(P2) clinical psychology Flashcards
assumptions of clinical psychology
- mental disorders are a form of illness to be diagnosed and treated (the medical model)
- types of mental disorder can be grouped and classified.
- types of treatment can be grouped within a particular approach to psychology (e.g. biological or non-biological)
define mental illness
mental illness refers to significant changes in thinking, emotion and/or behaviour. it also has a variety of effects (e.g. distress and/or problems in social, work and family activities)
how can mental health be seen as a ‘social construct’?
mental health intepretations and understandings differ across culture and societies. for instance, one society may interpret behaviour as deviant whereas another society may consider it the norm.
define psychopathology
the study of mental illness and the behaviours and experiences that may indicate illness/distress/impairment.
what are the two main classification systems for mental illnesses?
DSM-V- the diagnostic statistical manual of mental disorders
ICD-10- the international statistical classification of diseases and related health problems
what is the medical model of mental ill health?
an approach that treats mental illness in the same way as physical illness, using lists of symptoms, features and classifications to diagnose or categorise patients with a particular disorder.
what are the four D’s of diagnosis?
the four D’s are used to define abnormality.
deviance refers to behaviour and emotions that go against the social and cultural norms of society. these must be seen as socially unacceptable. (e.g. dancing alone in public may be seen as socially acceptable in some societies/cultures but socially unacceptable in others, which points towards mental illness). an example of deviance is paedophilia.
- Davis (2009) says betweeen 3% and 9% of males report interest in underage children. the intensity and frequency of urges is reported by considerably fewer.
distress refers to when someone with a disorder experiences negative feelings. it is thought that abnormality in a mental health sense is accompanied by feelings of distress.
- hypochondriasis, those who are deeply affected by the fear of illness even if they have been reassured.
dysfunction refers to a person being unable to carry out ordinary, daily tasks that they used to be able to. (e.g. not being able to go to work anymore or out with friends).
danger refers to danger towards others or to the individual. violent behaviour directed towards others signals danger, while behaviour that is a danger to individuals themselves would include suicidal thoughts.
- nicotine dependance is a mental health disorder linking to danger. davis (2009) cites figures showing that 10% of all current and former smokers in the USA have a smoking-related chronic disease, which illustrates the ‘danger’ from smoking-related diseases.
- davis (2009) also cites that individuals suffering from mental illness have a 25% higher chance of dying from unnatural causes.
fifth D:
duration refers to how long the symptoms have been present for.
- schizophrenia illustrates duration because for a diagnosis, episodes must happen over time.
who came up with the four D’s?
davis
when are the four D’s used?
the four D’s are useful in summarising how mental health professionals might define abnormality.
davis (2009) suggests that using the four D’s can help practitioners to see when a condition might need a DSM diagnosis. the four D’s can assist enough to become a diagnosis.
(AO3) evaluate the four D’s of diagnosis
STRENGTHS
- (davis, 2009) has shown how the four D’s can be used with the DSM-IV-TR and adds a fifth - duration. the four D’s have practical application because they are useful for a professional when considering when a patient’s symptoms or issues become a clinical diagnosis.
WEAKNESSES
- there is the potential for issues of subjectivity and a lack of objectivity, which raises issues about their reliability. if the four D’s are used by two different professionals, they may not reach the same conclusions about mental disorder. this is because ‘deviance’ for instance, may be considered different in one society/culture vs. another.
- it may be claimed that (davis, 2009) having to add another, fifth D (duration) means that the four D’s are insufficient themselves as a tool.
issues when using the four D’s to diagnose
deviance can be difficult in diagnosis because different mental disorders show similar deviance. however, some diagnoses are clearly illustrated by deviance (e.g. paedophilia) where the symptoms in the DSM clearly indicate deviance.
- Davis (2009)
dysfunction can be difficult to diagnose because many life events and issues can be dysfunctional. may be subjective.
distress is quite hard to measure because a person may be unable to function and carry out everyday tasks but they do not experience feelings of distress.
define neuroses
mental health issues that fall just outside of normal functioning, but the individual is still in touch with reality and knows they are ill.
define psychoses
mental health issues where the individual has lost touch with reality and is not on a continuum with normal mental health.
define prevalence
the proportion of the population that has a disease at a point in time.
define incidence
the rate of occurrence of new disease during a period of time
differences in DSM-IV-TR (2000) versus. DSM-5 (2013)
DSM-IV-TR
multi-axial system that consists of 5 axes:
axis I: considers clinical, major mental, developmental and learning disorders.
axis II: looks at underlying personality conditions, including mental retardation.
axis III: general medical conditions such as diabetes.
axis IV: psychosocial and environmental factors that affect the disorder (e.g. poverty, dysfunctional families).
axis V: assessing someone’s overal functioning using a rating score.
DSM-5
one of the goals of the DSM-5 is to harmonise with the ICD system, which was not the case for previous DSMs.
section I: explains the DSM-5’s organisation and the changes from the DSM-IV-TR (away from the multi-axial system).
section II: gives diagnostic criteria and codes and covers all of the mental disorders listed in chapters. such as bipolar disorder, schizophrenia.
section III: covers emerging measures and models, looking to the future of diagnosis.
AO3 evaluating the DSM, including the DSM-5
STRENGTHS
- DSM-5 underwent field trials before publication, which included re-test reliability where different clinicians independantly evaluated the same patient.
- the DSM is ultimately the best attempt at diagnosis in existence, given the limited understanding of mental disorders. albeit its criticisms, it has stood the test of time.
WEAKNESSES
- the british psychological society (BPS) has expressed concern about the DSM-5 because the DSM-5 brought in social norms to be considered when making a diagnosis and this requires the clinicians to make judgements about such norms or to use their own social norms, which may differ to the patient’s. deviance and dysfunction relate to culture and social norms as they might be different in different cultures.
- there was a criticism that when reviewing the DSM-5, individuals had to sign an agreement that they would not discuss the process of reviewing this version of the DSM-5. this is a problem because it means there is no transparency, meaning that the DSM-5 potentially lacks credibility because the results of any testing could not be challenged, which almost opposes scientific credibility.
differences between ICD and DSM
(1) ICD is produed by a global health agency with a constitutional public health mission
- whereas DSM is produced by a single national professional association
(2) ICD’s development is global, multidisciplinary and multilingual
- whereas DSM’s primary constituency is US psychiatrists
(3) ICD is distributed as broadly as possible at very low cost, with substantial discounts to low-income countries and available for free on the internet.
- whereas DSM generates a substantial portion of the American Psychiatric Associations Revenue; therefore, it is expensive.
operationalisation
(in relation to validity of the DSM)
operationalising variables means making them fully measurable so that what is done in a study is precise, replicable and clear.
if the DSM is to define mental disorders then mental disorders need to be operationalised. lists of symptoms and behaviour are the result of making a mental disorder measurable.
cultural issues: validity, diagnosis and the DSM
culture does NOT affect diagnosis, mental disorders are ‘scientific’
the DSM was developed in the USA but is used in many other cultures. this is a valid use if mental disorders are clearly defined with specific features and symptoms. mental disorders are scientifically defined illnesses that are explained in a scientific way like any other illness.
LEE 2006
supports this because he found that the DSM-IV-TR had construct validity for diagnosing korean boys with ADHD. the diagnosis occured in a non-western culture, which supports the idea that the DSM does have cross-cultural validity.
cultural issues: validity, diagnosis and the DSM
culture DOES affect diagnosis - a spiritual model
some studies have shown that culture can affect diagnosis. for example, symptoms that are seen in Western countries as characterising schizophrenia (e.g. hearing voices) may be interpreted in other countries as showing possession by spirits, which renders someone special in a positive way rather than negative.
EVRARD 2014
writes about how hearing voices can be because of a mental disorder but also because of individual differnces and interpreted as an exceptional experience. depending on cultural interpretations of what is being measured, the DSM is not always valid.
cultural issues: validity, diagnosis and the DSM
culture DOES affect diagnosis - a spiritual model
some studies have shown that culture can affect diagnosis. for example, symptoms that are seen in Western countries as characterising schizophrenia (e.g. hearing voices) may be interpreted in other countries as showing possession by spirits, which renders someone special in a positive way rather than negative.
EVRARD 2014
writes about how hearing voices can be because of a mental disorder but also because of individual differnces and interpreted as an exceptional experience. depending on cy
cultural differences in schizophrenia
differences in how hallucinations are interpreted and understood
LUHRMANN ET AL. (2015)
found that in the USA, hearing voices was a negative experience whereas in India and Ghana it was considered a positive experience because it was seen as a spiritual revelation. this suggests that the experiences of a mental disorder may differ across cultures, which challenges the validity of diagnoses as clinicians may be from a different culture.
cultural differences in schizophrenia
differences in how treatment affects people
MYERS (2010)
found from a case study that by using the recovery model, efforts to help people become more empowered citizens tended to generate more stress for those diagnosed with schizophrenia is their lives were already stressful. this shows that cultural differences (around work patterns) can lead to different reactions to treatment. myers cautions against using the same model of treatment in all cultures and says that sociocultural conditions affect outcomes.
culture bound syndromes
culture bound syndromes are a set of mental health problems found and recognised as illness only in a particular culture.
for example, penis panic
in some cultures, males think that their penis will retract into their bodies and women believe the same about their breasts. this is known as genital retraction syndrome (GRS) and such panics have been found mainly in asia and africa. it is thought to be related to witchcraft.
AO3 evaluation of cultural issues, validity, diagnosis and the DSM
STRENGTHS
- the DSM-5 provides updated criteria on cross-cultural concepts of mental illness. this is a strength because accounting for culture-bound syndromes and accounting for culture improves the validity of diagnosis.
what makes a valid classification system?
- In order to be valid a classification system must accurately diagnose a mental health disorder, and lead to the right treatment for the diagnosed mental health disorder.
- If a classification system has concurrent validity then it should come up with the same diagnosis for the same symptoms at the same time as
another classification system. - Predictive validity is when upon diagnosing a mental health disorder accurate predictions can be made about how the disorder will progress, and how it will respond to treatment.
- To have a valid classification system then symptoms of a disorder have to be operationalised and measurable e.g. social withdrawal for
schizophrenia.
(AO3) evaluating reliability of diagnoses using DSM
CREDIBILITY the reliability of diagnoses can be significantly improved when clinicians communicate with other clinicians when making diagnosis because this increases inter-rater reliability. (Spitzer & Fleiss)
OBJECTIONS (W) lack of objectivity in interpretation of the four D’s, which also raises issues about the reliability of using them. for example, if the four D’s are used by two different therapists, they may not reach the same diagnosis (e.g. dissociative identity disorder/multiple personality, is a recognised disorder in the USA but not in Britain).
RELIABILITY (S) Goldstein (1988) tested the reliability and validity of diagnosis between the DSM-II and DSM-III. She used the single blind technique, where clinicians carry out the rediagnosis separately, without knowing the previous diagnosis, so they were not affected by bias/expectations. She found that there was evidence of reliability within the DSM-III, i.e. separate clinicians agreed on diagnosis. (They were consistent).
VALIDITY (W) Rosenhan’s (1973) study found that clinicians using DSM were unable to distinguish well, ‘normal’ participants from those with real psychiatric symptoms. This challenged the validity of DSM as a diagnostic tool. This led to important revisions in DSM, leading to a number to updated editions in the light of new evidence.
APPLICATION (S) DSM-V reflects social changes in society (e.g. there is more awareness of cultural differences in mental health) the DSM-V replaces the ‘culture bound syndromes’ and replaces it with advice on ‘cultural concepts of distress’, which is more inclusive and representative within our multicultural society.
(AO3) evaluating the validity of diagnoses using DSM
STRENGTHS
- there is supportive evidence from lee (2006) who conducted a study to investigate whether the DSM-IV-TR diagnosis of ADHD was suitable for korean children. using a questionnaire method with 48 primary school children, he found that there was construct validity between the DSM-IV-TR and the questionnaire data. this is a strength because it shows that different research methods (e.g. questionnaires) yield the same diagnosis as the DSM, proving validity. it also shows that there is cross-cultural validity using the DSM as a diagnostic tool in a different (non-western) culture.
- it may be said that great efforts have been made to improve the validity of the DSM-IV-TR till the current version now DSM-5 where it accounts for culture-bound symptoms now.
- the claim that the DSM is valid is supported by the claim that it is reliable because the two go hand in hand. if the DSM is reliable, it must be valid. Goldstein (1988) tested the reliability and validity of diagnosis between the DSM-II and DSM-III. She used the single blind technique, where clinicians carry out the rediagnosis separately, without knowing the previous diagnosis, so they were not affected by bias/expectations. She found that there was evidence of reliability within the DSM-III, i.e. separate clinicians agreed on diagnosis. (They were consistent).
WEAKNESSES
- (COUNTER-ARGUMENT TO LEE 2006) it’s possible that questionnaires produce the findings that they are searching for. for instance, if ADHD is classified by children being ‘hyperactive and impulsive’, teachers know that the children have that label and they will then say that the children are impulsive and hyperactive. this is a problem because the diagnosis is self-fulfilling.
- it has been said that co-morbidity is hard to diagnose using the DSM- a system that relies in health professionals choosing the closest match from a list of symptoms and features.
(co-morbidity refers to the state of having more than one mental disorder, or more generally more than one illness or disease).
- it may be claimed that splitting a mental disorder into symptoms and features is reductionist and a holistic approach might be more valid. for example, in counselling they aim to treat the person by considering whole aspects rather than symptoms. the DSM lacks this because diagnosis appears to be more important than treatment.
define construct validity
construct validity refers to the degree to which a psychological test or assessment represent that mental disorder.
*(e.g. in the case of depression, the number of days the patient has lacked the motivation to go to work).
construct validity can be increased by operationalising the mental disorders by creating lists of symptoms and behaviour that are measurable.
define concurrent validity
concurrent validity shows you the extent of agreement between the different measures or assessments taken at the same time.
*(e.g. if a diagnosis using the DSM comes up with the same mental disorder that another diagnosis has given at the same time, then the new diagnosis is likely to have concurrent validity).
define predictive validity
predictive validity assesses how well a test predicts a criterion that will occur in the future. it measures the test’s ability to foresee the performance of an individual on a related critetion measured at a later point in time. it gauges the test’s effectiveness in predicting subsequent real-world outcomes or results.
- to find predictive validity, a test would be carried out and results collected. then another/different measure would be done the same time later that would test that same feature. if the tests matched the earlier measure then this shows predictive validity.
define convergent validity
a subtype of construct validity. it assesses the degree to which two measures that theoretically should be related, are related.
- a correlation test would be carried out. if two scales measure the same construct, for example, then a person’s score on one should converge (correlate) with their score on the other.
type I error / false positive
diagnosing someone with a mental disorder when they are healthy
type II error / false negative
diagnosing someone as healthy when in reality they are ill
(AO3) evaluating reliability of diagnoses using DSM
CREDIBILITY the reliability of diagnoses can be significantly improved when clinicians communicate with other clinicians when making diagnosis because this increases inter-rater reliability. (Spitzer & Fleiss)
OBJECTIONS (W) lack of objectivity in interpretation of the four D’s, which also raises issues about the reliability of using them. for example, if the four D’s are used by two different therapists, they may not reach the same diagnosis (e.g. dissociative identity disorder/multiple personality, is a recognised disorder in the USA but not in Britain).
RELIABILITY (S) Goldstein (1988) tested the reliability and validity of diagnosis between the DSM-II and DSM-III. She used the single blind technique, where clinicians carry out the rediagnosis separately, without knowing the previous diagnosis, so they were not affected by bias/expectations. She found that there was evidence of reliability within the DSM-III, i.e. separate clinicians agreed on diagnosis. (They were consistent).
VALIDITY (W) Rosenhan’s (1973) study found that clinicians using DSM were unable to distinguish well, ‘normal’ participants from those with real psychiatric symptoms. This challenged the validity of DSM as a diagnostic tool. This led to important revisions in DSM, leading to a number to updated editions in the light of new evidence.
APPLICATION (S) DSM-V reflects social changes in society (e.g. there is more awareness of cultural differences in mental health) the DSM-V replaces the ‘culture bound syndromes’ and replaces it with advice on ‘cultural concepts of distress’, which is more inclusive and representative within our multicultural society.
ICD-10
the ICD includes a look at the general health of a population and is used to measure incidence (when health problems occur) and prevalence (proportion of population that have a health condition). it is the ICD that provides mortality (number of deaths) and morbidity (number of diseases) for the WHO, world health organisation.
categories of the ICD-10
ICD-10 starts with the following categories:
I- certain infectious and parasitic diseases
II- neoplasms
III- diseases of the blood and blood-forming organs and certain disorders involving the immune system
IV- endocrine, nutritional and metabolic diseases
V- mental and behavioural disorders
VI- diseases of the nervous system
CLASSIC STUDY: Rosenhan (1973) the pseudopatient study
AIM Rosenhan aimed to test the reliability of mental health diagnosis to see if medical professionals could tell the sane (pseudo patients) from the insane in a clinical setting. He also wanted to investigate the effect of labelling on medical diagnosis.
SAMPLE staff and patients in the psychiatric hospitals in the United States. The hospitals were in 5 different states.
*pseudopatients were observers NOT participants
PROCEDURE pseudopatients went to clinical interviews and reported their symptoms.
After admission, they started behaving normally and stopped reporting hearing voices. They took a notepad and pen along with them to record what they saw and heard (unstructured observation).
They tried to do this covertly, but if the staff detected them they carried on recording things overtly.
As soon as they were admitted, pseudopatients requested to be discharged and they secretly disposed of the medication (e.g. flushed pills down the toilet) but otherwise, acted polite and friendly and obeyed all the instructions asked of them.
structured observation Rosenhan conducted two structured observations during the study:
- in 3 hospitals, a record was kept of how many patients voiced suspicions about the pseudopatients and how much time the staff spent on the ward, interacting with the patients.
- in 4 hospitals, the pseudopatient approached staff with a scripted question: “Pardon me, Mr [or Dr or Mrs] X, could you tell me when I will be eligible for grounds privileges?” (or “ . . . when I will be presented at the staff meeting?” or “. . . when I am likely to be discharged?”). The member of staff’s answer and body language were recorded.
follow on study After the main study ended, Rosenhan contacted his own hospital and revealed the results. The hospital agreed to a second study, but this time they would be aware that new pseudopatients would be seeking admission over the next 3 months. Staff were issued with a questionnaire to rate each new patient on a 10-point scale: 9-10 meant high confidence that the patient was really ill but 1-2 meant a strong suspicion that this was a pseudopatient.
RESULTS All 12 hospitals diagnosed the pseudopatients as mentally ill. 11 hospitals diagnosed schizophrenia, 1 hospital (the private hospital) diagnosed manic-depression (bipolar disorder). The pseudopatients went to hospitals that had diagnosed them with schizophrenia.
None of the staff recognised that the pseudopatients were healthy. It took between 7 and 52 days for the pseudopatients to be discharged; the mean length of stay was 19 days.
The pseudopatients were discharged with a diagnoses of “schizophrenia - in remission” (meaning the person has schizophrenia but the symptoms appear to have stopped) in 7 cases; 1 pseudopatient was discharged with a diagnosis of “schizophrenia” on their medical record.
- although staff were not suspicious of the psedudopatients, other patients were. 35/118 patients accused the pseudopatients of not being genuinely ill.
The pseudopatients observed many disturbing things while in the hospitals.
Staff abusing patients: The pseudopatients were well-behaved and none of them were harmed in any way, but they observed other patients being verbally or physically abused by staff. Rosenhan reports that patients were awakened in the morning by an attendant shouting “Come on you m—- f—-s, out of bed!” and one patient was beaten for saying to an attendant “I like you”.
Patients refusing medication: The pseudopatients disposed of their pills but when they went to flush them down the toilet, they often observed that other patients had done the same thing
Depersonalisation & powerlessness: The patients weren’t treated as persons. There were no doors on toilet cubicles and staff would inspect their medical records and personal belongings without asking permission. Staff would not make eye contact with patients. Staff would discuss patients within earshot, as if the patients could not hear them. Attendants would abuse patients while other patients were watching, but not when doctors were present.
CONCLUSIONS
“it is clear that we cannot distinguish the sane from the insane in psychiatric hospitals” (Rosenhan)
Rosenhan draws attention to the private hospital that diagnosed a pseudopatient with manic-depression. This is a more treatable disorder than schizophrenia. Rosenhan notes that wealthier people are more likely to get diagnosed with milder problems that have better therapeutic outcomes, which shows that your class background affects the way you are diagnosed.
In particular, Rosenhan identifies a tendency toward false positives (Type I errors) in normal diagnoses, but Type II errors (false negatives) when “the stakes are high” (ie. when the hospital knows its diagnoses are being assessed).
Rosenhan is very concerned that the conditions in psychiatric hospitals do not help with therapy; in fact, they make patients worse. Rosenhan agrees with Goffman (1961) that conditions in psychiatric hospitals are psychologically mortifying - they make healthy behaviour and healthy thoughts more difficult.
(AO3) evaluating Rosenhan (1973)
GENERALISABILITY (S) Rosenhan made a point of using a range of psychiatric hospitals - private and state-run, old and new, well-funded and under-funded - from across the United States.
(W) Nevertheless, 12 is a small sample for a country as big as the USA and a few “bad apples” could have skewed the results of Rosenhan’s observations.
(W) There’s been a lot of progress in mental health care since the 1970s (indeed, Rosenhan’s study prompted many reforms), so perhaps the results are “time-locked” and cannot be generalised to psychiatric diagnosis and care today. For example, Rosenhan’s pseudopatients were diagnosed using DSM-II. Today’s DSM-5 requires the patient to show TWO symptoms (not just one) and have the symptoms for at least 6 months.
RELIABILITY (W) Rosenhan trained his pseudopatients beforehand, but they didn’t all follow the same standardised procedures.
Data from a 9th pseudopatient was not included in Rosenhan’s report because, among other things, he did not follow procedures.
The graduate student asked his wife to bring in his college homework to do, revealing he was a psychologist.
Another pseudopatient revealed that he was going to become a psychologist and one of his visitors was a college Psychology professor
One pseudopatient struck up a romantic relationship with a nurse.
Rosenhan explains this as the pseudopatients resisting the effects of depersonalisation and powerlessness. However, it also suggests they failed to follow instructions and act consistently.
APPLICATION (S) This study had a huge impact on mental health care, not just in America but worldwide. It caused psychiatric hospitals to review their admission procedures and how they trained their staff to interact with patients. It started the move away from dependency on the “chemical straitjacket” of drugs to treat mental health. Today, the study is a compulsory part of training in psychiatric medicine and nursing.
Along with Robert Spitzer’s criticisms, this study was a major influence on reforming the DSM. DSM-III (1980) defined mental illnesses much more carefully, with clear guidelines for including or excluding people from each classification. For example, in DSM-III, a hallucination needed to be repeated several times; in DSM-IV (1994) hearing voices needed to be experienced for over a month before a diagnosis of schizophrenia can be made and DSM-5 makes this 6 months.
VALIDITY (W) despite being a field-study, it lacked ecological validity. Seymour Ketty (1974) criticised Rosenhan, saying that, because the pseudopatients were faking an unreal mental condition, it doesn’t tell us anything about how people with genuine mental conditions are diagnosed. Psychiatrists don’t expect someone to carry out deception in order to be admitted to a psychiatric hospital; therefore, the study lacks EV.
ETHICS (W) The hospital staff were deceived about the pseudopatients’ symptoms being real. The doctors and nurses in the hospitals could not consent to take part or exercise their right to withdraw from the study. The other patients in the study had no possibility of consenting or withdrawing and didn’t enter psychiatric hospitals in order to be in psychology research
(S) Rosenhan did protect confidentiality - no staff or hospitals were named.
(W) Rosenhan may be criticised for failing in a duty of care towards his own researchers - the pseudopatients. He put them in a harmful environment where they experienced tension and stress. None of them were physically abused but they witnessed physical abuse going on. They were instructed in how to avoid taking medication, but if they had been forced to take medication, it could have produced side-effects on them.
- However, Rosenhan took a few precautions. In his own case, he notified the hospital manager and chief psychologist of what he was doing. For all the pseudopatients, he prepared lawyers who would intervene to get the pseudopatients out of hospitals if they requested it.
(W) A different ethical issue with Rosenhan’s study is that it contributed to a crisis of public confidence in the American mental health system - which may have prevented people who genuinely needed help from seeking it.
what is schizophrenia?
a psychotic mental disorder where patients may experience, perceive and interpret things differently from others and may lose the ability to distinguish between the real and unreal. this is characterised by symptoms like hallucinations, delusions, disorganised thinking etc.
what are symptoms of a mental disorder?
the behaviours, thoughts and feelings experienced by the patient/client associated with their diagnosis e.g. hallucinations. They may be observable, or may be reported to the clinician by the patient (privately experienced, self-report).
+ symptoms
Symptoms that are found in patients with schizophrenia that are not found in the normal population such as hearing voices (auditory hallucinations).
- symptoms
the absence or lack of normal levels of functioning such as apathy or avolition, poor self care, lack of speech (also known as poverty of speech or alogia), and the absence or ‘flattening’ of normal emotional responses (also known as flattened affect).
cognitive symptoms of schizophrenia
poor working memory, poor executive functioning (understanding and decision-making), difficulty in concentrating, difficulty in memory
features of a mental illness
Features of a mental illness are facts about the illness, such as age of onset of symptoms; how commonly it occurs in a particular population (prevalence); whether there are gender or culture differences, or groups at higher risk of diagnosis; the course of the illness; subtypes of the illness (in DSM-IV)
DSM-V diagnostic criteria for schizophrenia
To receive a schizophrenia diagnosis using DSM-5, someone can have any of the symptoms and features, but he must have the following:
1) At least two symptoms from Criteria A:
Delusions, Hallucinations, Disorganised Speech, Disorganised Behaviour, Negative Symptoms
2) Level of functioning has declined. This means that the symptoms must impair one’s life and get in the way of her ability to work (or go to/participate in school), have positive relationships (or any relationships at all), and practice self-care.
3) These must have been present for at least one month.
4) Schizoaffective disorder, major depression, and bipolar disorder have been ruled out
5) Substance use/abuse has been ruled out as a cause
features of schizophrenia
- Lifetime Prevalence - Schizophrenia is found in any nation at a rate of 1.4 - 4.6 per 1000 people (Jablensky, 2000)
- age of onset is typically 18 to early 20’s in men
- age of onset is typically late 20’s to early 30’s in women
- schizophrenia is more common in lower socio-economic backgrounds
- schizophrenia is more common in urban rather than rural areas
- risk factors of schizophrenia include drugs like marijuana
what are delusions in schizophrenia?
false ideas you feel convinced are true. common delusions include:
(1) paranoia the belief that people are watching you or want to hurt you
(2) delusions of grandeur the belief you are important, heroic or super powers
(3) delusions of identity thinking you are someone else like Jesus for example
(4) thought insertion the belief that your thoughts are not your own and have been put in your mind by someone else
what are hallucinations in schizophrenia?
when you see or hear things that aren’t real.
seeing (visual hallucinations)
hearing (auditory hallucinations)
what are disorganised thoughts in schizophrenia?
a key aspect of schizophrenia where speech may become tangential (jumping from one topic to another) or speech may be highly circumstantial (speaking continuously and never getting to the point).
types of schizophrenia
paranoid schizophrenia
paranoid schizophrenia is characterised by someone being suspicious of others and having delusions of grandeur. there are often hallucinations as well.
types of schizophrenia
disorganised schizophrenia
disorganised schizophrenia is characterised by speech being disorganised and hard to follow, as well as the person having inappropriate moods for a given situation. there are no hallucinations.
types of schizophrenia
residual schizophrenia
residual schizophrenia is where there are low level positive symptoms but psychotic symptoms are present.
types of schizophrenia
catatonic schizophrenia
catatonic schizophrenia is when someone is very withdrawn and isolated and has very little movement.
types of schizophrenia
undifferentiated schizophrenia
when someone doesn’t fit any of the above types.
schizophrenia key terms
thought insertion
if someone thinks their thoughts are put there by someone else
schizophrenia key terms
catatonic supor
standing motionless like a statue in bizarre postures
