Schizophrenia: diagnosis

Question 1

what is a psychosis?

Answer 1

• a severe mental health problem where individual loses contact with reality -> unlike neurosis where individual is aware of the problem.

Question 2

What are the types of schizophrenia?

Answer 2

• Disorganised schizophrenia
• catatonic schizophrenia
• paranoid schizophrenia
• undifferentiated schizophrenia
• residual schizophrenia

Question 3

what is disorganised schizophrenia?

Answer 3

• behaviour is disorganised and not goal directed.
• symptoms: thought disturbances (delusions, hallucinations), absence of expressed emotion, incoherent speech, social withdrawal.
• usually diagnosed in adolescence.

Question 4

what are the 2 subtypes of catatonic schizophrenia?

Answer 4

• echolalia
• echopraxia

Question 5

what is echolalia (catatonic)

Answer 5

• involuntary parrot-like repetition of a word or phrase spoken by another person.

Question 6

what is echopraxia (catatonic)

Answer 6

• involuntary imitation of body movements of another person, sometimes produced by catatonic patients.
  -> severe unusual gestures or use of body language.
  -> complex sequence of finger, hand and arm movements.

Question 7

what is another symptom of catatonic schizophrenia

Answer 7

• total immobility for hours at a time, patient simply stares blankly into space.

Question 8

what is paranoid schizophrenia

Answer 8

• delusions of various kinds (persecution, grandeur etc) -> remains emotionally responsive.
• more alert than patients with other schizophrenia types.
• argumentative.

Question 9

what is undifferentiated schizophrenia?

Answer 9

• broad ‘catch-all’ category -> patients who do not clearly belong within any other category.
  -> shows symptoms but does not clearly fit in any specific category.

Question 10

what is residual schizophrenia?

Answer 10

• although had episode of schizophrenia during past 6 months and exhibit some symptoms -> not strong enough to merit putting them in other categories.
  -> consists of patients experiencing mild symptoms.

Question 11

what are the positive symptoms of schizophrenia?

Answer 11

• hallucinations
• delusions
• disorganised speech
• grossly disorganised or catatonic behaviour

Question 12

what are the negative symptoms of schizophrenia?

Answer 12

• speech poverty
• lack of emotion
• avolition (becoming disinterested)
• lack of ability to function normally
• negative symptoms are less dramatic but last longer than positive symptoms.

Question 13

what are the secondary symptoms of schizophrenia?

Answer 13

• depression
• loss of employment
• breakdown of relationships

Question 14

when are men and women usually diagnosed with schizophrenia

Answer 14

• men: 15-25 years old
• women: 30+ years old

Question 15

what are the evaluations for diagnoses of schizophrenia

Answer 15

positive:
- reliability -> consistency of diagnoses

negative:
- lack of reliability
- co-morbidity
- cultural bias

Question 16

(+) Explain how diagnoses is consistent

Answer 16

• practitioners are provided with a common language, permitting communication of research ideas and findings -> may ultimately lead to development of better treatments.
• evidence suggests reliability has improved as a classifications systems have been updated.

Question 17

(-) explain how diagnosis lacks reliability (Cheniaux)

Answer 17

Cheniaux et al study:
- inter-rater reliability (diagnoses must be 80% consistent amongst clinicians for the same patient).
- had 2 psychiatrists independently diagnose 100 patients using both DSM + ICD criteria -> had very inconsistent diagnoses.
- poor reliability.

Question 18

(-) Explain how co-morbidity can negatively affect accuracy/reliability of diagnoses.

Answer 18

• co-morbidity: occurrence of 2 illnesses or conditions occurring simultaneously.
  -> confusion of which disorder is being diagnosed, e.g. schizophrenia or depression.
• patients have also been found to have a diagnosis of depression (50%) or substance abuse (47%) etc.
• can raise issues of descriptive validity, having simultaneous disorders suggests schizophrenia may not actually be a separate disorder.

Question 19

(-) explain how diagnosis suffers from cultural bias (Whaley) (Copeland)

Answer 19

• those of African/afro-carribean descent are more likely than whites to be diagnosed.
• Whaley: reason blacks are diagnosed more (2.1% > 1.4%) is cultural bias -> ethnic differences in symptom expression are overstated or misinterpreted.
• Copeland: 69% American psychiatrists diagnosed a patient as having schizophrenia compared with 2% of British psychiatrists.