Schizophrenia

• Schizophrenia


  A severe mental disorder characterised by profound disruptions in thinking. This can effect language, perception, emotions and sense of self.
• 2 major systems for classification and diagnosis of SZ

  • ICD-10
  • DSM-5
• What does the ICD-10 state a person needs to be diagnosed?


  2 or more negative symptoms
• What does the DMS-5 state a person must have to be diagnosed?


  1 positive symptom
• Positive symptoms


  Are atypical symptoms experienced in addition to normal experiences. They are highly exaggerated ideas, perceptions or actions that show the person can’t tell what’s real from what isn’t.
• How do patients with schizophrenia react?


  They withdraw from reality and live in a world of fantasy with a life of delusion and hallucination.
• What does type 1 schizophrenia include?

  • Positive symptoms
  • Shows a loss of touch with reality
  • Hallucinations
  • Delusions
  • Occurs in short episodes
  • Responds well to medication
• What do type 2 schizophrenics act like?

  • Negative symptoms
  • Disruptions of normal emotions and actions
  • Chronic episodes
  • Resistant to medication
  • Struggle to function adequately
  • Avolition
  • Speech poverty
• Negative symptoms


  Atypical experiences that represent the loss of usual experience. Refer to the absence of lack of normal mental functioning involving, thinking, behaviour and perception. The word negative means the absence of normal experiences
• Examples of positive symptoms of schizophrenia

  • Hallucinations
  • Delusions
• Hallucinations

  Unusual sensory experience, Some are related to the environment whilst others are not.

  E.g voices are heard either talking to or commenting on the sufferer, often criticising them.

  Hallucinations can be experienced in relation to any sense.

  E.g see distorted facial expressions or occasionally people/animals that are not there
• Delusions


  Irrational beliefs that can take many forms. Common delusions involve being an important historical, political or religious figure.

  Delusions also commonly involves being persecuted perhaps by the government or aliens or by not having superpowers.

  Another class of delusions concerns the body being controlled.

  Delusions can make a sufferer of schizophrenia behave in ways that make sense to them but seem bizarre to others.
• Example of negative symptoms of schizophrenia

  • Avolition
  • Speech poverty
• Avolition


  Finding it difficult to begin or keep up goal directed activity.

  Severe loss of motivation to carry out everyday tasks.
• Speech poverty

  Changes in patterns of speech.

  • The ICD-10 recognises speech poverty as a negative symptoms due to the reduction in the amount and quality of speech in schizophrenia.
  • Accompanied by the delay in verbal responses during a conversation.
  • DSM places emphasis on speech disorganisation in which speaker changes topic mid-sentence.
• Population valdity

  Can we generalise findings to all schizophrenics
• Construct validity


  Do all studies results support the explanation of schizophrenia
• Criterion validity


  Evaluates how accurately a test measures the outcome it intended to measure
• Ecological validity


  Concerns whether a study can be generalised to another setting
• Concurrent validity


  If.2 or more research finds are similiar
• Internal validity


  Is it measuring what it intends to measure
• External validity


  Is it measuring what it intends to measure outside of the study
• Temporal validity


  Whether or not findings can be generalised to other periods of time
• How would reliability be assessed in classification system?

  • Refers to consistency of classification system, do all doctors use DSM-5 to assess symptoms, NO so lower reliability.
  • Diagnostic reliability means a diagnosis should be repeatable (test retest reliability), NO not all doctors make the same diagnosis
  • Different clinicians must reach the same conclusion (inter-rater reliability), NO not all will meet the same conclusions
• Research for inter-rater reliability

  Cheniaux

  • 2 psychiatrist diagnosing 100 patients independently using DSM and ICD
  • One diagnosed 26 with DSM and 44 using ICD
  • One diagnosed 13 with DSM and 24 using ICD
  • So poor inter-rater reliability between diagnosis.
• Research for validity in schizophrenia


  Rosenhan

  • 9 participants, with no present or past symptoms of psychiatric disorders
  • Fake hallucinations to enter psychiatric hospitals
  • On admittance stopped simulating symptoms
  • When asked how they felt, they said they no longer had symptoms
  • They received medication
  • Diagnoses were made
  • So doctors have no truly objective method of diagnosing schizophrenia as there is no actual evidence.
• What happened in a Rosenhan follow up study?

  Participants who actually had schizophrenia were declined as they thought they were part of deception, therefore there is a large flaw in validity.
• Co-morbidity

  The occurrence of 2 illnesses or conditions together. E.g a person having both schizophrenia and a personality disorder. This is where 2 conditions are frequently diagnosed together, which questions the validity of classifying the 2 disorders seperately.
• How is co-morbidity a limitation of classification?

  • Schizophrenia has co-morbidity with other conditions.
  • Buckley et al, found half the people with a diagnosis of schizophrenia also had a diagnosis of depression.
  • Questions the validity of the illnesses diagnosis and classification because it may be a single condition.
  • Schizophrenia may not exist as a distinct condition.
• Symptom overlap


  Occurs when 2 or more conditions share symptoms. This is where conditions share symptoms making it difficult to classify the 2 disorders separately.
• Why is symptom overlap a limitation of diagnosis and classification of schizophrenia?

  • Overlap between symptoms of schizophrenia and bipolar disorder, as they both involve positive symptoms such as delusions and negative symptoms like Avolition.
  • Suggests schizophrenia and bipolar may not be 2 conditions but variations of a single condition.
  • Meaning it is hard to distinguish between both conditions and could lead to unreliable or incorrect diagnosis.
• Why does the diagnosis of schizophrenia have low validity?

  • Cheniaux et al had 2 psychiatrists assess 100 clients using ICD-10 and DSM-5 and found that 68 were diagnosed with schizophrenia under ICD and 39 under DSM.
  • Suggesting schizophrenia is more likely to be diagnosed using the ICD in comparison to DSM.
  • Therefore schizophrenia is either over-diagnosed or under-diagnosed depending on diagnostic system.
• How does the diagnosis and classification of schizophrenia have good reliability?

  • Considered reliable when different clinicians reach the same diagnosis for the same individual (inter-observer reliability), and when the same clinician reaches the same diagnosis for the same individual on 2 occasions (test re-test reliability).
  • Osorio et al, reported reliability being high when diagnosing SZ in 180 people using DSM-5. Pairs of interviewers achieved inter-rather reliability of +0.97 and test-retest reliability of +0.92
  • Diagnosis is now consistently applied;
• How is the diagnosis and classification of schizophrenia subject to cultural bias?

  • Some symptoms such as hearing voices have different meanings in different cultures. For example people in Haiti believe voices are communications from ancestors
  • British people of african-Caribbean origin are 9 times more likely to receive a diagnosis compared to white British people (Pinto and Jones).
  • Some cultures see hearing voices as irrational and bizarre.
  • Discrimination using a culturally biased diagnostic system.
• What are the 3 concepts in family dysfunction (psychological explanation of schizophrenia)?

  • Schizophrenogenic mother
  • Double bind theory
  • Expressed emotions
• researcher in schizophrenogenic mother

  Fromm- Reichmann
• Researcher in double bind theory?

  Bateson et al
• What does schizophrenogenic mother suggest?

  Fromm-Reichmann claimed that the schizophrenogenic mother caused an individual to develop schizophrenia.

  • Mother is cold, rejecting and controlling
  • This creates a family climate of tension
  • Consequently this leads to distrust which develops into paranoid delusions
• Explain double bind theory (family dysfunction)?

  Bateson et al suggested that family climate is important in the development of schizophrenia.

  • Developing child may find themselves trapped in situations where they fear they are doing the wrong thing but receive mixed messages about what is right or wrong.
  • The child feels unable to seek clarification to prevent interpersonal conflict.
• Example of Double bind theory?

  Being told they need to be independent but being overprotected and receiving criticism for being independent.