introduction to schizophrenia

• Classification of mental disorder

  The process of organising symptoms into categories based on which symptoms frequently cluster together
• Schizophrenia

  A severe mental disorder where contact with reality and insight are impaired, an example of psychosis
• Positive symptoms of schizophrenia

  • Hallucinations
  • Delusions
• Hallucinations

  A positive symptom of schizophrenia. They are unusual sensory experiences that have either no basis in reality or are distorted perceptions of things that are there

  • hearing voices
  • distorted facial expression
• Delusions

  A positive symptom of schizophrenia. They involve irrational beliefs that have no basis in reality, for example, a person believes that they are someone else or that they are the victim of a conspiracy
• Negative symptoms of schizophrenia

  • Speech poverty
  • Avolition
• Speech poverty

  A negative symptom of schizophrenia. It involves reduced frequency and quality of speech. Delay in the person verbal responses during conversations
• Avolition 'apathy'

  A negative symptom of schizophrenia. It involves loss of motivation to carry out tasks and results in lowered activity levels - difficult to keep up with goal-directed activity

  Andreasen - 3 signs of avolition: poor hygiene and grooming, lack of persistence in work or education and lack of energy
• Co-morbidity

  The occurrence of two disorders or conditions together, for example a person has both schizophrenia and a personality disorder. Where two conditions are frequently diagnosed together it calls into question the validity of classifying the two disorders separately
• Symptom overlap

  Occurs when two or more conditions share symptoms. Where conditions share many symptoms this calls into question the validity of classifying the two disorders separately
• diagnosis and classification of schizophrenia

  • experienced by about 1%
  • commonly diagnosed in men, city dwellers and lower socio-economic groups
• diagnosis and classification of schizophrenia

  Classification of mental disorder

  • World Health's organisations International classification of disease ICD-10
  • American psychiatric association diagnostic and statistical manual edition 5 DSM-5
• AO3 - diagnosis and classification - strength

  P: reliability

  E: said to be reliable when different diagnosing clinicians reach the same diagnosis - inter-rater reliability

  • same clinicians reaches the same diagnosis for the same individual on two occasions - test-retest reliability
  • after DSM-5 schizophrenia diagnosis improved

  E: Osorio - excellent reliability for the diagnosis of schizophrenia in 180 individuals using the DSM-5

  L: we can be reasonably sure that the diagnosis of schizophrenia is consistently applied
• AO3 - diagnosis and classification - limitation

  P: validity

  E: one way to assess validity of a psychiatric diagnosis is criterion validity

  Cheniaux - 2 psychiatrists independently assess the same 100 clients using ICD-10 and DSM-IV criteria

  • 68 were diagnosed - ICD-10
  • 39 were diagnosed - DSM

  L: schizophrenia is either over- or underdiagnosed according to the diagnostic system - low validty
• AO3 - diagnosis and classification - limitation

  P: co-morbidity

  E: if condition occur together a lot of the time then this calls into question the validity of their diagnosis and classification - might actually be a single condition

  E: commonly diagnosed with other conditions - half those diagnosed with schizophrenia also had a diagnosis of depression. This is a problem because it means schizophrenia may not exist as a distinct condition and at least some people diagnosed with schizophrenia may have unusual cases of conditions like depression
• AO3 - diagnosis and classification - limitation

  P: existence of gender bias

  E: men diagnosed with schizophrenia more commonly than women - women less vulnerable than men

  E: women are underdiagnosed because they have closer relationships and hence get support - women may function better than men

  L: underdiagnosis is a gender bias and means women may not therefore be receiving treatment and services that might benefit them
• AO3 - diagnosis and classification - limitation

  P: existence of culture bias

  E: some symptoms of schizophrenia - hearing voices - have different meanings in different cultures

  • Haiti - voices are communicators from ancestors

  E: British people of African-Caribbean origin are 9x as likely to receive diagnosis as white British people - diagnosis of clients by psychiatrists from a different cultural background leads to an overinterpretation of symptoms in black British people

  L: British African-Caribbean people may be discriminated against by a culturally-biased diagnostic system
• AO3 - diagnosis and classification - limitation

  P: symptom overlap with other conditions

  E: considerable overlap between the symptoms of schizophrenia and the symptoms of other conditions

  • schizophrenia and bipolar disorder involve positive symptoms and negative symptoms

  E: Schizophrenia is hard to distinguish from bipolar disorder - hard to diagnose or it suggests schizophrenia and bipolar may not be two different conditions

  L: symptom overlap means that schizophrenia may not exist as a distinct condition and that even if it does it is hard to diagnose