General

• what does schizophrenia (Sz) mean

  split mind/divided self, known as 'split form reality' by Bleuler
• how much of the population is affected - who is it most common for

  1%

  more common in working class populations, similar rates in males/females
• what are the 2 types of Sz

  positive and negative
• describe positive and negative symptoms of Sz

  positive: general excesses in behaviours/thoughts/feelings that non-mentally ill people don't have

  negative: general deficits in behaviours/thoughts/feelings that non-mentally ill people do have
• give some examples of positive symptoms - explain them

  + delusions - strongly held beliefs that persist despite opposing evidence

  + disorganised speech - vague/incoherent speech

  + hallucinations - experience seemingly real perceptions of something not actually present
• give some examples of negative symptoms - explain them

  - speech poverty - lessening of speech quality/fluency and gives short replies

  - emotional disturbance - may appear to have no reaction to good/bad news, react inappropriately in situations

  - avolition - difficulty maintaining goals, lack drive/energy to maintain
• what are the 2 ways of classifying/diagnosing Sz

  DSM-5

  ICD - 11
• what are the differences between the 2 types

  DSM - must have at least 2 symptoms, 1 must be positive

  ICD - 1 positive or 2 negative are sufficient for diagnosis
• what are the 2 main issues with diagnosis

  - reliability in diagnosis

  - validity in diagnosis
• what is reliability - how do you maintain it


  a measure of consistency

  test re-test and inter-rater reliability are important
• what does reliability mean for diagnosis of Sz


  whether 2 or more mental health professionals would come to the same diagnosis with the same patient
• what evidence questions the reliability of diagnosing Sz

  - Cheniaux et al: 2 psychologists independently diagnose 100 patients using DSM & ICD criteria

  - using DSM: 1 diagnosed 26, another 13

  - using ICD: 1 diagnosed 44, another 24

  This suggests the reliability of diagnosis is questionable

  Also implies reliability of DSM may be higher than ICD
• what is the positive evaluation of diagnosis

  + even if reliability isn't perfect, using classifications is more objective as it lays out criteria

  + reliability has improved over time, on DSM 1 only 54% concordance
• what is validity


  a measure of accuracy
• what does validity mean in relation to diagnosis

  - whether a person is diagnosed with the correct disorder

  - whether the classification system provides an accurate list of real symptoms for a real system
• who inspired the Rosenhan study - what did she do

  Elizabeth Cochrane:

  pulled faces/tugged at hair and called others crazy, she was quickly admitted to a madhouse, once in she acted sane
• what were the aims of the Rosenhan study


  - to investigate mental hospitals/institutions and their conditions

  - to see how reliable the diagnosis system is
• what did the participants in the Rosenhan study do in their meeting

  pseudo patients said they were hearing a voice, but acted completely sane other than that and answered all questions accurately
• how did the pseudo patients act once being admitted to a mental hospital

  acted normal

  say they felt fine and symptoms had gone

  asked to be removed

  took notes on life in the ward
• what were the main findings

  All were admitted to a mental hospital

  7 diagnosed with Sz

  1 diagnosed with bipolar
• what do the findings suggest about validity/reliability

  + high reliability as patients were consistently diagnosed when displaying the same symptoms

  - low validity, none of the p's actually had Sz/bipolar so diagnosis was wrong +manual was uploaded because of this
• what did Rosenhan do after an institution said it would never happen in their hospital - what does this further support

  - Rosenhan said he'd send fake patients over the next 3 months they proudly announced 41 fakes, but he didn't actually send any

  - shows poor validity and unreliable diagnosis as those that genuinely needed help may have been turned away
• what were the implications of Rosenhan's study for the psychiatric profession

  - socially sensitive: lead to reduced trust within the profession and system as a whole, those working at the hospital were viewed badly
• what are the consequences if someone is misdiagnosed

  the stigma that is associated with mental health disorders is a life long sentence, so can negatively affect different aspects of life, such as work
• what are the 3 factors that affect validity in diagnosing Sz

  1. comorbidity

  2. symptom overlap

  3. gender bias

  4. culture bias
• what is comorbidity


  the co-occurrence of two or more disorders in a single individual
• what disorders often occur with Sz - why is this an issue

  - depression (50%)

  - substance abuse (47%)

  - PTSD (29%)

  - OCD (23&)

  it complicates diagnosis, questions validity if disorders occur together because it could be a single condition
• what does symptom overlap mean - give an example

  there is overlap of symptoms of Sz and other disorders, e.g: bipolar has hallucinations, delusions and avolition
• why is this an issue

  it questions if there are 2 separate disorders so questions validity of diagnosis

  misdiagnosis can lead to the wrong drugs being given, can lead to harmful side effects/ineffective treatment
• what is gender bias

  a gender bias is where there are differential treatment/diagnosis of mental illness in one gender
• what is the evidence for the gender bias of Sz

  since the 1980's more men have been diagnosed than women, so could indicate there are different factors that could cause the disorder in males and females

  This questions the validity of diagnosis: are doctors biased in their view of the patient or are more likely to diagnose males?
• what conclusions/questions does this raise about gender bias in Sz

  - is it a genuine gender difference where men are more likely to get Sz

  - is it a gender bias where men are more likely to get diagnosed, but rates of actually having it are similar between
• what has been argued about this evidence

  female patients are more likely to function better (maintain jobs/familt life) with Sz, so women may be un-diagnosed because they have better functioning so they doubt a diagnosis of Sz

  This implies there could be a gender bias where doctors are underdiagnosing female patients
• what is an interactionist approach


  it acknowledges a range of causes interacting together (e.g biological/social/psychological) to cause Sz
• it is known as the diathesis stress model - what does this mean

  diathesis: vulnerability

  stress: a stress/trigger for the vulnerability

  diathesis stress = one or more underlying factors means the person is vulnerable to the disorder (diathesis) but it only develops if there is a stress/trigger present