Schizpohrenia

Question 1

Schizophrenia classification

Answer 1

-1% of population
- symptoms usually start around 15-45 yrs
-men are more likely to develop

Question 2

Positive symptoms

Answer 2

-hallucinations or delusions
- in addition to normal experiences

Question 3

Negative symptom

Answer 3

-loss of normal experiences and abilities
-avolition
-speech poverty

Question 4

Avolition

Answer 4

Lack of purposeful, willed behaviour, no energy or sociability, or attempt at personal hygiene
- reduction of interests and desires
- no goal directed behaviour

Question 5

Speech poverty

Answer 5

brief verbal communication, loss of quality and quantity however can be classed as +ve if speech is exsecively disorganised
-decrease in fluency and productivity
- fewer words
-often slur

Question 6

Hallucinations

Answer 6

-additional sensory experiences such as seeing distorted objects that look like faces or hearing critical voices
- 70% of patient suffer from auditory hallucinations

Question 7

Delusions

Answer 7

-irrational beliefs about themselves or world
- e.g feelings of persecution: belief they are bing spied on or plotted against by others e.g government
-grander: may believe they are an important religious figure or religious e.g the pope or queen

Question 8

-ve of schizophrenia classification

Answer 8

-beck in a review of 153 patients who had been diagnosed by multiple doctors found only a 54% concordance rate between doctors assessment
-suggests low inter-rater reliability in diagnosis is schizophrenia
-also suggests many people have been diagnosed incorrectly, potentially having inappropriate treatment, or not diagnosed and missing out on treatments

• symptom overlap
• bipolar also share hallucinations and delusions as symptoms
  -fact that there is such a symptom overlap leads us to question whether bi polar and schizophrenia are even two separate conditions
• may need to think of definitions we use for schizophrenia
  -undermining its validity of the diagnosis
• gender bias
  -see gender differences, men seem to develop symptoms earlier, average of 25, 5 yrs sooner than women
  Men more likely to experience -ve symptoms and women +ve.
• suggested women’s experiences are taken less seriously and under diagnosed compared to men

-Bucky found the following co morbidity rates with schizophrenia
-depression;50%
-drug abuse : 47%
- PTSD: 29%
-OCD: 23%
- as well as complicating treatment plans, this suggests the OG diagnosis of schizophrenia may be in error if the disorder share symptoms

Question 9

Reliability

Answer 9

-the consistency of the diagnosis
- inter- rater reliability: there is an agreement in diagnosis by different psychiatrists across time and cultures
- test retest reliability: whether diagnostic tests are consistent on different occasions

Question 10

Evaluation of reliability

Answer 10

-criticism that the DSM and ICD tools are routinely used with a high level of reliability with mental health clinicians
- e.g chineaux asked 2 psychiatrists to independently diagnose 100 patients using the DSM and the ICD
Inter rater realibaility was poor , example the DSM one psychiatrist diagnosed 26 patients with SZ whilst the other only diagnosing 13
- is a weakness of the diagnostic systems as they failed to produce consistent results show it shows the diagnosis of SZ is poor.
-additionally recent research found the rlinability of SZ has improved
- osorio et al reported excellent reliability for the diagnosis if SZ using DSM-5
-inter rater reliability scored 97
-test retest scored 92
Even tho classification systems aren’t perfect they do provide clinicians with common language permitting communication of ideas and findings which may lead to a better understanding of SZ and therefore more treatments

Question 11

Co morbidity

Answer 11

-issue for reliability
- referees to the presence of two or more disorders or diseases simultaneously occcuring w/ SZ
- e.g ppl woth SZ commonly suffer with
Substance abuse 57%
Anxiety 15%
Depressions 50 %
-if a sufferer can experience simultaneous disorders this could suggest SZ may not be a separate disorder
-could lead to professionals giving diffferent diagnosis’s of the same patient

Question 12

Evaluation of co morbidity

Answer 12

-large body of evidence to suggest many sufferers also have issues of subasyance abuse
- Buckley found 50% of SZ patients also have depression or substance abuse. Alcohol cannabis and cockney can be abused by people with SZ
-not only does co morbid substance abuse make a reliable diagnosis difficult to achieve
- it also leads to low level of functioning, increased hospitalisation and lower compliance with medication
-so affective treatment is more difficult to achieve
- strength as is demonstrated the complexities involved in giving a reliable diagnosis of person with SZ is also using drugs
-sufferers who use recreational drug may find itt difficult to achieve a reliable diagnosis as its difficult to know what sympotoms are the effect if SZ or the drugs
- additionally, Jesé et all states those sufferers of SZ with co morbid conditions are excluded from research and yet for the majority of patients
- suggests research findings into the causes of SZ may nt=ot be based on reliable research ass samples are not consistent

Question 13

Culture bias

Answer 13

The extent to which the diagnostic system reflects beliefs about what is viewed as normal and acceptable in western predominantly white cultures
-reduces validity of diagnostic system
IDC + DSM were developed by western cilinicials, criticised for lacking cultural relativism
-e.g those who hear voices, may be normal in their own culture yet classifie as having SZ
-can effect reliability of diagnostic systems
- research suggests there is a significant variation between cultures when it coms to diagnosing SZ
-Copeland gave 134 US and 194 British psychiatrists a description of a patient
-60% of us diagnose SZ
- 2% of British ones did
-shows diagnosis was unreliable across cultures

Question 14

Evaluation of culture bias

Answer 14

• research suggests the diagnosis of SZ is affected by culture bias
  -e.g pinto and jones reported that in Haiti some ppl believed that voices are communications from ancestors
  -British people of African- Caribbean origin are up to 9 times more likely to receive dignosis that white British people although ppls living in African Caribbean controls are not, ruling out a genetic vunreablity
• weakness of diagnostic systems as is highlights the difference in diagnostic statistic of some cultural groups is due to the biased over-interpretations of symptoms by psychiatrists
  -however higher statistics could represent the effects of the poorer housing, higher rates of unemployments and social isolation that are more commonly xperience by Minotaur’s group lie like African Caribbean groups.

Question 15

Validity

Answer 15

-the extent at which the methids used to measure SZ are accurately measuring them
- e.h may have hallucinations but no SZ (symptom overlap, comorbidity) , psychiatrists misinterpreting behaviour (culture bias gender)
Can assess validity using predictive validity: if diagnosis leads to successful treatment then diagnosis seen as valid
-research findings are mixed, some report when u match patients to DSM there’s good correlation suggesting dagnosis is valid

-however two diagnosed patients can differ greatly on the precise symptoms each displays
-e.g one shows delusions and other does not bu both have SZ diagnosis
Suggests single labelling of SZ is not valid
-more valid to use presence or absence of +ve or -ve symptoms to distinguish different forms of SZ ad DSM 5 does.

Question 16

Evaluation of validity

Answer 16

-threat to validity of diagnosis is that the same way people diagnosed with SZ rarely share the same symptoms likewise there is no evidence that they share the same outcomes
- prognosis from patients diagnosed with SZ varies with about 20 % recovering their previous level of functioning.
-10% acieveing significant and lasting improvements
- 30% showing some improvement with intermittent relapses
-problem as diagnosis therefore has little predictive validity because some people never appear to never recover from disorder while many do
- additionally what does appear to influence it come is more to do with gender and psychosocial factor such as social skills, academic achievement and family tolerance of SZ behaviour

Question 17

Gender bias

Answer 17

-accuracy of diagnosis is dependent on gender of individual
-diagnostic system may be gender bias or clinicians may base their diagnosis on steryptypial beliefs
- statistically since 1980s men are diagnosed more than women
-may be due to genetic factors as women are less vulnerable
-more likely because they have support and there for function better
- cotton found that patients with SZ who were female functioned better than men
E.g mor likely to work and have god family relationships
-may explain hy women are not diagnosed woth SZ as frequently

Question 18

Evaluation of gender bias

Answer 18

-research suggests gender bias is a problem in diagnosis so therefore subsequent treatment
- evidence shows males could be more likely to be committed to psychiatric institutions when they show mild signs of SZ due to risk of being deviant, females however are more likely to be voluntary patients beacuse they a re more likely to seek help earlier
-strength as it supports Ida that gender differences in diagnosis exist
-their better interpersonal functioning may bias clinicians to underdiagnose SZ in women
- threatens validity of diagnostic system because people may get incorrect or no diagnosis based on gender.

Question 19

System overlap

Answer 19

• symptoms of SZ are found in other disorders
  -e.g halllucinations in bi polar
  -this makes it difficult for clinicians to accurately decide and diagnose which disorder someone has

Question 20

System overlap evaluation

Answer 20

-research suggests symptom overlap can cause issues when accurately and reliably diagnosing SZ
- ophoff found a genetic overlap between bio polar and SZ
-3 of 7 gene locations on the genome associated with SZ were also associated woth bi polar, both involve +ve symptoms like delusions and -ve symptoms like avolition
Height th Polk me when trying to distinguish SZ from other disorders and in terms of classification suggests SZ and bi polar may not to be two diff conditions

-additionally Ellison and Ross point put that there’s not only a great overlap in SZ and bi polar but people with DID have more symptoms of SZ than people diagnosed with SZ
- this is a problem as it brings to question whether SZ. Bi polar and DID are separate at all or part of the same spectrum.
- due to system overlap is can lead to years of delay in receive correct treatment, leading to further degeneration of mental health and increase in suicide risk.
-again questions validity of the methods used to assess SZ
-despite issues classification systems are updated and revised to improve the accuracy and reliability by creating more clear and distinct labels for illnesses

Question 21

Additional evaluation of reliability and validity

Answer 21

-major conseqences of invalid or unrealisable diagnosis of SZ related to social stigma by being ncrrecly labelled
- such as innacurate diagnosis can have long lastive -ve impact on lives of those diagnosed
- despite problems, classification systems allow a common language which helps to communicate ideas and allow for greater opportunities for research which can lead to better understanding of SZ

Question 22

How it’s classified

Answer 22

• diagnosed by classification systems
• DSM-5 and the ICD-10
  -can defer in their classifications of SZ
  -DSM requires one +ve symptom to be present
• ICD does not

Question 23

DSM-5

Answer 23

Criterion A- must show two or more of symptoms for a on month period
Criterion B- reduction in one or more major functioning such as work
Criterion C - continuous disturbance must persist for 6 months during which patient must experience at least 1 month of active symptom