schizophrenia Flashcards
(36 cards)
How to diagnose sz
~ Both ICD-11 + DSM-5 state that psychotic symptoms should be present in patient for at least one month.
~ DSM-5 requiring that symptoms continue for up to 6 months
What is sz
chronic’ mental illness ongoing, significantly impedes daily life and requires constant medical attention
How does the ICD-11 define sz
psychotic disorder characterised by severe + significant impairments in determining what is real and what is fantasy
~ at least 2 positive or negative symptoms are present in the patient
How does the DSM-5 define sz differently to DSM 4
DSM 5 = experienced at least 2 of the positive or negative symptoms
DSM 4 = at least 1 positive symptom was present in the patient
what do positive symptoms cause
alarm + distress to both the patient and other people as they are active manifestations of the illness
What are 2 positive symptoms
Hallucinations: voices talking to the patient, often critically and with negative intent; seeing distortions in what is around them e.g. in facial expressions; seeing things that are not there
Delusions: misguided or irrational beliefs (patient’s belief that they are Jesus), paranoia (the CIA are spying on them), unfounded ideas as to their own ability or even their body (they have magic powers/ are possessed by an evil spirit
what are negative symptoms
withdrawal from life/loss of normal functioning
examples of 2 negative symptoms
Speech poverty: (alogia) not being able to take part in a conversation due to delayed responses, lack of vocabulary, vagueness); producing speech which is incoherent, (e.g. inventing words), doesn’t follow the rules of grammar
Avolition: (apathy) person takes no interest in life or in themselves; they neglect personal hygiene, neglect their work or education, neglect activities that they usually find pleasurable; involves a complete lack of motivation to achieve even the simplest of tasks
what is validity in sz diagnosis
realness/trueness of what is being measured
what causes a diagnosis to be invalid in sz
clinician, having reviewed the patient’s symptoms, gives a diagnosis of an illness that does not actually fit those symptoms
How can a diagnosis be reliable in sz
= must show consistency + agreement across diagnosing clinicians (same set of symptoms must be given, same diagnosis regardless of who is doing the diagnosing)
~ Inter-rater reliability: if more than 1 clinician is diagnosing the same patient then they should both/all agree as to the diagnosis
-> Issues with reliability
occur when (as does
happen) clinicians
disagree as to the
diagnosis
How can a diagnosis be unreliable in sz
clinicians don’t use the same diagnostic tools e.g. one clinician uses the DSM + other uses the ICD, regardless of year of publication of both of these manuals
What are 2 researchers that investigated reliability/validity in diagnosis
validity= Rosenhan
reliability =Santelmann et al
What was Rosenhans study into validity of sz diagnosis (+-)
- field experiment
- he + 8 confederates reported false symptoms and were all (but one) admitted to mental hospitals with a diagnosis of schizophrenia
+ high ecological validity (naturalistic setting+ naive pps), insight the findings gave into the ‘sticky’ label of diagnosis - lack of ethical validity due to deception involved + lack of control in field experiments
What was Santelmann et al study into reliability of sz diagnosis (+-)
- meta-analysis of 25 studies with a total sample of 7912 patients diagnosed by different raters
- found that reliability of sz diagnosis had consistently lower inter-rater reliability than diagnosis of major depressive disorder + bpd
+ reliability due to large sample size and robust quantitative data
- potential selection bias regarding the studies chosen for the meta-analysis
What is co-morbidity
when one patient is diagnosed with two or more mental illness
- difficulties in diagnosing a co-morbid patient is trying to ascertain the extent of one illness over another particularly when there is symptom overlap (Is this depression or is it part of patient X’s schizophrenia)
What is symptom overlap + example
when two or more illnesses share some of the same symptoms
e.g. avolition (a negative symptom of schizophrenia) overlaps with symptoms of depression - lethargy, lack of motivation, neglecting personal hygiene etc
What is 1 issue for clinicians when faced with symptom overlap
the DSM and the ICD use different criteria to classify the same symptoms
e.g. the DSM might produce a diagnosis of schizophrenia whereas the ICD diagnosis might be bi-polar disorder for the same set of symptoms
study that supports co-morbidity (+-)
Buckley et al. (2009) found sz co-morbidities: 50% for depression; 47% for substance abuse disorder; 29% for PTSD; 23% for OCD; 15% for panic disorder
+ support it provides for co-morbidity as a diagnosis issue
- lack of clarity as to why depression has higher rates of co-morbidity than other disorders
study that goes supports both co-morbidity+ symptom overlap (+-)
Newson et al. (2021) - a meta-analysis of 107,349 that DSM-5 diagnostic criteria do not sufficiently distinguish between schizophrenic symptoms and those of co-morbid/overlapping disorders such as depression
+ secondary data research process is swift and cost-effective
- lack of insight into why symptom overlap and co-morbidity occur (no explanatory power)
culture bias in diagnosis
clinician does not take a patient’s culture into account when making a diagnosis
Gender bias in diagnosis
(3)
= any instances of a person being diagnosed according to their gender, rather than their symptoms
E.g. a female is not diagnosed with sz even when she presents symptoms as clinician may view her as a ‘hysterical female’ rather than taking her symptoms seriously (alpha bias)
= clinician doesn’t take a patient’s gender into account when making a diagnosis e.g. male models of health are used to diagnose a woman
= not pay enough attention to the fact that the risk factors for developing sz are different for male + females so there should be no ‘one size fits all’ approach (beta bias)
who supports gender bias and culture bias
gender bias= Hambrecht et al
culture bias= Schwartz et al
what was Schwartz et al study into culture bias (+-)
African Americans are 2.4 times more likely to be diagnosed with sz compared with non-African American individuals -> culture bias in the diagnostic process and cultural insensitivity on the part of clinicians
+ good application (findings of this research could be used to inform diagnosis going forward)
- use of rating scales to assess symptoms (fine detail of symptoms is lost when having to apply a standardised measure to them)
