Schizophrenia: Classification of schizophrenia

Question 1

What is the nature of schizophrenia?

Answer 1

Schizophrenia is defined as a psychotic disorder marked by severely impaired thinking, emotions, and behaviours. Schizophrenic patients are typically unable to filter sensory stimuli and may have enhanced perceptions of sounds, colours, and other features of their environment. SZ ranks among the top ten cases of disability in the world and affects about 4 in 1000 people at some time in their lives.

Question 2

How do you diagnose someone with schizophrenia?

Answer 2

There are two types of classification systems for mental disorders: The Diagnostic and Statistical Manual of psychiatric disorders is currently the DSM-V (only positive symptoms are needed) and the International Classification of Diseases is currently the ICD-10 ( only negative symptoms need to be present)

These two systems have different requirements for the diagnosis of schizophrenia. Despite both requiring the persistence of symptoms for at least 1 month, the DSM-V has more specific diagnostic criteria and so requires at least 2 or more delusions, hallucinations, disorganised speech and catatonic behaviour, whereas the ICD-10 takes a broader approach to diagnosis, simply stating that the clinical picture is dominated by relatively stable, often paranoid delusions, usually accompanied by hallucinations.

Question 3

What are the 2 types of symptoms of SZ?

Answer 3

Positive and negative

Question 4

What are the positive symptoms of SZ?

Answer 4

Those that appear to reflect an excess or distortion of normal functions - things ‘normal’ people don’t do

Question 5

What are negative symptoms of SZ?

Answer 5

Those that appear to reflect a diminution or loss of normal functions which often persist during periods of low (or absent) positive symptoms - things ‘normal’ people do. Negative symptoms weaken their ability to manage without significant outside help. Individuals with sz are often unaware of the extent of their negative symptoms and are typically less concerned about them than their relatives may be. Enduring negative symptoms are sometimes referred to as the ‘deficit syndrome’.

Question 6

Under the DSM, how does someone become diagnosed with SZ?

Answer 6

Requires at least a one-month duration of 2 or more positive symptoms.

Question 7

What is the main classificatory system for SZ?

Answer 7

The DSM

Question 8

Name the 4 main positive symptoms of SZ.

Answer 8

1) Hallucinations
2) Delusions
3) Disorganised speech
4) Grossly disorganised or catatonic behaviour

Question 9

What are delusions?

Answer 9

Bizarre beliefs seem real to the person with schizophrenia, but they are not real. Sometimes these delusions can be paranoid and natural. This often involves a belief that the person is being followed or spied upon by someone. They may believe that their phone is tapped all that there are video cameras hidden in their home. Delusions may also involve inflated beliefs about the person’s power and importance. For example, the individual may believe that there are famous or have special powers or abilities. An individual may also experience delusions of reference when events in the environment appeared to be directly related to them – for example, special personal messages are being communicated through the TV or radio.

Question 10

Name 3 different types of delusions for SZ

Answer 10

1) Persecutory delusions
2) Thought insertion
3) Grandiose delusions

Question 11

What are hallucinations?

Answer 11

These are bizarre and unreal perceptions of the environment that are usually auditory (hearing voices that other people can’t hear) but may also be visual (seeing lights, objects or faces that other people can’t see), olfactory (smelling things that other people can’t smell) or tactile (feeling of bugs are crawling under one’s skin or touching something on the skin). Many schizophrenics report hearing a voice or several voices, telling them to do something (such as harm themselves or someone else) or commenting on their behaviour.

Question 12

What is disorganised speech?

Answer 12

Is the result of abnormal thought processes, where the individual has problems organising his or her thoughts as this shows up in their speech. They may slip from one topic to another, even in mid-sentence, and in extreme cases the speech may be so incoherent that it sounds like complete gibberish – something that is often referred to as ‘word salad’.

Question 13

What is grossly disorganised and catatonic behaviour?

Answer 13

Includes the inability or motivation to initiate a task, or to complete it once it started, which leads to difficulties in daily life and can result in a decreased interest in personal hygiene. The individual may dress or act in ways that appear bizarre to other people, such as wearing heavy clothes on a hot summer’s day. Catatonic behaviours are characterised by a reduced reaction to the immediate environment, rigid postures or aimless motor activity.

Question 14

Name 4 negative symptoms for SZ

Answer 14

1) Affective flattening
2) Alogia (speech poverty)
3) Avolition
4) Anhedonia

Question 15

What is speech poverty (Alogia)?

Answer 15

Characterised by the lessening of speech fluency and productivity. This is thought to affect slowing or blocking thoughts. Patients who display speech poverty display a number of characteristic signs. They may produce fewer words in a given time on a task of verbal fluency. This is not a matter of not knowing as many words as non-schizophrenics, but more a difficulty of spontaneously producing them. Speech poverty may also be reflected in less complex syntax. This type of speech appears to be associated with a long illness and earlier onset of the illness.

Question 16

What is avolition?

Answer 16

A reduction of interests and desires as well as an inability to initiate and persist in goal-directed behaviour (e.g sitting in the house for hours every day, doing nothing). Avolition is distinct from Poor social function or disinterest, which can be the result of other circumstances. For example, an individual may have no social contact with family or friends because they have none, or communication with them is difficult. This would not, however, be considered avolition, which is specified as a reduction in self-initiated involvement in activities that are available to the patient.

Question 17

What is affective flattening?

Answer 17

A reduction in the range and intensity of emotional expression including facial expression, Voice tone, eye contact and body language. Compared to controls without this symptom, individuals show fewer body and facial movements and smiles, unless they have Co-verbal behaviour. When speaking, patients may also show a deficit in prosody ie. paralinguistic features that provide extra information that is not explicitly contained in a sentence, and which gives cues to the listener as to emotional or attitudinal content and turn taking.

Question 18

What is anhedonia?

Answer 18

A loss of interest or pleasure in all or almost all activities, or a lack of reactivity to normally pleasurable stimuli. It may be pervasive or it may be confined to a certain aspect of the experience. Physical anhedonia is the inability to experience physical pleasures such as pleasure from food, body contact and so on. Social anhedonia is the inability to experience pleasure from interpersonal situations such as interacting with other people.