Diagnosis and Classification

Question 1

What is schizophrenia?

Answer 1

-severe mental disorder where contact with reality and insight are impaired

Question 2

What are 6 symptoms of schizophrenia?

Answer 2

1. delusions
2. hallucinations
3. disorganised speech
4. abnormal psychomotor behaviour
5. negative symptoms
6. social/occupational dysfunction

Question 3

What is the link between diagnosis and classification?

Answer 3

-identify clusters of symptoms that occur together and classify as one disorder

Question 4

What are the 2 major systems for classification?

Answer 4

1. DSM-5
2. ICD-10

Question 5

What are positive symptoms?

Answer 5

-atypical symptoms experienced in addition to normal experiences

Question 6

What are negative symptoms?

Answer 6

-atypical experiences that represent loss of a usual experience

Question 7

What is the criteria in the DSM-5?

Answer 7

-1 positive symptom must be present

Question 8

What is the criteria in the ICD-10?

Answer 8

-2 or more negative symptoms are sufficient for diagnosis

Question 9

What are hallucinations?

Answer 9

-unusual sensory experiences
-some are related to events in the environment
-or some have no relationship to what the senses are picking up from environment

Question 10

What are delusions?

Answer 10

-irrational beliefs
-may involve being an important political or religious figure
-commonly involve being persecuted
-also commonly concerns the body - may believe they are under external control

Question 11

What is speech poverty?

Answer 11

-reduction in the amount and quality of speech
-accompanied by a delay in the persons verbal responses during conversation

Question 12

What is speech disorganisation?

Answer 12

-speech becomes incoherent or the speaker changes topic mid sentence

Question 13

What is avolition?

Answer 13

-finding it difficult to begin or keep up with goal directed activity
-sharply reduced motivation to carry out a range of activities

Question 14

What are the 3 signs of avolition?

Answer 14

1. poor hygiene
2. lack of persistence
3. lack of energy
   ‘Nancy Andreasen’

Question 15

1) What is one strength of the diagnosis of schizophrenia?

Answer 15

-good reliabilty - means consistency
-Osorio reported excellent reliability for the diagnosis
-inter rater reliability of + 97
-consistently applied

Question 16

1) What is one limitation of the diagnosis of schizophrenia?

Answer 16

-validity
-general validity concerns whether we assess what we are trying to assess
-Cheniaux - had 2 psychiatrists assess the same 100 patients under ICD and DSM
-68 were diagnosed under the ICD
-39 under the DSM
either under or over diagnosed
-criterion validities is low

Question 17

2) What is one limitation of the diagnosis of schizophrenia?

Answer 17

-gender bias
-used to be common in women
-a possible explanation may be is that women are less vulnerbale, because of genetic factors
-more likely that women are under diagnosed as they have closer relationships and hence get support
-leads to women with schizophrenia functioning better than in men
-women may not be receiving treatment

Question 18

3) What is one limitation of the diagnosis of schizophrenia?

Answer 18

-culture bias
-some symptoms like hearing voices may have different meanings in different cultures
-in Haiti - hearing voices are communications from ancestors
- explanation may be diagnosis of clients by psychiatrists from different cultural background
-leads to over-interpretation of symptoms

Question 19

What is co-morbidity?

Answer 19

-the occurrence of 2 disorders or conditions together
-where 2 conditions are frequently diagnosed together calls into question the validity of classifying the 2 disorders separately

Question 20

What is symptom overlap?

Answer 20

-occurs when 2 or more conditions share symptoms
-questions the validity of classifying the 2 disorders separately

Question 21

How is the DSM-5 tested for reliability?

Answer 21

-inter rater reliability
-a Kappa score of 1 = perfect agreement, 0 = no agreement
-DSM 5 = 0.46

Question 22

How are positive symptoms more acceptable in African cultures?

Answer 22

-cultural beliefs in communication
-people are ready to acknowledge such experiences
-when reported to a psychiatrist from different culture = may be seen as irrational compared to what they think is ‘normal’
-ethnocentric
-Copenland

Question 23

What research did Luhrmann conduct into cultural differences?

Answer 23

-interviewed 20 adults from ghana, 20 from india and 20 from USA with schizophrenia
-found african cultures reported positive experiences with voices
-US were more likely to report these as violent

Question 24

What was Rosenhan’s study?

Answer 24

-aims to test the validity of psychiatry diagnoses
-8 pseudo patients were diagnosed with a mental disorder
-all of them were hospitalised to 12 hospitals
-they all observed deficits in patient-staff contact
-findings provided convincing evidence against the accuracy of diagnoses
-leads to uncertainty in recent neurological findings

Question 25

What does Rosenhan’s study tell us about the problems of reliability of diagnosis?

Answer 25

-any findings found may be questioned in respect to reliability and validity
-demonstrates psychiatrists can’t reliably tell the difference between people who are sane and insane
-therefore definitions need to be operationalised and more rigid structured diagnosis

Question 26

Define reliability in the context of schizophrenia

Answer 26

-reliability is the consistency of results
-clinicians must be able to reach the same conclusions

Question 27

Identify and explain one way the reliability of the diagnosis of schizophrenia can be tested

Answer 27

-inter-rater reliability
-diagnosed using the DSM-5
-if a kappa score of 0.46 is reached = positive diagnosis of schizophrenia
-a perfect score would equal 1

Question 28

What is validity in terms of schizophrenia?

Answer 28

-the extent to which a diagnosis reflects the actual disorder
-represents something that is real and distinct from other disorders
-eg. whether the DSM-5 mesures what is says it measures

Question 29

How can gender bias impact diagnosis?

Answer 29

-gender based diagnositic criteria or clinicians basing judgements on stereotypical beliefs about gender
-Boverman

Question 30

What research did Boverman do in relation to gender bias in schizophrenia?

Answer 30

-US definitions of mentally healthy adult are taken strath from what it means to be a mentally healthy male
-generally led to believe women were less healthy as they deviate from male behaviour
-may be simply down to differences in help-seeking behaviour

Question 31

What evidence is there into symptom overlap?

Answer 31

-Ellison and Ross
-people with dissociative identity disorder have more schizophrenia symptoms that people diagnose as schizophrenia
-they both experience positive and negative symptoms
-this lack of distinction calls into question the validity of both classification and diagnosis

Question 32

What further research did Read conduct?

Answer 32

-most people with schizophrenia have sufficient symptoms to receive at least one other diagnosis
-eg. bipolar disroder shares symptoms such as delusions and avoiltion
-brings into question whether S is a unique disorder that is distinct from others