM V would have (prior to its publication in 2013). He notes that the clinical characteristics have been ‘tightened up’ to be much clearer, with certain parts being removed. He argues that this new system will exclude 2% of patients who have currently been diagnosed. He argues that the DSM V will lead to a much more reliable diagnosis of schizophrenia.
What are the two issues that validity to do with diagnosing schizophrenia is centred around?
Does schizophrenia actually exist as a unitary disorder?
Is diagnosis accurate?- differing from reliability as two psychiatrists may both agree but both be wrong.
What are the two factors that cast doubt on the validity of diagnosis?
The wide range of experiences- there are many symptoms of schizophrenia and one schizophrenic may not have any of the same symptoms as another schizophrenic.
The similarities with other mental illnesses- schizophrenia doesn’t have any pathognomonic symptoms (symptoms exclusive to one disorder) and so it is a possibility that someone diagnosed with schizophrenia could actually be suffering from another mental illness.
What are the two reasons that validity is important?
- It’s important to make an accurate diagnosis so that the patient is given appropriate treatment.
- It’s important to avoid labelling a person as schizophrenic if there’s a chance they aren’t schizophrenic as there’s a huge stigma surrounding the condition.
What is the illustrating study for the importance of validity?
Thornicroft et al looked at 732 patients with schizophrenia and found that since their diagnosis 47% found it hard to keep or maintain friends, 29% found it hard to keep a job and 43% suffered discrimination by their own family members. This illustrates the stigma that comes with schizophrenia.
What research studies do you need to know to support that there is low validity in the diagnosis of schizophrenia?
Rosenhan Kim and Berrios Ellason and Ross Bleuer Marius Romme
Describe Rosenhan’s study (validity)
Rosenhan and eight (all mentally healthy) each went to a separate psychiatric institution complaining of hearing a voice saying the word “thud”. All other details except their occupation were not lies. All but one of the pseudo-patients was admitted to the ward as suffering from schizophrenia with the remaining person diagnosed with manic depressive psychosis. All behaved normally once they were in the institution and were detained there for between 7 and 52 days. This supports the low validity as doctors inaccurately diagnosed eight of the nine people with schizophrenia. This study threw great doubt on validity of diagnosing schizophrenia although it should be noted that the patients did lie and so were partially testing the doctors ability to detect a lie.
Describe Kim and Berrios’ study (validity)
Found evidence that in Japan 80% of patients who have schizophrenia are undiagnosed and thus unaware of the fact. This wasn’t due to the doctors inability but due to the large stigma attached as in some cases doctors don’t want to burden their patients. In an attempt to rectify the situation Japan renamed schizophrenia from ‘mind split disease’ to ‘integration disorder’.
Describe Ellason and Ross’ study (validity)
Investigated the idea the lack of pathognomonic symptoms in schizophrenia reduces the validity of the concept. They compared patients that had schizophrenia and dissociative identity disorder and found that the overlap was so great that those with dissociative identity disorder had more symptoms of schizophrenia than those diagnosed with schizophrenia. This supports the idea that the overlap between mental illness is great and therefore it is easy to misdiagnose a person.
Describe Bleuer’s study (validity)
Looked at predictive validity of the disease. The idea being if a patient has been accurately diagnosed appropriate treatment should lead to improvements. Bleuer looked at 2000 patients and found 20% made a full recovery, 40% recovered from positive symptoms and 40% continued wth psychotic episodes. This supports that schizophrenia is not a valid concept.
Describe Marius Romme’s study (validity)
Marius Romme is an eminent psychiatrist and one of schizophrenia’s biggest critics. He claims that schizophrenia has no scientific validity because when diagnosing schizophrenia no attention is paid to how the person came to develop the symptoms. This goes back to all schizophrenic sufferers being treated in the same way with little regard to subtle differences in their symptoms. This is harmful as if no attention is paid to how the symptoms arose there is little that can be done in treatment.
What are the two biological explanations of schizophrenia?
Dopamine hypothesis (higher level) Genetics
What are the two psychological explanations?
Family factors
Socio-cultural factors
What is the original dopamine hypothesis?
Dopamine is a neurotransmitter that is involved in voluntary movement, motivation, mood and attention.
Snyder proposed that too much dopamine caused schizophrenia. He noticed that anti-psychotic medication used to control the positive symptoms. Snyder found that anti-psychotics blocked dopamine receptor sites. Receptor sites are areas in the brain that absorb neurotransmitters. If a receptor site is blocked the neurotransmitter isn’t registered by the brain and so has no effect on the body. In this case, dopamine levels would be reduced. Snyder also looked at the effect of amphetamines and LSD on ‘normal’ people. Such drugs increase dopamine and cause symptoms such as delusions and hallucinations. Some say that people who take a substantial amount of these drugs are indistinguishable from a schizophrenic.
Why was there a revised dopamine hypothesis?
It was seen as too simplistic. This was mainly due to the fact that it only really explains the positive symptoms of schizophrenia. The anti psychotics that block the dopamine receptor sites only relieve the positive symptoms of the disorder. This suggests that the negative symptoms have a separate cause.
What is the revised dopamine hypothesis?
Abnormal levels of dopamine cause schizophrenia. Excess dopamine production in the mesolimbic pathway causes the positive symptoms and low dopamine production in the mesocortical pathway causes the negative symptoms of schizophrenia.
