Schizophrenia

• Cheniaux et al (2009)had two psychiatrists independently diagnose 100 patients using both DSM and ICD criteria. What were the results?

  Psychiatrist 1 using DSM = 26. Psychiatrist 1 using ICD = 4. Psychiatrist 2 using DSM = 13. Psychiatrist 2 using ICD = 24.
• Name 2 weaknesses of the diagnosis of schizophrenia.

  Poor inter-rater reliability and reliability.
• Criterion validity


  The extent to which different assessment systems arrive at the same diagnosis for the same patient.
• Cheniaux et al (2009)study suggests that it is much more likely to be diagnosed using which one? ICD or DSM?


  ICD.
• Cheniaux et al (2009)study suggests that it is much more likely to be diagnosed using ICD rather than DSM. This suggests that schizophrenia is either o..........-d.............. in ICD or un............-d............ in DSM.


  Over-diagnosed and under-diagnosed.
• One weakness of the diagnosis of schizophrenia is that it has poor v........

  Poor validity.
• Schizophrenia.


  Term comes from two Greek words: 'schizo', meaning 'split', and 'phrena' meaning 'mind'. The 'split' in schizophrenia occurs between a person's thought processes and reality.
• Co-morbidity


  Morbidity refers to a medical condition or how common it is. Co-morbidity is the occurrence of two illnesses or conditions together
• How can conditions occurring together often be a problem?

  It calls into question the validity of their diagnosis and classification because they might actually be a single condition
• Schizophrenia is commonly diagnosed with other c..........

  Conditions.
• Confusing picture of schizophrenia is a....

  Weakness of diagnosis and classification.
• Symptom overlap


  There is considerable overlap of symptoms of schizophrenia and other conditions.
• Both schizophrenia and bipolar disorder, for example, involve positive symptoms like.....


  Delusions and negative symptoms like avolition.
• The overlap of symptoms calls into question the v...... of both the cl........... and the d.......... of schizophrenia.

  Validity of both the classification and the diagnosis of schizophrenia.

  
• On Being Sane in Insane Places highlighted what?

  The unreliability of diagnosis.
• What is gender bias in diagnosis?

  The tendency for diagnostic criteria to be applied differently to males and females.
• What does gender bias in schizophrenia diagnosis suggest?

  If women are under-diagnosed then this suggests that the validity of the diagnosis of schizophrenia is poor, because the procedures for diagnosis work well only on patients of one gender.
• Cultural bias in diagnosis.


  The tendency to over-diagnose members of other cultures as suffering from schizophrenia.
• A........ A.......... and English people of Afro-C............ origin are several times more likely than white people to be diagnosed with schizophrenia.


  African Americans and Afro-Caribbean.
• How is cultural bias in diagnosing schizophrenia a problem.

  It suggests that the validity of the diagnosis is poor because either it is confounded by cultural beliefs and behaviours in patients, or by a racist distrust of black patients on the part of mental health practitioners.
• Explain what it means by positive symptoms of schizophrenia.


  Atypical symptoms that are experienced in addition to normal experiences. They add to the condition. Examples include hallucinations and delusions.
• Explain the term avolition.

  Sometimes called 'apathy', avolition is a negative symptom that involves a loss of motivation to execute tasks and results in lowered activity levels.
• What does Rosenham's study tell us about the reliability of the diagnosis schizophrenia?


  The diagnosis of schizophrenia is not very reliable and is problematic because the staff failed to identify the pseudo-patients. Gender bias and cultural bias are also issues in the diagnosis of schizophrenia.
• Under ICD a patient might receive a d.......... of schizophrenia, however many of the same patients would receive a diagnosis of b.......... disorder under DSM criteria.

  Under ICD a patient might receive a diagnosis of schizophrenia, however many of the same patients would receive a diagnosis of bipolar disorder under DSM criteria.
• Why does schizophrenia have to be treated holistically?

  No two people with schizophrenia are the same.
• What is the genetic basis for schizophrenia?

  Most modern mental health professionals believe that schizophrenia is at least partly biological in origin. We are going to consider the genetic vulnerability to schizophrenia, the possible role of the neurotransmitter dopamine and the neural correlates of schizophrenia. These three explanations are inter-related because, if schizophrenia is genetic, then those genes lead to biological differences such as abnormal levels of dopamine and/or structure of the brain (neural correlates).
• Gottesman studied families. What was the conclusion?


  If both your parents suffer from schizophrenia, then you have a 46% chance of developing it yourself (compared to a 1% chance of someone selected at random will suffer).
• Schizophrenia - The more genetically s....... relatives are, the more c........... is found.

  The more genetically similar relatives are, the more concordance is found.
• Kendler;1983) looked at concordance rates for MZ and DZ twins.
• Is there a candidate gene for schizophrenia?

  No, it's polygenic. Different combinations of factors lead to schizophrenia.
• How many separate genetic variations that are associated with increased risk of schizophrenia?

  108.
• There is strong evidence for genetic vulnerability to schizophrenia. Describe the results for Tienari et al's 2004 adoption study.


  Children of schizophrenia sufferers are still at a heightened risk of schizophrenia if adopted into families with no history of schizophrenia.
• Ripke et al's 2014 study supports the link between genetics and schizophrenia at a molecular level. What were the results?


  Particular genetic variations significantly increase the risk of developing schizophrenia.
• What does hyperdopaminergia in the subcortex mean?


  High dopamine levels/activity in the central areas of the brain.
• What does hypodopaminergia in the cortex mean?

  Low dopamine levels/activity in the outer bits of the brain.
• What affect does high dopamine activity in the Broca's area have on schizophrenia?

  Speech poverty and/or auditory hallucinations.
• What affect does low dopamine activity in the prefrontal cortex have on schizophrenia?

  Influence the onset of the negative symptoms like delusions and disorganised thoughts.
• Define family dysfunction


  Abnormal processes within the family like poor family communication, cold parenting and high levels of expressed emotion. These may be risk factors for both the development and maintenance of schizophrenia.
• What are the characteristics of the schizophregenic mother?

  Cold, rejecting and controlling. Tends to create a family climate characterised by tension and secrecy, which leads to distrust that later develops into and paranoid delusions and ultimately schizophrenia.
• Outline double-bind theory


  Developing child regularly finds themselves trapped in situations where they fear doing the wrong thing, but receive mixed messages about what this is, and feel unable to comment on the situation's unfairness or seek clarification. When a child executes tasks that are perceived to have been done incorrectly (which is often), the child is punished by withdrawal of love.