Schizophrenia (Sz)

Question 1

Schizophrenia

Answer 1

A mental illness that usually occurs in late adolescence or early adulthood, but it can occur at any time in life. It is classified as a psychosis, as the sufferer has no concept of reality. Essentially the illness is due to a breakdown of the patient’s personality

Question 2

Psychosis

Answer 2

A term used to describe a severe mental health problem where the individual loses contact with reality (unlike neurosis where the individual is aware that they have problems)

Question 3

Symptoms of Schizophrenia

Answer 3

• Multiple personalities
• Lack of facial expression
• Repetitive behaviours
• Sudden weight loss
• Loss of interest
• Bizarre postures
• Muddling of words
• Neglect of hygiene
• Hallucinations
• Delusions of grandeur
• Thought insertion
• Compulsions
• Avolition

Question 4

Hallucinations

Answer 4

• Involve disturbances in perception (rather than disturbances in thought) They are false perceptions that have no basis in reality
• The most common hallucinations are auditory ones (hearing voices) but can include smell, touch and sight
• Visual hallucinations
• Seeing distorted facial expressions

Question 5

Delusions

Answer 5

False beliefs that are firmly held despite being completely illogical, or for which there is no evidence

Question 6

Delusions of persecution

Answer 6

The belief that others want to harm, threaten or manipulate you. Schizophrenics may believe that they are being spied on, that nasty rumours are being spread about them or that people are plotting to kill them

Question 7

Delusions of grandeur

Answer 7

This is the idea that you are an important individual, even god-like and have extraordinary powers. One of the most frequent of this type of delusion is the belief that they are Jesus Christ

Question 8

Delusions of control

Answer 8

Individuals may believe that they are under control of an alien force that has invaded their mind and/or body. This may be interpreted, for example as the presence of spirits or implanted radio transmitters

Question 9

Negative symptoms

Answer 9

Cause a decline in functioning. They appear to reflect a loss of normal function.

Question 10

Speech poverty

Answer 10

The inability to speak properly, characterised by a lack of ability to produce fluent words; this is thought to reflect slowing or blocked thoughts. It can manifest itself as short and empty replies to questions.

Question 11

Avolition

Answer 11

The reduction, difficulty or inability to start and continue with goal-directed behaviour. It is often mistaken for apparent disinterest. E.g. no longer being interested in going out and meeting with friends. Sometimes called apathy

Question 12

Compulsions

Answer 12

Behaviours that have to be done. These may be instructions from somebody else.

Question 13

Mood disturbances

Answer 13

Affective flattening - lack of emotion in responses
Inappropriate affect - the wrong emotion for the topic/situation e.g. laughing at a funeral

Question 14

Positive (adding) symptoms of Schizophrenia

Answer 14

• Hallucinations
• Delusions
• Thought disorders
• Disorganised speech

Question 15

Negative (taking away) symptoms of Schizophrenia

Answer 15

• Reduction in range and intensity of emotional expression
• Avolition
• Asocial behaviour
• Speech poverty
• Neglect of hygiene

Question 16

Positive symptoms

Answer 16

Symptoms that are not usually present in a normal person. They reflect an excess or distortion of normal functioning.

Question 17

DSM

Answer 17

• Diagnostic and Statistical Manual of Mental Disorders (DSM)
• Used in America
• Used to recognise the subtypes but the most recent version (DSM-5) have dropped these

Question 18

Clinical characteristics of Schizophrenia from DSM

Answer 18

Criterion A - Two or more of the following symptoms
- Delusions
- Hallucinations
- Disorganised speech
- Grossly disorganised or catatonic behaviour
- Negative symptoms
- Only on of these symptoms is needed if delusions are bizarre and hallucinations include a voice that constantly commentates

Criterion B - Social/occupational dysfunction

Criterion C - Duration
- Continuous signs of the disturbance persist for at least 6 months

Question 19

ICD

Answer 19

• International Statistical Classification of Diseases and Related Health Problems (ICD)
• World Health Organisation
• UK
• ICD-10 featured subtypes but the current version (ICD-11) does not contain the subtypes

Question 20

ICD-10 - Five main subtypes of Sz

Answer 20

• Disorganised
• Catatonic
• Paranoid
• Undifferentiated
• Residual

Question 21

Disorganised Schizophrenia

Answer 21

• Generally disorganised behaviour
• Thought disturbances
• Absence of expressed emotion, incoherent speech, mood swings, loss of interest

Question 22

Catatonic Schizophrenia

Answer 22

• Severe motor abnormalities
• Unusual gestures or use of body language
• Repetitive movements
• Total immobility for hours at a time, with the patient simply staring blankly

Question 23

Paranoid Schizophrenia

Answer 23

• Delusions (persecution or grandeur)
• Patient remains emotionally responsive and are more alert
• Argumentative
• Least serious but most well known

Question 24

Undifferentiated Schizophrenia

Answer 24

Includes patients who do not clearly belong in any other category

Question 25

Residual Schizophrenia

Answer 25

Describes people who, although they have had an episode of Schizophrenia during the past 6 months and still exhibit some symptoms but these are not strong enough to put the patient in another category. Symptoms are mild.

Question 26

Rosenhan (1973) Aim

Answer 26

To investigate how situational factors affect a diagnosis of schizophrenia. Sane confederates went into psychiatric hospitals and told medical health professionals they had a hallucination, and observed whether staff would realise that they were sane. If staff did not detect their sanity, it would have implications for methods of diagnosing mental illness and show that situational factors affect diagnosis.

Question 27

Rosenhan (1973) Method

Answer 27

8 confederates acted as pseudo patients, going to 12 different hospitals. The real participants were the hospital staff who did not know about the experiment. The pseudo patient called the hospital for an appointment. When they arrived they complained of hearing voices saying “empty”, “hollow” and “thud”. They said that the voices were unclear, unfamiliar and of the same sex as the pseudo patient. Pseudo patients gave false names, occupations and
symptoms, but gave real life histories. Once on the ward, the pseudo patients stopped pretending symptoms, behaved normally and wrote observations. Pseudo patients were discharged only
when they convinced staff that they were sane.

Question 28

Rosenhan (1973) Results

Answer 28

On admission, staff diagnosed 11 pseudo patients with schizophrenia, and one with manic-depression. Staff never detected their sanity. Nurses reported their behaviour as showing “no abnormal indications”, but did interpret their behaviour in the context of their diagnosis. The average hospital stay was 19 days. All pseudo patients were discharged with diagnosis of schizophrenia ‘inremission’. 35 real patients detected sanity (e.g., saying “You’re not crazy”).

Question 29

Rosenhan (1973) Conclusion

Answer 29

Rosenhan’s research showed that psychiatrists cannot reliably tell the difference between an insane and sane person, calling into question the reliability of a schizophrenia diagnosis. ‘Normal’ behaviour was misinterpreted as ‘abnormal’ to support their idea that the pseudo patients had a mental illness. This suggests the validity of psychiatric diagnoses was low and the DSM was flawed.

Question 30

Follow up study - Rosenhan

Answer 30

• Staff in on hospital were asked to rate patients, seeking admission on a 10 point scale from ‘highly likely to be a pseudo patient’ (1 or 2) to ‘least likely to be a pseudo patient’
• At this point, they were aware of the previous study and were told that one or more pseudo patients would be sent their way unannounced
• 41 out of 193 patients received a 1 or 2 score
• No pseudo patients were actually sent