Diagnosis and classification

• Types of schizophrenia?

  • PARANOID SCHIZOPHRENIA- characterised by powerful delusions and hallucinations  
  • HEBEPHRENIC SCHIZOPHRENIA- characterised by primarily negative symptoms  
  • CATATONIC SCHIZOPHRENIA- disturbance to movement, leaving the person immobile or overactive 
• What are positive symptoms?

  any atypical experiences in addition to normal experiences (an excess or distortion of normal functioning). They include hallucinations and delusions. 
• What are hallucinations?

  • unusual sensory experiences
  • some hallucinations are related to events in the environment whereas others bear no relationship to what the senses are picking up from the environment
  • E.g. voices heard talking/commenting on the person, usually criticism. 
• Types of delusions?

  • PERSECUTION- the belief that others want to harm/threaten/manipulate (e.g. the government) 
  • GRANDEUR- the belief that they are an important individual, sometimes god-like or have extraordinary power  
  • CONTROL- the belief that their body is under external control e.g. being controlled by aliens/the government  
  • REFERENCE- the belief that events in the environment appear to be directly related to them e.g. special/personal messages are being communicated through the TV screen 
• What are negative symptoms?

  Negative symptoms- atypical experiences that represent the loss of a usual experience (a diminution/loss of normal functioning)
• Types of negative symptoms?

  • Avolition
  • Speech poverty
  • Flat effect
  • Anhedonia
• What is avolition and what were Andreason's 3 signs?

  • finding it difficult to begin/keep-up with goal-directed activity
  • reduced motivation to carry out a range of activities.
  • 3 signs: POOR HYGEINE/GROOMING 
  • LACK OF PERSISTENCE IN WORK/EDUCATION 
  • LACK OF ENERGY 
• What is speech poverty?

  • Changes in patterns of speech
  • Reduction of speech quality and fluency
  • Delay in personal responses
• What is affective flattening/flat effect?

  • a reduction in the range and intensity of emotional expression including facial expression, voice, tone, eye contacts and body language
  • show fewer body and facial movements and smiles and co-verbal behaviour.
• What is anhedonia?

  • a complete loss of interest in pleasure for all activities and a lack of reactivity to normally pleasurable stimuli
  • Physical anhedonia and social anhedonia.
• What is an issue with the reliability of diagnosis? (AO3)

  • CHENIAUX ET AL (2009)
  • two psychiatrists independently diagnose 100 people
  • using both DSM and ICD criteria
  • Inter-rater reliability was poor
  • one psychiatrist diagnosing 26 with schizophrenia according to DSM, 44 according to ICD
  • other diagnosed 13 according to DSM and 24 to ICD
  • This poor reliability is a weakness of diagnosis of schizophrenia, using different manuals may hinder the diagnosis process.  
• Strength of reliability in diagnosing schizophrenia? (AO3)

  • OSARIO ET AL (2019)
  • reported excellent reliability of +.97 and test-retest reliability of +.92
  • suggests that the diagnosis of schizophrenia is consistent and clinicians have a high agreement rate
  • means diagnosis is not an assumption and has a basis of consistent results using the same manual (ICD/DSM) 
• Issues with validity for diagnosis? (AO3)

  • Validity is the extent to which we are measuring what we are intending to measure.
  • One standard way to assess validity of a diagnosis is criterion validity; do different assessment systems arrive at the same diagnosis for the same person?
  • Schizophrenia is much more likely to be diagnosed under ICD than DSM.
  • This suggests that schizophrenia is either over-diagnosed in ICD or under-diagnosed in DSM.
  • Overall, a weakness of poor diagnosis. 
• what is an issue with co-morbidity for DIAGNOSIS of schizophrenia? (research support AO3)

  • Schizophrenia is commonly diagnosed with other conditions.  
  • BUCKLEY ET AL (2009) concluded that around 50% (1/2)  people with a diagnosis of schizophrenia also have a diagnosis of depression
  • 47% with substance abuse.
  • PTSD also occurred in 29% of cases and OCD with 23%.
  • This is a weakness as schizophrenia is difficult to diagnose and classify and could be mistaken when its really depression.  
• What is an issue with symptom overlap with the DIAGNOSIS of schizophrenia?(AO3)

  • KETTER (2005) points out that misdiagnosis due to symptom overlap can lead to years of delay in receiving relevant treatment
  • during which time suffering and further degeneration can occur, as well as high levels of suicide
  • symptom overlap can have serious consequences.
  • Focusing on fixing this issue could save money and lives. 
  • The lack lack of distinction calls into question the validity of the classification and diagnosis of schizophrenia as a unique syndrome with its own characteristics signs and symptoms.
• What is classification?

  Organising symptoms into categories based on which symptoms cluster together in sufferers (e.g. categorising the symptoms of schizophrenia)
• What is diagnosis?

  • deciding whether someone has a particular mental illness using the classifications
• What is reliability?

  • The level of agreement on the diagnosis of schizophrenia by different psychiatrists (inter-rater reliability) across time (test-retest reliability) and cultures. It is also the stability of the diagnosis over time given no change in symptoms.
• What is validity?

  Validity is the extent to which we are measuring what we are intending to measure
• Issues of gender biason diagnosis

  • JULIA LONGENECKER ET AL reviewed studies of the prevalence of schizophrenia and concluded that since the 1980s, men have been diagnosed more than women. (prior to this there was no difference). A form of androcentrism and alpha bias
  • may be because men are more genetically vulnerable to developing schizophrenia than women
  • However, it could be suggested that diagnosis is bias of gender as women typically function better than men (e.g. more likely to work, good family relationships as suggested by Cotton et al. 2009)
  • This high functioning may explain why some women haven’t been diagnosed whereas men with similar symptoms have
  • Practitioners may under-diagnose this because good interpersonal functioning masks symptoms or the quality of interpersonal functioning makes the case seem too mild to warrant a diagnosis
• Issues of cultures bias in diagnosis

  • African Americans and English people of Afro-Caribbean origin are several times more likely than white people to be diagnosed
  • Positive symptoms such as hearing voices may be more acceptable in African cultures because of beliefs in communication with ancestors
  • may lead to an overdiagnosis of schizophrenia of Afro-Caribbean
  • Escobar pointed out overwhelmingly white psychiatrists may tend to over-interpret symptoms and distrust the honesty of Afro-Caribbean in diagnosis
  • calls into question the validity of diagnoses of schizophrenia as psychiatrists may impose their own cultural standards for schizophrenia onto those from other cultures (imposed etic)