Classification and Diagnosis

• positive symptoms

  an excess or distortion of normal functioning
• negative symptoms

  appear to reflect a reduction or loss of normal functioning
• hallucinations

  • positive symptom
  • unusual sensory experience
  • some are related to events in the environment whereas others bear no relationship to what the sense are picking up from the environment (e.g. voices either talking to or commenting on the person)
  • can be experienced in relation to any sense (distorted facial expressions or seeing people or animals that aren't there)
• delusions

  • positive symptom
  • paranoia and delusions are irrational beliefs
  • common delusions can involve being an important, historical, political or religious figure
  • commonly involve being persecuted
  • can concern the body - may believe that they or a part of them is under external control
  • although the vast majority of individuals are not aggressive and are more likely to be victims that perpetrators of violence, some delusions can lead to aggression
• avolition

  • negative symptom
  • finding it difficult to begin or keep up with goals-directed activity
  • people with schizophrenia often have sharply reduced motivation to carry out a rang of activities
  • Andreason (1982) - identified three identifying signs of avolition - poor hygiene and grooming, lack of persistence in work or education and lack of energy
• speech poverty

  • negative symptom
  • characterised by changes in patterns of speech
  • this is sometimes accompanied by a delay in the person's verbal responses during conversation
  • places emphasis on speech disorganisation in which speech becomes incoherent or the speech changes topics mid sentence
• reliability

  • a diagnosis should be consistent between professionals
  • specifically found through inter rater reliability
  • kappa scores - a statistic used to measure inter rater reliability, that counts for chance of agreement
  • if someone receives the wrong diagnosis, they receive the wrong treatment
• validity

  is the diagnosis actually diagnosing schizophrenia
• co-mobidity

  • most patients with schizophrenia have diagnosis (e.g. bipolar, depression, OCD, substance abuse, PTSD)
  • symptoms such as delusions and avolition are part of the criteria for more than one disorder
  • at the point of diagnosis
  • Ellason and ROss (1995) - assessed the symptoms of schizophrenia patients and DID patients and DID patients had more symptoms of SCZ than SCZ did
• Gender Bias

  • males are more likely to be diagnosed than females (around 40% more with males)
  • Loring and Powell (1988) - psychiatrists asked to assess case studies of patients; is described as male or neutral, 56% diagnosed: if female 20%
  • Broverman et al (1970) - mental health professionals equate normal behaviour with healthy male behaviour
  • Cotton et al (2009) - women tend to have higher social functioning and stronger family relationships than men
  • undermines validity, the diagnosis isn't completely true-based on stereotypes not symptoms
• culture bias

  • African Americans around 5 times more likely to be diagnosed with schizophrenia than Euro Americans
  • people can present with the same symptoms and not get the same diagnosis - not reflecting the symptoms
  • Luhrmann et al (2015) - 60 patient interviews; Indian/Ganahian patients reported negative experiences (the symptoms are not consistent across cultures - communicating with ancestors)
  • Escobar (2012) - psychiatrists tend to over interpret or even distrust the experiences of Afro-Caribbean patients (ethnic minorities feel alienated by the mental health system and therefore don't want to come forward)
  • reliability problem as symptoms and diagnosis are not consistent between cultures