Intro

Question 1

Positive Symptoms

Answer 1

• Additional experiences beyond those of the ordinary

Question 2

P. Symptoms - Hallucinations

Answer 2

• Unusual sensory experiences that can sometimes be related to events in the environment and other times bear no relationship to what the senses are picking up
• They can be experienced in relation to any sense – seeing distorted facial experiences, seeing people/animals that aren’t there, etc

Question 3

P. Symptoms - Delusions/Paranoia

Answer 3

• Irrational beliefs that can take a range of forms – common delusions include being an important figure like Jesus, or being persecuted by governments/aliens, or having superpowers, etc
• Another class of delusions concerns the body – a person may believe that they are under external control
• Delusions can make a person behave in ways that make sense to them but seem bizarre to others
• Most sufferers aren’t aggressive and are more likely to be victims of violence, but some delusions can lead to aggression

Question 4

P. Symptoms - Disorganised Speech/Thinking

Answer 4

• An individual speaks in ways that are completely incomprehensible (word salad) – sentences make little sense/topic randomly changes midway
• Feeling that thoughts have been inserted/withdrawn from the mind (thoughts being broadcasted)

Question 5

Negative Symptoms

Answer 5

• Involve the loss of usual abilities and experiences – they include speech poverty and avolition

Question 6

N. Symptoms - Speech Poverty/Disorganisation

Answer 6

• Speech poverty is a reduction in the amount and quality of speech – this is sometimes accompanied by a delay in the person’s verbal responses during conversation
• Nowadays, more emphasis is placed on speech disorganisation (DSM-5 system), where speech becomes incoherent/the speaker changes topic mid-sentence
• Speech poverty is considered negative while disorganisation is classified as positive

Question 7

N. Symptoms - Avolition

Answer 7

• When you find it difficult to begin/keep up with goal-directed activity – people with schizophrenia often have sharply reduced motivation to carry out a range of activities
• Nancy Andreasen (1982) identified 3 signs of avolition – poor hygiene and grooming, lack of persistence in work and education, and lack of energy

Question 8

Some Stats

Answer 8

• Affects about 1% of the world population
• Diagnosed more in cities than the countryside; diagnosed more in working-class than middle-class people
• Only about 8% of people are aggressive
• 30-50% of people attempt suicide
• Since the 1980s, men had been diagnosed more commonly than women (a ratio of 1:4:1, Fisher and Buchanan 2017)
• About 25% of sufferers will get better after only one episode of the illness; 50-65% will improve, but continue to have bouts of the illness; the remainder will have persistent difficulties (Stirling and Hellewell in 1999

Question 9

Classification

Answer 9

• Schizophrenia is classified differently in the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders) and ICD-10 (International Classification of Diseases) systems
• In the DSM-5 system, one of the positive symptoms must be present for diagnosis
• In the ICD-10 system, 2 or more negative symptoms are sufficient for diagnosis

Question 10

Evaluation - Low reliability of diagnosis

Answer 10

• Cheniaux et al (2009) had 2 psychiatrists independently diagnose 100 patients using both DSM and ICD criteria, and found that inter-rater reliability was poor as one psychiatrist diagnosed 26 people with schizophrenia using DSM and 44 using ICD, while the other diagnosed 13 with DSM and 24 with ICD
• This inconsistency between professionals and the classification systems is a limitation

Question 11

Evaluation - Low validity

Answer 11

• Criterion validity asks whether different assessment systems arrive at the same diagnosis for the same patient
• Cheniaux et al’s study shows that schizophrenia is much more likely to be diagnosed using ICD than DSM, meaning that schizophrenia is either over-diagnosed in ICD or under-diagnosed in DSM

Question 12

Evaluation - Co-morbidity (when 2+ conditions occur together)

Answer 12

• Buckley et al (2009) concluded that around ½ of patients with a diagnosis of schizophrenia also have a diagnosis of depression (50%), substance abuse (47%), PTSD (29%) or OCD (23%)
• This poses a challenge for both classification and diagnosis as if the conditions are very similar to each other, it may be that they are a single condition

Question 13

Evaluation - Symptom overlap

Answer 13

• There is considerable overlap between symptoms of schizophrenia and other conditions, with conditions like schizophrenia and bipolar disorder both involving symptoms like delusions and avolition
• Under ICD, a patient might be diagnosed as schizophrenic but under the DSM, they might be diagnosed with bipolar disorder

Question 14

Evaluation - Gender bias

Answer 14

• Longenecker et al (2010) reviews studies of the prevalence of schizophrenia and concluded that since the 1980s, men have been diagnosed more often than women
• Cotton et al (2009) found that female patients typically function better than men, which may explain why some women escape diagnosis because their better interpersonal functioning may bias practitioners to under-diagnose schizophrenia
• This is a problem as men and women with similar symptoms may experience differing diagnoses

Question 15

Evaluation - Cultural bias

Answer 15

• African-Americans and English people of Afro-Caribbean origin are much more likely to be diagnosed with schizophrenia
• Rates in the West Indies and Africa aren’t high, so this isn’t due to genetic vulnerability
• Higher diagnosis rates in UK may be because some behaviours classed as positive symptoms of schizophrenia are ‘normal’ in African cultures (hearing voices)
• Escobar (2012) pointed out that (overwhelmingly white) psychiatrists may tend to over-interpret symptoms and distrust honesty of black people during diagnosis