Schizophrenia - Diagnosing Schizophrenia

Question 1

Define Schizophrenia

Answer 1

Schizophrenia is defined ‘’ as a psychotic disorder marked by severely impaired thinking, emotions, and behaviours.’’

Question 2

What are Schizophrenia patients typically unable to do?

Answer 2

Schizophrenia patients are typically unable to filter sensory stimuli and may have enhanced perceptions of sounds, colours, and other features of their environment’’

Question 3

Sufferers may experience either or both ______ and _______ symptoms.

Answer 3

positive, negative

Question 4

What are positive symptoms?

Answer 4

Positive symptoms enhance the typical experience of sufferers, and occur in addition to their normal experiences e.g hallucinations and delusions

Question 5

What are negative symptoms?

Answer 5

Negative symptoms take away from the typical experience of sufferers and so represents a ‘loss’ of experience e.g speech poverty and avolition.

Question 6

Explain hallucinations

Answer 6

A positive symptom, additional sensory experiences such as seeing distortions in objects that look like faces, or hearing critical voices.

Question 7

What do auditory hallucinations involve?

Answer 7

Auditory hallucinations may involve hallucinating the voices of loved one or the deceased and are, for example, thought to be caused by an excess of dopamine receptors in Broca’s area.

Question 8

Explain delusions.

Answer 8

A positive symptom of schizophrenia. Irrational beliefs about themselves or the world. For example feelings of persecution ie. the government or feelings of grandeur ‘‘president’’

Question 9

What are some different types of delusions?

Answer 9

Persecutory, delusions of grandeur, delusional jealousy, erotonomania and somatic delusional disorders

Question 10

Explain speech poverty

Answer 10

A negative symptom . Brief verbal communication style. Loss of quality and quantity of verbal responses.

Question 11

‘Derailment’ is a common type of speech poverty. How is this caused?

Answer 11

Dysfunctions are in central conflict and so the sufferer cannot suppress the automatic associations that come with each new word or idea.

Question 12

Describe avolition

Answer 12

A lack of purposeful, willed behaviour. No energy, sociability affection or attempt at personal hygiene. Generally apathetic.

Question 13

What are the two types of classification systems for mental disorders?

Answer 13

The Diagnostic and Statistical Manual (DSM-5)
International Classification of Disease (ICD-10)

These two systems have different requirements for the diagnosis of schizophrenia.

Question 14

What is the diagnostic criteria for the DSM-5?

Answer 14

• Persistence of symptoms for at least 1 month
• At least 2 or more - delusions, hallucinations, disorganised speech and catatonic behaviour

It has a more specific diagnostic criteria than the ICD-10

Question 15

What is the diagnostic criteria for the ICD-10?

Answer 15

Simply states that ‘‘the clinical picture is dominated by relatively stable, often paranoid delusions, usually accompanied by hallucinations.’’

Question 16

What are the main differences between the DSM-5 and the ICD-10?

Answer 16

• what organisations produce them
• the number of symptoms and specificity of symptoms required for diagnosis
  -the recognition of different subtypes of schizophrenia

Question 17

What are the different subtypes of schizophrenia? Who recognises them?

Answer 17

Positive schizophrenia = having symptoms of prominent delusions, hallucinations

Mixed schizophrenia = the prominent symptoms are either both negative or positive, or neither is prominent.

Subtypes are currently recognised in the ICD-10 only, whereas previous editions of the DSM also made these distinctions.

Question 18

What are the limitations of diagnosing schizophrenia?

Answer 18

• There is a significant co-morbidity between schizophrenia and other mental health disorders, such as OCD and PTSD suggested by Buckley et al (2009). These researchers found that 29% of their SZ patients suffered PTSD whilst, 50% suffered depression. This suggests that because SZ is so frequently diagnosed with other psychiatric
  disorders, then these two disorders may actually be the same. It would therefore make sense to combine them. There are issues of validity in the diagnosis of SZ and attempting to differentiate its symptoms from that of other disorders.
• Gender bias in the diagnosis of schizophrenia, as suggested by Longenecker et al (2010), who could not find an explanation for the sudden increase in the number of male SZ diagnoses made after 1980s. Cotton et al (2009) suggests there are no differences in genetic susceptibility for men and women in terms of SZ, so gender bias must be to blame. Dispositional traits of most women, such as high interpersonal functioning and being able to work even when suffering, means that such traits may mask the symptoms of schizophrenia or distort their severity so that they are not serious enough to call for a diagnosis. This means that the current system of the diagnosis of SZ does not account for these biases, increasing the likelihood of inaccurate diagnoses.
• Culture bias. African Americans are far more likely to be diagnosed with SZ compared to patients belonging to Western cultures, due to their increased openness about admitting to certain SZ symptoms which may appear normal in their respective cultures. For example, the phenomenon of hearing voices may be considered a desirable sign of increased spirituality and connectedness with ancestors, and so may even be encouraged. However,
  both classification systems would view this as a hallmark characteristic of SZ and, combined with the potential distrust in African Americans that white psychiatrists may have, could increase the likelihood of false diagnoses.

Question 19

What is reliability?

Answer 19

How consistent the results are using the same measuring tool, so if we measure again we get the same results.

Question 20

What is validity?

Answer 20

Are the measurements made correctly referring to something real in the world, so in schizophrenia, that a person really has the disorder when diagnosed, or that schizophrenia is a real disorder with clear and unique symptoms.

Question 21

What is inter-rater reliability?

Answer 21

The measure of how two observers agree. For example two doctors giving the same diagnosis.

Question 22

What is test-retest reliability?

Answer 22

The same doctor giving the same diagnosis over time with the same symptoms.

Question 23

What did Beck do to test inter-rater reliability?

Answer 23

Review of 153 patients who had been diagnosed by multiple doctors. Found only a 54% concordance rate between the doctor’s assessments. Suggests there is low inter-rater reliability in the diagnosis of schizophrenia. This also suggests many people have been diagnosed incorrectly, potentially having inappropriate treatments.

Question 24

What is co-morbidity?

Answer 24

Schizophrenia is often diagnosed with other disorders. This could be leading to inaccurate diagnosis of schizophrenia, when it could be a severe case of depression. Or as these diagnoses often occur together they are perhaps not separate disorders.

Question 25

According to Buckly what are the co morbidity rates with schizophrenia? What does this suggest?

Answer 25

Depression 50%
Drug abuse 47%
PTSD 29%
OCD 23%
Suggests that the original diagnosis of schizophrenia may be in error if the disorders share symptoms

Question 26

What is symptom overlap?

Answer 26

Bipolar disorder also has hallucinations and delusions as a symptom. If the two disorders are so similar i may be they are not actually distinct and they should be redefined.

Question 27

What is an issue with validity in relation to gender?

Answer 27

Men and women are equally likely to be diagnosed, however men’s average age of diagnosis is 25, 5 years sooner than women. Men are more likely to have drug abuse as a comorbidity, have worse social functioning and suffer negative symptoms. Women are more likely to display positive symptoms.

Question 28

What is an issue with validity in relation to culture?

Answer 28

People with Afro-Caribbean heritage in the UK and African Americans are up to nine times more likely to be diagnosed with Schizophrenia compared to 1% of the general population.

Question 29

How have issues with validity as a result of culture bias come about?

Answer 29

As schizophrenia rates are also 1% in countries of origin the rise in diagnosis rates are likely due to cultural bias or as Fernando suggests ‘‘category failure’’ western definitions of mental illness are applied to non-western cultures.

E.g How hearing the voices of angels would be defined as an auditory hallucination in the UK but a religious experience in the west indies.

Question 30

Give a study related to validity in schizophrenia.

Answer 30

Loring and Powell - sent 290 psychiatrists two identical case studies however gender and race of the case studies where changed to a white male, black male, white female, black female, or no gender or race disclosed. Found over diagnosis of the black case studies and underdiagnosis of female case studies. The most accurate diagnosis was when the gender and race of the psychiatrist was the same as the case study. Suggests existence of both gender and culture bias in psychiatrists diagnosis of schizophrenia.