Diagnosing Schizophrenia

Question 1

What type of disorder is schizophrenia?

Answer 1

1. A thought process disorder,
2. Characterised by disruption to a person’s perceptions, emotions, and belief.

Question 2

How can Schizophrenia develop? Who does it mostly affect? What consensus is there medically on the disorder?

Answer 2

1. The onsent of schizophrenia can be acute (a sudden onsent, where behaviour changes within a few days), or chronic (a gradual deterioration in mental health that develops slowly over time),
2. Males and females are equally affected. In males, schizophrenia usually develops in their late teens or early 20s, while females tend to develop it 4/5 years later. Overall, 0.5% of the population is affected,
3. It is thought that schizophrenia isn’t a single disorder but that there are various subtypes - however, there isn’t an agreed definition.

Question 3

Potential perceptual symptoms of schizophrenia?

Answer 3

1. Auditory hallucinations; hearing things that aren’t there. People often hear voices saying abusive things,
2. Auditory hallucinations are the most common type of hallucination in schizophrenia, but there are other types of hallucination too. Some people see, feel, smell, or taste things that aren’ there.

Question 4

Potential social symptoms of schizophrenia?

Answer 4

1. Social withdrawal - not taking part in or enjoying social situations,
2. People might be aloof or avoid eye contact.

Question 5

Potential cognitive symptoms of schizophrenia?

Answer 5

1. Delusions - believing things that aren’t true. People can have delusions of grandeur or of paranoia and persecution. Others experience delusions of control - they believe their behaviour is being controlled by somebody else. For example, thought insertion is when someone feels that thoughts are being put into their head. Thought withdrawal is when they believe that someone is removing their thoughts. They might also believe that people can read their thoughts - this is thought broadcasting,
2. Language impairments - irrelevant and incoherent speech. People often show signs of cognitive distractibility, where they can’t maintain a train of thought. They might also repeat sounds others say (echolalia), speak nonsense or gibberish, speak in nonsensical rhmes (clang associations), experience speech poverty (giving brief replies in conversation and show no extra, spontaneous speech) and invent words (neologisms).

Question 6

Potential affective/emotional symtpoms of schizophrenia?

Answer 6

1. Avolition - a lack of drive, motivation, or interest in achieving goals,
2. Lack of interest in hygience and personal care,
3. Lack of emotion - not reacting to typically emotional situations. This is also called emotional blunting,
4. Inappropriate emotions - reacting in an inappropriate way, e.g. laughing at bad news.

Question 7

Behavioural symptoms of schizophrenia?

Answer 7

1. Stereotyped behaviours - continuously repeating actions, which are often strange and don’t have a purpose,
2. Psychomotor disturbance - not having control of your muscles. People may experience catatonia, where they sit in an awkward position for a long-time. In this state people will sometimes stay in whatever position they are put in. Catatonic stupor involves lying rigidly and not moving for long periods of time. People are conscious during these episodes and can remember what was going on around them, although they don’t seem aware of it at the time.

Question 8

What are positive and negative symptoms?

Answer 8

1. Positive symptoms are those that add something to experience or behaviour,
2. Negative symptoms are those deficiencies of typically present experience/emotion/behaviour.

Question 9

Positive symptoms of schizophrenia?

Answer 9

1. This is where people experience something, feel that something is happening to them, or display certain behaviours - they are extra experiences and behaviour that are not normally there,
2. They include: hallucinations; delusions; jumbled speech; disorganised behaviour.

Question 10

Negative symptoms of schizophrenia?

Answer 10

1. This is where people don’t display ‘normal’ behaviours - these symptoms are a lack of experiences/behaviours which are normally there,
2. They include: speech poverty; lack of emotion; avolition; lack of ability to function normally.

Question 11

What is the DSM?

Answer 11

1. The DSM is the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders,
2. It contains a list of mental health disorders, outlining the symptoms themselves and how long these symptoms should be present for, to result in a diagnosis,
3. It aims to give diagnosis of mental disorders reliability and validity.

Question 12

What is reliability is diagnosis of mental disorders?

Answer 12

1. How far the classification system produces the same diagnosis for a particular set of symptoms,
2. In order for a classification system to be reliable the same diagnosis should be made each time its used,
3. This means that different clinicians should reach the same diagnosis.

Question 13

What is validity in diagnosis of mental disorders?

Answer 13

1. Validity is whether the classification system is actually measuring what it aims to measure,
2. Descriptive validity - how similar individuals diagnosed with the disorders are,
3. Aetiological validity - how similar the cause of the disorder is for each sufferer,
4. Predictive validity - how useful the diagnostic categories are for predicting the right treatment.

Question 14

What symptoms does the DSM say an individual must have to be schizophrenic?

Answer 14

They must show at least two of:
1. Delusions,
2. Hallucinations,
3. Disorganised speech,
4. Disorganised or catatonic behaviour,
5. Any negative symptoms.
At least one of their symptoms must be from the first three of these. Their symptoms have to have been present for at least six months, with at least one month of active symptoms.

Question 15

Problems with the reliability of schizophrenia diagnoses?

Answer 15

1. Schizophrenia diagnosis may be be affected by cultural bias (Harrison et al., 1984),
2. Cultural bias has also been shown to stem from medical staff themselves (Copeland et al., 1971),
3. Reliably diagnosing schizophrenia can also be difficult due to gender bias (Loring andf Powell, 1988).

Question 16

Harrison et al. (1984), findings?

Answer 16

1. Showed that there was an over-diagnosis of schizophrenia in West Indian psychiatric patients in Bristol,
2. No research has found any cause for this, so it suggests that the symptoms of ethnic minority patients have been misinterpreted,
3. This questions the reliability of the diagnosis of schizophrenia - it suggsts that patients can display the same symptoms but receive different diagnoses because of their ethnic background.

Question 17

Copeland et al. (1971), findings?

Answer 17

Found that 69% of American psychiatrists in the study diagnosed a particular patient (shown in a video) as having schizophrenia compared with only 2% of British psychiatrists asked to diagnose the same patient.

Question 18

Loring and Powell (1988), method and findings?

Answer 18

1. Conducted a study where 290 psychiatrists were asked to diagnose the same two patients,
2. When they were told the patient was male, 56% diagnosed the patient as having schizophrenia,
3. If they were told the patient was female, this dropped to around 20%, despite symptoms being identical,
4. This gender bias wasn’t as clear if the psychiatrists were female. So, gender bias comes not only from the gender of the patient, but also the gender of the practitioner.

Question 19

Longenecker et al. (2010), gender bias in schizophrenia diagnosis?

Answer 19

Could not find any explanation for the sudden increase in schizophrenia diagnoses in males after the 1980s,

Question 20

Cotton et al. (2009), gender bias in schizophrenia diagnosis?

Answer 20

Suggests that because there are no differences in genetic susceptibility for men and women in terms of schizophrenia, then gender bias must be to blame.

Question 21

Problems with validity in diagnosis of schizophrenia?

Answer 21

1. Rosenhan (1973),
2. Symptom overlap can cause problems with the validity of diagnosis. Lots of the most common symptoms in schizophrenia are also found in other disorders. For example, avolition is also a symptom of depression. This makes it hard to determine which disorder the patient may have.

Question 22

Rosenhan (1973), findings on the problems with validity in Schizophrenia diagnoses?

Answer 22

1. Conducted a study where people with no mental health problems got themselves admitted into a psychiatric unit by saying they heard voices - they became pseudopatients,
2. Once they had been admitted they behaved ‘normally’. However, their behaviour was still seen as a symptom of their disorder by the staff in the unit,
3. For example, one pseudopatient who wrote in a diary was recorded as displaying ‘writing behaviour’,
4. This questions the validity of the diagnosis of mental disorders - once people are labelled as having a disorder, all of their behaviour can be interpreted as being caused by the disorder.

Question 23

What is comorbidity?

Answer 23

1. Means having two or more conditions at the same time,
2. For example, patients with schizophrenia may also have depression,

Question 24

How can comorbidity affect diagnosis?

Answer 24

1. Comorbidity can also be an issue un making a reliable and valid diagnosis of schizophrenia,
2. It could be that some of their symptoms belong to one known disorder, but that the others belong to an untreated mental disorder which hasn’t been recognised yet.

Question 25

Buckley et al. (2009), comorbidity and diagnoses of schizophrenia?

Answer 25

1. Researchers found that 29% if their schizophrenic patients suffered from post-traumatic stress disorder, whilst 50% suffered depression, 2. Particularly in the case of depression, this suggests that if schizophrenia is so frequently diagnosed with other psychiatric disorders, then their two disorders may actually be the same, and so a more accurate and valid method of diagnosis would be to combine these two.