diagnosis

• What is schizophrenia?


  - A mental illness affecting how an individual thinks, feels and behaves

  - A form of psychosis

  - affects 0.7% of the population

  - Peak onset is between 15-35, with an earlier onset in males

  - roughly equal rates across genders

  - a range of symptoms

  - a diagnosis requires a specialist
• What is psychosis?


  loss of contact with reality
• What % of the population are affected by schizophrenia?

  0.7%
• What ages does schizophrenia first occur in males or females?

  Males = age 15 - 25

  Females = 25 - 35

  
  

  (earlier onset in males)
• What are the two types of symptoms characterised with schizophrenia

  Positive and negative symptoms
• What are the positive symptoms of schizophrenia?


  + These are symptoms that add to an experience as a result of the condition

  
  

  + Hallucinations

  + Delusions

  + disorganised speech

  + Grossly disorganised or catatonic behaviour
• What are Hallucinations?


  + Unreal perceptions of reality

  + typically auditory or visual

  + can be tactile and olfactory

  + often bizarre

  + some report voices telling them to do certain things
• What are delusions?


  + Bizarre unreal beliefs that seem and appear real to the individual

  + These can be paranoid, people can believe that they are being followed

  + delusions of grandeur can be seen, which is an inflated belief about someone's power or importance

  + delusions of persecution, believe they are being targeted

  + Delusions of reference, when someones believes the events in the TV are about them
• What is disorganised speech?

  + incoherent speech

  + slips of words

  + changes in conversation or mid sentence

  + can sometimes sound like gibberish

  + can be known as a "word salad"
• What is grossly disorganised or catatonic behaviour?

  + The inability or motivation to finish a task

  + causes problems in daily living as it can cause a disinterest in personal hygiene

  + People may dress in strange clothes, wearing a coat in summer

  + catatonic behaviour is a reduced reaction to the immediate environment
• What are the negative symptoms of schizophrenia?

  A reduction or loss in normal functioning

  
  

  - Speech poverty (alogia)

  - Avolition

  - Affective flattening

  - Anhedonia
• What is speech poverty?

  - reduction in speech production

  - speech was less fluent

  - use of mainly simple sentence structures
• What is avolition?


  - lack of motivation

  - reduction in interest

  - lack of motivation to complete or start every day tasks

  - highly impacts daily living

  - can reduce social functioning
• What is affective flattening?

  - reduction in the range and intensity of emotions that are expressed

  - can include facial expression, tone of voice, eye contact, and body language

  - reduced smiling and co-verba behaviour
• What is Anhedonia?


  - loss of interest of pleasure in almost all activities

  - reduction in typical pleasure stimuli
• What are the 2 diagnostic criterias used by the UK and the USA

  UK - ICD-11 Criteria

  USA - DSM-V Criteria
• What does the ICD-11 Criteria for a schizophrenia diagnosis require


  a) thought insertion or withdrawal

  b) delusions

  c) Hallucinations

  d) - symptoms

  e) depressive behaviour

  f) manic behaviour

  g) psychomotor symptoms

  h) cognitive symptoms

  
  

  guidelines:

  - Must have 1 or more from A-C

  - Symptoms present most of the time for at least a month
• What does the DSM-V Criteria for a schizophrenia diagnosis require

  Section A, needs 2+ of these, and must include one or more from A-C

  a) delusions

  b) hallucinations

  c) disorganised speech

  d) disorganised behaviour

  e) alogia

  f) avolitions

  g) diminished emotional expression

  
  

  Section B, social and occupational dysfunction must be present

  
  

  Section C, symptoms present for at least 6 months, as well as a significant proportion of time for a 1 month period
• Advantages of having a diagnosis

  + allows for effective treatment and support, and funding

  + understanding their behaviour may be useful

  + reduced feelings of isolation and alienation

  + opportunity for prognosis/predictions

  + allows doctors and professionals to work more effectively
• Disadvantages of having a diagnosis

  - Diagnosis may lead to labelling and stigmatisation

  - Potential of leading to a self-fulfilling prophecy

  - Potential for misdiagnosis and ineffective treatment
• What are the two types of issues seen with schizophrenia diagnosis?

  - Reliability

  - Validity
• What is reliability with schizophrenia?

  - the consistency of a classification

  - same diagnosis across different doctors

  - same classification over time
• What are the reliability issues and points associated with a schizophrenia diagnosis

  - Kappa scores

  - Research into validity

  - The influence of culture
• What was the procedure of Rosenhan's study (1973) into the validity of a schizophrenia diagnosis?

  - 8 sane confederates were sent to a number of psychiatric hospitals

  - all were told to report that they were hearing voices, with all ppts reporting the same 3 words

  - "Hollow, empty, thud"
• What was found in Rosenhan's study into the validity of a schizophrenia diagnosis?

  - 7 of the sane ppts were diagnosed with schizophrenia and one was diagnosed with manic depression

  (this questions the validity due to them all presenting the same but having a different diagnosis)

  - Once any of them were admitted into hospital they were to all behave normally without reporting any more voices

  - the average stay for those admitted to hospital was 19 days
• What was Rosenhan's follow up study?

  - He called up hospitals in the local ares saying that her would send out more (fake) pseudopatients to warn them

  - However none of these patients were sent

  - but hospitals reported that 21% of real patients were sent away, through hospitals believing in these fake patients
• Evaluation of Rosenhan's study into the validity of schizophrenia diagnosis

  Ethical concerns

  - real patients were sent away which could place them at risk of harm of death

  - They could have needed real health

  
  

  Lack of Validity

  - Could lack historical validity due to changes in the diagnostic criteria

  
  

  Bias

  - Researcher bias could be at play due to Rosenhan's role within the study
• What are Kappa scores?

  - a statistic used to measure inter-rater reliability, that accounts for chance agreement between raters

  - 0.01 - 0.4 = none-weak

  - 0.41 - 0.80 = moderate

  - 0.81 - 1 = excellent agreement
• What kappa scores in the reliability of schizophrenia?

  1994 - 0.4 (weak)

  2001 - 0.11 (very weak)

  2013 - 0.46 (using the DSM-5 criteria)

  
  

  Shows that the DSM-5 and other classifications are not fully reliable
• How does the influence of culture highlight issues with reliability?

  Research into schizophrenia and reliability

  
  

  - copeland (1971)

  --> 134 US psychiatrists, and 194 UK ones testing ppts for schizophrenia

  --> they only agreed on 2% of studies by UK ones

  --> 69% of US ppt were diagnosed

  --> however diagnosis should be the same between cultures, and so undermines the validity of schizophrenia diagnosis

  
  

  - Luhrmann (2015)

  --> interviewed 60 patients

  --> Indian and Ghanaian patients reported the voices being neutral/ positive

  --> Americans reported negative ones

  --> the lack of consistency undermines validity as symptoms should not change depending on location or culture

  
  

  - Brekke and Batio (1997)

  --> analysis of US patients

  --> white americans consistently had more severe symptoms than latino and african american groups

  --> symptoms should not depend on location and culture
• What points are there to talk about validity of a schizophrenia diagnosis

  - Gender bias

  - Symptom overlap

  - Co-morbidity
• What role does gender bias play in diagnosing schizophrenia and questioning the validity?

  - Males are more likely to be diagnosed than females

  - The is because female behaviour is typically seen as "abnormal" and "hysterical" and not in control of their emotions

  
  

  - Boverman (1988)

  --> found clinitions in the USA equated mentally healthy "adult" behaviour, however women are seen as less mentally healthy

  
  

  - Loring and powell (1988)

  --> psychologists assessed patient case studies

  --> if described as male or neutrally 56% were diagnosed with schizophrenia, with females only having a 20% chance of being diagnosed

  --> therefore undermining the validity and credibility of a schizophrenia diagnosis
• What is symptom overlap?

  When two or more conditions share symptoms
• What role does symptom overlap play in diagnosis schizophrenia and questioning the validity?

  - Ellason and Ross (1995)

  --> people with dissociative identity disorder (DID) actually have more schizophrenic symptoms compared to those with schizophrenia

  --> most people with schizophrenia have sufficient symptoms of other disorders and could have other diagnosis's
• What is co-morbidity?


  - when two or more conditions occur together simultaneously
• What role does co-morbidity play in diagnosing schizophrenia and questioning the validity?

  - Buckley (2009)

  --> found that people with depression have other conditions

  --> 50% also had depression

  --> 47% also had substance abuse

  --> 29% also had PTSD

  --> 23% also had OCD

  --> 15% also had a panic disorder

  --> if diagnosed together often it questions the validity of their diagnosis and classification, because they may actually be one single disorder

  
  

  - Sewts (2014)

  --> meta-analysis

  --> 12% of schizophrenia patients also fulfilled the diagnostic criteria of OCD

  --> 25% showed obsessive-compulsive issues

  --> predictive validity undermined by multiple disorders