Classification and Diagnosis

• what is the definition of schizophrenia?

  • type of psychotic illness where people lose touch with reality, thinking things which can't be true and/or hearing voices or seeing visions when there is no sensory stimuli to create them, it can affect any of the senses
  • episodic illness where periods of psychotic disturbance are usually interspersed with more normal periods of functioning
  • profound disruption of cognition and emotion which affects language, thought, perception, and sense of self
• what is psychosis?

  a term used to describe a severe mental health problem where individual lose contact with reality (unlike neurosis where individual is aware they have problems)
• what is a prodromal symptom?

  • an early symptom indicating the onset of a disease or illness
  • weeks/months preceding schizophrenia, an individual may show some prodromal symptoms
  • these symptoms are not enough to diagnose, as they occur in other illnesses
  • it is only in retrospect once full schizophrenia has been diagnosed that these symptoms may be seen as the onset of the disorder
• what are some examples of prodromal symptoms?

  • loss of interest in activities
  • avoiding company
  • stay away from school/work
  • lack in personal hygiene/appearance
  • mild degrees of depression
• what did Rosenhan 1973 do?

  • participant observation study to test the psychiatric system
  • a single fake incident of hearing voices/hallucinating led to weeks/months in a psychiatric ward
• what is classification?

  • all systems of mental disorders and diagnosis stem from the work of Kraepelin who claimed groups of symptoms occur together often, thus allowing us to call them diseases or syndromes
  • no single defining characteristic, cluster of symptoms which appear unrelated
  • regards each mental illness as distinct from all others with its own origins - symptoms, course, and outcomes, not socially constructed
  • DSM and ICD
• what is the importance of classification?

  • can't diagnose without classification
  • shared language/semantics
  • comparable groups for research
• what is diagnostic criteria?

  • for each disorder there is a specialised list of symptoms, all of which must be present, for a specified period of time, in relation to age and gender, with stipulation as to what other diagnoses mustn't be present, and the personal and social consequences of the disorder
• how do you make diagnosis more reliable and valid?

  • laying down rules for the inclusion or exclusion of cases
• what do diagnosis criteria function to inform?

  • inform effective treatment selection, to administrate functions e.g. medical aids, provide vocabulary for professionals to communicate (clinical shorthand)
  • informed judgements about what treatment is most likely to alleviate symptoms
  • comfort individual, something is medically wrong, not just 'them'
  • inform patients about course of disorder
• what is the definition of classification?

  taking a set of symptoms and categorising them, if an individual has a particular set of symptoms we can say they have schizophrenia, opposed to another illness like depression
• what is the definition of diagnosis?

  the clinical judgement that the individual is suffering from a specific disorder
• what is the function of the DSM and the ICD?

  • help us classify abnormality
  • give us guidance on how to diagnose abnormality
• what are positive symptoms?

  • an excess or distortion of normal functions e.g. hallucinations or delusions
• what are negative symptoms?

  • normal functions which are limited e.g. alogia or avolition
• what are hallucinations?

  • sensory experiences, some which are related to events in the environment whereas others bear no relationship to what the senses are picking up from the environment
  • e.g. hearing voices talking to/commenting on the sufferer, often criticising them, or seeing distorted facial expressions or people/ animals that aren't there
• what are delusions?

  • irrational beliefs, delusions of grandeur - involve being important historical, political or religious figures such as Jesus
  • can involve being persecuted by the Government, aliens or superpowers, can concern the body - may believe a part of them is under external control (experiences of control)
• what is Alogia?

  • speech poverty
  • changes/reduction in speech where there is a reduction in amount/quality of speech
  • delay in sufferers verbal responses during a conversation
• what is Avolition?

  • aka Apathy - loss of motivation to carry out tasks and results in lower activity levels
  • Anderson identified 3 signs of avolition - poor hygiene/grooming, lack of persistence in work/education and lack of energy
• what subtypes of Schizophrenia does the ICD-10 identify?

  • hebephrenic - primarily negative symptoms - apathy, lack of motivation
  • catatonic - withdrawn, mute, negative and often assumes unusual body positions - disturbance to movement, immobile or very mobile
  • paranoid - feels extremely suspicious or grandiose, strong delusions and hallucinations, often fine otherwise
  • undifferentiated - fits more than one category
  • residual - keeps coming back
• what is the difference between DCM and ICD in diagnosis of SZ?

  • DCM - 1 month symptoms, 6 months disturbance, ICD - 1 month symptoms
  • DCM - 2 symptoms (at least 1 positive), ICD - 1 symptom (if positive) or 2
  • DCM - takes account of social/occupational dysfunction, ICD - doesn't
  • DCM - 0 subtypes, ICD - 3 (/7) subtypes
• what is disordered thinking?

  • feeling that thoughts have been inserted or withdrawn from mind, thoughts broadcast, disordered speech
• what is asociality?

  • social withdrawal
• what is echolalia?

  • pathological repetition of words of others
• what is anhedonia?

  • loss of enjoyment in activities that were previously pleasant