Diagnosis

• What is Schizophrenia?

  A severe mental disorder where contact with reality and insight are impaired.
• How would you go about diagnosing schizophrenia?

  By using the Diagnostic and Statistical Manual of Psychiatric Disorders (DSM)
• What is the first step in the DSM?

  Two (or more) of the symptoms present for a significant portion of time during a one - month period (or less if successfully treated). At least one of these must be delusions, hallucinations or disorganised speech.
• What are the 5 classified symtoms of schizophrenia?

  1. Delusions
  2. Hallucinations
  3. Speech poverty
  4. Grossly disorganised or catatonic behaviour (no behaviour)
  5. Avolition.
• What is the second step in the DSM?

  For a significant amount of time since the onset, level of functioning in areas such as work, relationships or self-care is below the level achieved prior to the onset (if the onset is childhood, there is failure to achieve the expected level of these factors)
• What is the third step in the DSM?

  Continuous signs of disturbance persist for at least 6 months (must include 1 month of symptoms, or less if successfully treated)
• What is the fourth step in the DSM?

  Other mental disorders (schizoaffective, bipolar and depressive) have been ruled out because:

  1. No major depressive / manic episodes have occurred.
  2. If mood episodes have occurred during active-phase symptoms
• What is the fifth step in the DSM?

  The disturbance is not a side effect of drugs, other substances or another medical condition.
• What is the sixth step in the DSM?

  If there is a history of autism spectrum disorder or a communication disorder the additional diagnosis of schizophrenia is only made if there are prominent delusions or hallucinations in addition to the other required symptoms of schizophrenia and these are present for at least 1 month.
• What is Avolition?

  The reduction/inability to partake in goal-directed behaviour (doing nothing all day)
• What is Speech Poverty?

  A negative symptom of schizophrenia, resulting in lesser quality of speech.
• What are Hallucinations?

  Unreal perceptions of the environment, usually auditory (voices) but can be visual , olfactory (smells) or tactile (bugs under the skin)
• What are delusions?

  Bizarre beliefs that seem real to the person with SZ, can be paranoia, inflated beliefs about power and importance.
• Strengths of diagnosis & classification.

  GOOD RELIABILITY

  Inter-rater reliability & test-retest reliability.

  Prior to DSM-5, reliability for SZ patients was low. Osorio et al (2019) reported excellent reliability for the diagnosis in 180 individuals using the DSM-5
• Low validity in diagnosis of SZ.

  Cheniaux et al. (2009) found that 68 patients were diagnosed with SZ using the ICD system and 39 with the DSM.
• Co-morbidity with other conditions

  SZ is commonly diagnosed with other conditions, for example, depression or substance abuse. This means SZ may not exist as a distinct condition.
• Gender Bias in diagnosis.

  Since the 1980s men have been diagnosed with SZ more commonly (ratio of 1:4:1, Fischer & Buchanan 2017)This means that women may not be receiving treatment and the help they need.
• Culture bias in diagnosis.

  Some symptoms have different meanings in different cultures, for example hearing voices.
• Symptom overlap in diagnosis

  SZ has common symptoms with other disorders such as bipolar. (eg. avolition and delusions). This may mean that it is not two disorders but a variation of either SZ or Bipolar. This means that classification and diagnosis is flawed.