SZ- Classification of SZ

Question 1

What is schizophrenia?

Answer 1

Schizophrenia is a severe mental illness characterised by a profound disruption of cognition and emotion.

Question 2

Which two classification systems are used to diagnose schizophrenia?

Answer 2

1) The DSM 5 (only positive symptoms need to be present)

2) The ICD 10 (only negative symptoms need to be present)

Question 3

Where is the DSM used?

Answer 3

The DSM is used in America

Question 4

Where is the ICD used?

Answer 4

The ICD is used worldwide

Question 5

What does the DSM state?

Answer 5

The DSM states that you need to show at least one positive symptom for a period of one month to be diagnosed with schizophrenia.

Question 6

What does the ICD state?

Answer 6

The ICD states that you need to show at one positive and one negative (or two negative) symptoms for at least a month to be diagnosed with schizophrenia.

Question 7

What are the two types of schizophrenia?

Answer 7

Type 1 syndrome and Type 2 syndrome

Question 8

What is Type 1 more characterised by?

Answer 8

Type 1 is characterised more by positive symptoms e.g visual/auditory hallucinations and have better prospects for recovery

Question 9

What is Type 2 more characterised by?

Answer 9

Type 2 is characterised more by negative symptoms such as poverty of speech. There is poorer prospects for recovery.

Question 10

Give examples of positive symptoms.

Answer 10

• Auditory hallucinations
• Visual hallucinations: additional sensory experiences such as hearing voices, seeing things that aren’t there
• Delusions: irrational beliefs
• Disorganised speech

Question 11

Give examples of negative symptoms.

Answer 11

• Avolition is the reduction of goal-directed activity, manifested as a lack of motivation and drive
• Speech poverty (Alogia): Changes in speech patterns, usually a reduction in the amount and quality of speech
• Affective flattening: Reduction of range and intensity of emotional expression

Question 12

Why is reliability an issue associated with the classification and diagnosis of SZ?

Answer 12

• This refers to consistency of diagnosis.
• Inter-rater reliability is the extent to which different assessors will arrive at the same conclusion when diagnosing the same patient.
• If schizophrenia is diagnosed inconsistently, this could be problematic, as it may be over or under-diagnosed by psychiatrists, meaning patients will be incorrectly labelled as ‘schizophrenic’, or not diagnosed, meaning they won’t receive the treatment they need.

Question 13

Give examples of case studies where low reliability was found.

Answer 13

• Whaley (2001) found the interrater reliability between diagnoticians as low as +0.11 (using the DSM).
• Cheniaux et al (2009) found that one diagnostician diagnosed 26 out of 100 patients with schizophrenia using the DSM and 44 out of 100 patients using the ICD. The other diagnostician diagnosed 13 using the DSM and 24 using the ICD.

Question 14

Why may reliability be low?

Answer 14

1) Client-patient factors: client unable to talk about symptoms due to their mental state
2) Clinician factors: lack of trained clinicians/ improper training
3) Classification: Problems using DSM and the ICD because the diagnosis criteria are different e.g ICD has different types of schizophrenia whereas DSM got rid of types of schizophrenia.

Question 15

Why is validity an issue associated with the classification and diagnosis of SZ?

Answer 15

• Validity is the extent to which the classification of ‘schizophrenia’ is a true reflection of the illness the patient is suffering from (does it measure what it intends to measure?).
• Criterion validity is the extent to which using different classification systems produces the same diagnosis in the same patient.

Question 16

Give examples of evidence/case studies regarding validity.

Answer 16

(-) Birchwood and Jackson (2001) found about 20% of patients of schizophrenia show complete recovery and never have another schizophrenia episode, 10% show significant improvement, 30% show some improvement. 40% never really recover. 10% are so affected that they commit suicide. This great variation in prognosis suggests very poor predictive validity.

(+) Mason (1997) found that the use of newer classification systems has improved the predictive validity of diagnosis, particularly when the 6 month criteria for diagnosis was used (rather than 1 month).

Question 17

Why is co-morbidity an issue associated with the classification and diagnosis of SZ?

Answer 17

• Co-morbidity is the presence of two different disorders at the same time.
• If this is common, it may be that the two disorders are actually one disorder, and perhaps should be seen as one condition (for example, schizophrenia and depression).

Question 18

Describe a case study regarding co-morbidity.

Answer 18

Buckley et al (2009) found that 50% of schizophrenia patients also had a diagnosis of depression, 29% had a post-traumatic stress diagnosis, and 23% had an OCD diagnosis. This supports that there are problems with validity, namely the issue of co-morbidity.

Question 19

Why is symptom overlap an issue regarding to classification and diagnosis of SZ?

Answer 19

• Symptom overlap is when two or more disorders share some of the symptoms needed for classification.
• Schizophrenia and bipolar disorder share many symptoms (such as delusions and avolition), meaning that the same patient could receive two different diagnoses.
• As with co-morbidity, if disorders share many symptoms it may be more helpful to see them as one disorder.

Question 20

How is there gender and cultural bias in the diagnosis of schizophrenia?

Answer 20

• Men are far more likely to be diagnosed, potentially because women are able to cope better with the symptoms, and people of African origin are also more likely to be diagnosed.
• Perhaps this is due to the cultural significance of ‘hearing voices’, which may be seen by white Western psychiatrists as unusual or bizarre.
• These factors support that the classification of schizophrenia lacks validity and reliability.

Question 21

Give advantages for the classification and diagnosis of schizophrenia.

Answer 21

1) Communication shorthand: a patient with a mental disorder often has numerous symptoms. It is simpler to incorporate these symptoms into a single diagnosis and this makes communication between mental health professionals much easier
2) Treatment: treatments are often specific to certain disorders e.g. symptoms of schizophrenia respond well to certain anti-psychotic drugs but not anti-anxiety. A reliable diagnosis can point to a therapy that will alleviate symptoms.
3) Although there is variation, there are many underlying biological abnormalities seen in people with schizophrenia. It is hoped that a greater understanding of these abnormalities will lead to even more effective treatment.