Issues in the diagnosis of Schizophrenia

Question 1

Prevalence of Schizophrenia?

Answer 1

• affects 1% of population
• symptoms appear between 15-45
• Men more susceptible than women
• Men tend to be diagnosed mid 20s
• Women tend to be diagnosed early 30s

Question 2

Prognosis of Schiz?

Answer 2

• Symptoms most severe during first 5 years after onset
• 40% recover from positive symptoms
• 20% make full recovery, diagnosed early
• 40% have it for life

Question 3

What are positive symptoms?
Give two examples

Answer 3

• Symptoms normal people don’t experience
• Delusions & Hallucinations
• referred to as Category A symptoms

Question 4

What are negative symptoms?
Give two examples

Answer 4

• Symptoms normal people experience that schiz patients do not
• Avolition & Alogia (speech poverty)

Question 5

How does the DSM classify a schiz patient mainly?

Answer 5

• symptoms must persist for 6 months
• this period must include 1 month of two symptoms
• one of the two has to be positive

Question 6

What is the relationship to Autism the DSM outlines?

Answer 6

• If there is history of Autism in the patient, diagnosis of Schiz. is only made if there are delusions/hallucinations & other symptoms for at least 1 month (or less if successfully treated

Question 7

Describe Hallucinations as a positive symptom?

Answer 7

• Sensory experiences, seeing distortions, hearing critical voices
• Can include olfactory (phantom odours) which are smells

Question 8

Describe Delusions as a positive symptom?

Answer 8

• Irrational beliefs
• Feelings of persecution (from the government)
• Feelings of grandeur (thinking they’re royalty)

Question 9

Describe Avolition as a negative symptom?

Answer 9

• lack of purposeful behaviour
• No energy, lack of social activity, lack of personal hygiene
• Generally apathetic towards people
• won’t go outside

Question 10

Describe speech poverty as a negative symptom?

Answer 10

• lack of quantity & quality of verbal responses
• Disorganised verbal communication can become positive symptom

Question 11

What’s a positive implication of being diagnosed with a disorder?

Answer 11

• appropriate treatment
• placed on road to recovery
• family at ease

Question 12

What’s are 3 negative implications of being diagnosed with schizophrenia?

Answer 12

• stigma of schizophrenia
• labelling theory and self-fulfilled prophecy
• employment/housing

Question 13

In reliability of Schiz diagnosis what two types of reliability arise & what are they?

Answer 13

• Inter-rater reliability
• two+ clinicians make identical diagnosis of the SAME patient with SAME information
• Test-retest reliability (external reliability)
• clinicians make the same diagnosis of the patient on separate occasions with SAME information

Question 14

What factors could influence a low rate of agreement between clinicians?

Answer 14

• bias (gender, race)
• subjective guidelines
• vague symptoms

Question 15

A03 Reliability of diagnosis
Beck et al 1963?
(153 patients)

Answer 15

• Beck reviewed 153 patients diagnosed by 2 different psychiatrists
• Diagnosis concordance rate only 54%
• Suggests low inter-rater reliability in diagnosis
• Suggests many misdiagnosed leading to incorrect treatments

Question 16

A03 Reliability of diagnosis
Farmer 1988?
(PSE)

Answer 16

• Found standardised interview known as Present State Examination (PSE) increases reliability
• PSE focuses on frequency & severity of symptoms
• therefore diagnosis can be made reliable as all patients are asked the same things

Question 17

A03 Reliability of diagnosis
Copeland 1970?
(U.S. & British)
(can be used for cultural differences)

Answer 17

• Copeland gave description of a patient to 134 U.S. psychiatrists & 94 British psychiatrists
• 69% U.S. diagnosed patient with schiz
• 2% British diagnosed patient with schiz
• shows no consistency in diagnostic criteria
• shows DSM may be flawed
• shows differences in diagnosis dependent on country

Question 18

AO3 Reliability of diagnosis
Cheniaux 2009?
(DSM & ICD-10)

Answer 18

• classification systems are unreliable in diagnosis
• 2 psychiatrists evaluated 100 patients using DSM & ICD-10
• Psych 1 found 26 patients had schiz (using DSM) & 44 (using ICD-10)
• Psych 2 found 13 patients had schiz (using DSM) & 24 (using ICD-10)
• suggests low inter-rater reliability & low reliability between both classification systems.

Question 19

What is validity in schiz?

Answer 19

• are we measuring what we are intending to measure
• validity of diagnostic tools

Question 20

What two areas of validity affect schiz & what are they?

Answer 20

Comorbidity
- refers to when more than one disorder exists alongside schiz e.g. BPD & Schiz
- calls into question validity of classification of both illnesses
- should be seen as one separate condition

Overlapping symptoms
- none of schiz symptoms are exclusive to the disorder (pathognomonic)
- this makes valid diagnosis harder to achieve
- estimated 13% of population hear voices yet only 1% are diagnosed schizophrenics (read et al 2011)

Question 21

Pathognomic?

Answer 21

• where symptoms are not exclusive to one disorder e.g social avolition in Schiz.

Question 22

A03 Validity of diagnosis
Buckley 2009?
(comorbidity, other disorders)

Answer 22

• Buckley found comorbidity rates with schiz
• 50% depression, 47% drug abuse, PTSD 29%, OCD 23%
• as well as complicated treatment plans, diagnosis is wrong if disorders share symptoms
• e.g. BPD also has delusions as a symptom
• So schiz should be redefined

Question 23

A03 Validity of diagnosis
Konstantareas & Hewitt?
(autism & schiz)

Answer 23

• Compared 14 male sufferers of schiz & autism
• found none of schiz group had symptoms of autism
• But 50% (7) of autistics had negative symptoms of schiz
• Shows Overlapping symptoms of schiz

Question 24

A03 Validity of diagnosis
Benefits of classification systems (DSM)

Answer 24

• DSM helps with validity of diagnosis as it meets more than 1 criteria
• e.g. 2 or more characteristic symptoms for at least 6 months relative to patients condition
• So this helps to make accurate diagnoses for an area of medicine not physical

Question 25

AO3 Validity of diagnosis Rosenhan 1973? (8 pseudo-schizophrenics)

Answer 25

- Criticises the validity of Schiz. diagnosis - 8 healthy volunteers presented themselves to 12 pscyh hospitals claiming schizophrenic symptoms - All 8 were diagnosed with Schiz. & discharged with Schiz. in remission - Results suggests Doctors did not have valid methods for diagnosing Schiz.

Question 26

What are the 4 aspects of cultural bias in Schiz? I A N D

Answer 26

1. Cultural interpretations of symptoms affect diagnosis (insanity or gift) 2. Negative cultural attitudes (stigma) 3. Culture/nationality of clinician 4. Race discrimination evident in diagnosing Schiz.

Question 27

Outline Cultural interpretations of Schiz symptoms affecting diagnosis of the disorder?

Answer 27

- Some research shows that religious & cultural groups perceive Schiz. differently - e.g. 'insane' in one culture is a spiritual 'gift' in another - this can complicate a valid diagnosis of Schiz.

Question 28

Outline negative cultural attitudes to Schiz that affect the diagnosis of the disorder?

Answer 28

- Psychological distress & mental health issues attract different levels of stigma in different cultures affecting diagnosis of Schiz. - implies without being diagnosed, people with schizophrenia will continue to suffer and fail to receive effective treatment

Question 29

Outline the culture/nationality of the clinician which affects the diagnosis of the disorder?

Answer 29

- nationality/culture of the clinician creates reliability & validity issues when diagnosing Schiz. - Some nationalities diagnose Schiz. in different ways - US & UK diagnose in similar ways however the US is far more likely diagnose Schiz.

Question 30

Outline race discrimination which affects the diagnosis of the disorder?

Answer 30

- research implies some nationalities have more Schiz. than others - It is suggested clinicians perceive diverse ethnic groups very differently and then discriminate - Implies to avoid misdiagnosis clinicians should be mindful of unconscious bias

Question 31

AO3 Cultural Bias Copeland 1970? (US & British)

Answer 31

- Copeland gave description of a patient to 134 U.S. psychiatrists & 94 British psychiatrists - 69% U.S. diagnosed patient with schiz - 2% British diagnosed patient with schiz - shows no consistency in diagnostic criteria - shows DSM may be flawed - shows differences in diagnosis dependent on country

Question 32

AO3 Cultural Bias Malgady 1987? (VooDoo)

Answer 32

- Research demonstrated different cultures interpret symptoms of Schiz. in different ways - In traditional Costa Rican culture, hearing voices is associated with spirits speaking to the individual - On the other hand this is a positive symptom of Hallucinations in the US through the DSM - Shows culture can disrupt schiz diagnosis & DSM is invalid as its not universally applicable

Question 33

AO3 Cultural Bias Practical Applications? (psych training)

Answer 33

- Strong practical applications that have come from research (Malgady) into cultural biases. - Finding cultural biases allows for training of clinicians into the differences in interpretations of symptoms. - This can improve diagnosis of SZ because it will be standardised & applicable to everyone in society irrespective of culture.

Question 34

AO3 Cultural Bias Escobar 2012? (Cocaine - White)

Answer 34

- Some White clinicians may over interpret symptoms of Black people during diagnosis. - Factors including mannerisms & language encompass difficulties in black patients relating to white clinicians. - The myth black people rarely suffer from affective disorders may be causing this problem. - So clinicians & researchers must pay more attention to their unconscious bias and focus on the objective facts.

Question 35

What are 3 aspects of Gender Bias which affects the diagnosis of schizophrenia? U B U

Answer 35

1. Unreported facts when diagnosing schizophrenia in men & women 2. Biased research 3. Underdiagnosing female patients suffering from schizophrenia

Question 36

Outline unreported facts in gender when diagnosing schizophrenia?

Answer 36

- Men suffer more severe negative symptoms & more substance related disorders than women - Men are more likely to be admitted to psychiatric wards (Goldstein 1993)

Question 37

Outline Biased research in gender when diagnosing schizophrenia?

Answer 37

- Some psychologists claim research into schiz. has disregarded females patients - questions usefulness & representation

Question 38

Outline underdiagnosing of female patients when diagnosing schizophrenia?

Answer 38

- Research has suggested women go under-diagnosed compared to males - clinicians ignore differences between predisposing risk factors between genders - this gives them different vulnerability factors in life - Implies women are denied access to treatment & have to continue suffering from schiz. symptoms

Question 39

AO3 Gender bias Cotton 2009? (Females are nice so I doubt they have schiz.)

Answer 39

- Suggests better interpersonal functioning of women causes doctors to dismiss their symptoms - women seem to recover more & suffer less relapse than males - Beta bias will transpire if clinicians disregard female sufferers - Shows existence of gender bias if gender differences are ignored if its the case male patients are more likely to relapse than females

Question 40

AO3 Gender bias Nasser 2002? (Androcentrism)

Answer 40

- Incorporating gender in research analysis is essential - Gender influences onset, illness, & treatment - Early research into schiz. was mainly on men - Research findings will not be appropriate for women - If research exclusively focuses on men it can be deemed androcentric and lacks generalisability to target populations

Question 41

AO3 Gender bias Lorring & Powell 1988? (290 m&f psychiatrists)

Answer 41

- Randomly selected 290 male & female psychiatrists to read 2 cases - using DSM they were asked to offer their judgements - when patient was male/no gender: 56% said schiz. - gender bias was less prominent with female psychiatrists (20%) - Further support for lack of validity in the DSM in relation to gender

Question 42

AO3 Gender bias Practical application? (psych training)

Answer 42

- Research can help to train psychologists to not misdiagnose females - especially if they have symptoms associated with other disorders (overlapping symptoms) - This should result in females receiving correct diagnosis Male sufferers, in turn, should also not be over diagnosed - Findings from Lorring & Powell can show biases when diagnoses are made - this improves the validity of the process