Schizophrenia

Question 1

Diagnosis and Classification of Schizophrenia - A01

Answer 1

• schizophrenia is experienced by 1% of population (mostly males)
• diagnosis is done by identifying symptoms and classifying what disorder someone has
• diagnosis from ICD-10 (has more negative symptoms) and DSM-5 (has more positive symptoms)
• positive symptoms are additional experiences that are not ordinary, someone with schizophrenia experiences (eg. hallucinations, delusions)
• negative symptoms involve a loss of usual abilities and experiences (eg. speech poverty and avolition)

Positive Symptoms
- positive symptoms are additional experiences beyond those of ordinary existence
- hallucinations: unusual sensory experience, can be related to events in the environment, such as voices in someone’s head being heard commenting on self or others, hallucinations can be related to any sense, such as seeing distortions facial expressions or people.
- delusions: irrational beliefs, also known as paranoia, can come in various forms such as involving being an important historical, religious or political figure, being persecuted by the government or aliens or having superpowers, they may believe their body is under external control making them act behave in a way that makes sense to them but not to others, some delusions can lead to aggression and can make them more likely to be victims of violence

Negative Symptoms
- negative symptoms involve the loss of usual abilities and experiences
- speech poverty: changes in patterns of speech, reduction in the amount of quality of speech in schizophrenia, sometimes involves a delay in the person’s verbal responses in conversations, more recently there is emphasis on speech disorganisation where speech becomes incoherent or topics are changed mid-sentence, speech disorganisation is classified as a positive symptom in the DSM-5 whereas speech poverty is a negative symptom
- avolition (sometimes called apathy) is the term referring to finding it difficult to keep up with goal directed activity, people with schizophrenia often have a reduced motivation to carry out a range of activities, Anderson (1982) identified three signs of avolition: poor hygiene and grooming, lack of persistence in work or education, and lack of energy

Question 2

Strength and Issues with the Diagnosis (A03)

Answer 2

Strength - Good Reliability, reliability means consistency and the diagnosis for schizophrenia is said to be reliable when different clinicians independently reach the same diagnosis for the same individual (inter-rater reliability), and when the same clinician reaches the same diagnosis for the same individual on different occasions (test-retest reliability), Osorio et al. (2019) reported high reliability for the diagnosis of schizophrenia in 180 individuals using the DSM-5, pairs of interviewers achieved inter-rater reliability of +97 and test-retest reliability of +92, therefore we can be reasonably sure that the diagnosis of schizophrenia is consistently applied

Limitation - Low Validity, validity measures whether we are really testing what we want to test and one way to assess the validity of a psychiatric diagnosis is criterion validity, Cheniaux et al. (2009) had two psychiatrists independently assess the same 100 clients using the ICD-10 and DSM-IV and found that 68 were diagnosed under the ICD-10 and 39 under the DSM, suggesting that schizophrenia is either under or over diagnosed according to the diagnostic system but either way the criterion validity is low.
however, in the Osorio study there was excellent agreement between clinicians when they used two methods from the DSM system, meaning the criterion validity for diagnosing schizophrenia is actually good provided it takes place within a single diagnostic system

Limitation - Co-morbidity with other conditions, if conditions occur together a lot then the validity of the diagnoses and classification can be questioned as they might actually be a single condition, schizophrenia has often been diagnosed with other conditions, Buckley et al.’s research found that half of those diagnosed with schizophrenia were also diagnosed with depression and substance abuse, this is a problem for classification as it means schizophrenia may not exist as a distinct condition and is a problem for diagnosis as some people may be diagnosed with schizophrenia may have other conditions like an unusual case of depression

Limitation - Gender Bias, since the 1980s men have been diagnosed with schizophrenia more than women (1.4:1 ratio, Fischer and Buchanan 2017), one explanation is that women are less vulnerable than men due to genetic factors, however it is more likely that women are underdiagnosed because they have closer relationships and therefore get more support from others (Cotton et al. 2009) and therefore women with schizophrenia function better than men with schizophrenia, this underdiagnosis is a gender bias as it means women may not therefore be receiving treatment and services that might benefit them

Limitation - Culture Bias, some symptoms of schizophrenia (particularly hearing voices) can mean different things to different cultures, for example in some Caribbean societies voices may be attributed as communication with ancestors - Afro-Caribbeans’ living in the UK are ten times more likely to recieve a diagnosis than white British people although people living in the Caribbean countries are not, ruling out a genetic vulnerability, the most likely explanation for this is culture bias in diagnosis of clients by psychiatrists from different cultural backgrounds, this appears to lead to an overinterpretation of symptoms in British black people (Escobar 2012), therefore meaning that Afro-Caribbean people may be discriminated against by a culturally-biased diagnostic system

Limitation - Symptom Overlap with other conditions, there is a considerable overlap between symptoms of schizophrenia and other conditions such as schizophrenia and bipolar disorder both having delusions and avolition, in terms of classification this suggests that schizophrenia and bipolar disorder may not be two distinct conditions but variations of a single condition, therefore in terms of diagnosis it makes it harder to distinguish schizophrenia from other conditions like bipolar disorder, similarly to co-morbidity symptom overlap means that schizophrenia may not exist as a distinct condition and that even if it does it is hard to diagnose, therefore both the classification and diagnosis are flawed

Question 3

Biological Explanations for Schizophrenia - Genetic (A01)

Answer 3

Genetic Basis of Schizophrenia
- family studies have confirmed that the risk of schizophrenia increases with genetic similarity to a relative with the condition

Question 4

Biological Explanation for Schizophrenia - Genetic (A03)

Question 5

Biological Explanation for Schizophrenia - Neural Correlates (A01)

Question 6

Biological Explanation for Schizophrenia - Neural Correlates (A03)

Question 7

Psychological Explanations - Family Dysfunctions (A01)

Question 8

Psychological Explanations - Family Dysfunctions (A03)

Question 9

Psychological Explanations - Cognitive Explanation (A01)

Question 10

Psychological Explanations - Cognitive Explanation (A03)

Question 11

Biological Therapy for Schizophrenia - Drug Therapy (A01)

Question 12

Biological Therapy for Schizophrenia - Drug Therapy (A03)

Question 13

Psychological Therapy - Cognitive Behaviour Therapy (A01)

Question 14

Psychological Therapy - Cognitive Behaviour Therapy (A03)

Question 15

Psychological Therapy - Family Therapy (A01)

Question 16

Psychological Therapy - Family Therapy (A03)

Question 17

Management of Schizophrenia (A01)

Question 18

Management of Schizophrenia (A03)

Question 19

The Interactionist Approach to Schizophrenia (A01)

Question 20

The Interactionist Approach to Schizophrenia (A03)