Schizophrenia - Diagnosis & Classification Flashcards
pos + neg symptoms, Rosenhan, studies
Positive symptoms
Additional experiences of the disorder beyond ordinary existence
Hallucinations
Sensory experiences that don’t truly exist (visual, auditory, gustatory, tactile, olfactory)
Delusions
Irrational beliefs that can cause unusual behaviour
Disorganised speech/thought
Struggle to coherently speak or think
Negative symptoms
Loss of experiences/abilities and detract from ordinary experiences
Speech poverty
Reduction in quality & amount of speech (i.e. delayed responses)
Avolition
Reduced motivation or difficulty beginning goal-oriented activities
Diminished emotional expression
Lack showcasing emotions, no tone or expression changes
Rosenhan study 1: Aim & sample
See whether a group of sane people presenting themselves as having a disorder would be diagnosed insane (12 psychiatric hospitals across 5 states)
Rosenhan study 1: Research method
8 pseudo-patients inc. Rosenhan, participant observation
Rosenhan study 1: Procedure
- Phoned hospital and claimed they were hearing voices (words unlinked with schz - empty, hollow, thud)
- Acted normally once admitted and said no longer experienced symptoms
- Display exemplary beh.
Rosenhan study 1: Results & effects of labelling
- All were admitted, all but 1 given schz. diagnosis
- In hospital from 7-52 days
- None were suspected by staff but 35/118 other patients suspected them
- Type 1 error due to being overcautious, interpret normal behaviours as pathological due to diagnosis
Rosenhan study 2: Aim & sample
Would psychiatrists/MH workers be undercautious due to the first study (1 of the hospitals from the first study)
Rosenhan study 2: Research method
Questionnaire
Rosenhan study 2: Procedure
- Staff informed pseudo-patients would be being admitted in the next 3 months
- None were truly presented
- Asked to rate all admitted patents on a 10-point scaled (1/2 being high confidence of pseudo)
Rosenhan study 2: Results
193 were admitted
- 41 suspected by at least 1 staff
- 23 suspected by 1 psychiatrist
- 19 suspected by 1 psychiatrist & 1 other staff
Type 2 error - undercautious
Rosenhan: Conclusions
Diagnosis was seen as invalid because the sane & insane could not be distinguished from one-another
Could be reliable due to all but 1 in first study recieving same diagnosis
Lack of accuracy in diagnosis has consequences
+ Key study findings: Osorio et al
Single diagnostic system is more reliable (180 participants) - inter-rater reliability of diagnosis +0.97, test-retest +0.92
- Key study findings: Cheniaux et al
Independent assesment of 100 people using either diagnostic (39 w/DSM, 68 w/ICD) - loses reliability
Key study findings: Szasz’s views on MH
- MH is a myth
- Causes stigmatisation
- They are only real with physiological impacts
- Behaviour is not a disease
Co-morbidity
Simultaneous existence of multiple disorders alongside a primary disorder
Symptom overlap
Symptoms existing for multiple disorders
- Buckley et al (co-morbidity)
50% also have depression, 47% substance abuse, 23% OCD - classification lacks validity
- Symptoms of bi-polar (overlap)
Manic episodes (delusions)
Depressive episode (diminished emotional expression, avolition)
- Pinto & Jones (ethnicity)
African-Caribbean origin -> 9x more likely to be diagnosed schizophrenic
- Fischer & Buchanan (gender)
Men diagnosed more (1.4:1) [Cotton et al - underdiagnosed due to closer relationships with people leading to more support for condition]
- Afro-Caribbean views of hallucinations
Interpreted different in Haiti as its considered communication with ancestors (ethnocentric/culturally biased diagnosis)
