Schizophrenia Flashcards
(106 cards)
What is sz
Psychotic disorder, the sufferer looses touch with reality and lacks insight- they have no awareness that they are ill.
How common is sz and who is most likely to get it
1% of the population will suffer from sz
Early 20s in males but slightly later in females.
More common in men who are working class
Define classification and Diagnosis
Classification - the process of organising symptoms into categories based on which symptom clusters together eg- deciding that sz is a distinct mental illness different to others and what the symptoms actually are.
Diagnosis- deciding where or not particular individuals has those symptoms and therefore is suffering with the illness
What are the two major classification systems for psychological disorders
DSM V - diagnostic and statistical manual, volume 5- produced by the American psychiatric assocation
ICD 10- international classification of disease update 10 - produced by the world health association
How do the DSM and the ICD differ for diagnosing sz
- The DSM requires at least one of the positive symptoms
- ICD requires to or more of the negative symptoms
- ICD includes a number of subtypes such as paranoid sz and hebephrenic sz but the latest addition no longer includes these subtypes
What criteria would someone need to meet to be diagnosed with sz by the DSM
A: two or more of the following symptoms
-delusions
-hallucinations
-disorganised speech
-grossly disorganised or catatonic behaviour
-negative symptoms eg- avolition
( only one symptom is required if symptoms are bizarre)
Criteria b
- social occupational dysfunction
Criteria c
- signs are present for 6 month including one month of symptoms that meet criteria A.
Describe hallucinations as a symptom of sz
Bizarre perceptions of stimuli in the environment or have no relation to reality. May include auditory voices, visual- seeing someone who’s not there, olfactory - smelling things that other people can’t smell.
Most common- voices telling them to do something or commenting on their behaviour
Describe delusions as a symptom of sz
Give 3 examples
Irrational beliefs
Eg- delusion of grandeur where they may belief they are an important historical political or religious figure such as Jesus or the queen.
Eg- delusion of persecution where they believe that an individual or organisation is conspiring against the
Eg- delusion of reference when events in the environment seem to be directly related to them eg- personal messages being communicated through he TV
Describe avolition as a symptom of sz
Lack of purpose
Loss of motivation to carry out tasks
Become apathetic and find it difficult to begin or maintain goal directed activity
Poor hygiene and grooming, lack of persistence in work or education and lack of energy
Describe speech poverty as a symptom of sz
What does the DSM place emphasis on
Reduction in the Amount and quality of speech
Often repetitive content
Slow to respond during conversation
One word answers
On tasks of verbal fluency they produce fewer words in a given time than none sufferers
Not due to poor vocab but the difficulty in spontaneously producing words
The DSM places emphasis on speech disorganisation, speech may become Incoherent (word salad). Changes topic mid sentence. Reflects abnormal thought process. Individual struggles to organise their thoughts.
How can positive and negative symptoms be explained
Positive - additional to normal behaviour eg hallucinations
Negative - lack or absence of normal behaviour eg avolition
What is reliability in classification of sz
The extent to which the classification of sz is consistent over time and across the different classification and diagnostic systems
How may the classification of sz lack reliability
DSM and ICD have different criteria’s to be diagnosed with sz
Bizarre is objective
What is meant by inter- rater reliability in diagnosing sz
The level of agreement on the diagnosis by different psychiatrists across time and culture eg- when different clinicians make identical diagnoses independently of each other.
What study may criticise inter rater reliability in sz
Elie Cheniaux et Al 2 psychiatrists independently diagnosed 100 patients using the DSM and ICD criteria 1. 26 with sz according to the DSM 44 according to the ICD 2. 13 according to the DSM 24 ICD
What study supports the argument that ‘bizarre is objective “
Mojtabi and Nicholas 1995
50 senior psychiatrists were asked to differentiate between bizarre and non bizarre delusions
Inter rater correlations of only 0.4
Showing - even this central characteristic of sz lacks the reliability sufficient for it to be a reliable method of distinguishing between sz and none sz behaviour
What might be the implications of poor reliability in diagnosis
- receiving the wrong treatment
- people who don’t have sz being diagnosed with it - going through pointless treatment
- some people who actually have sz and are not being diagnosed with it
What is test retest reliability in sz
Stability of diagnosis over time given no change in symptoms eg- a clinician makes the same diagnosis on separate occasions based on the same info
What is validity in classification
The extent to which schizophrenia exists as a mental illness that is distinct from other illnesss. The extent to which the symptoms of sz are actually symptoms of sz.
What is validity in diagnosis in sz
The accuracy of diagnosis - the extent to which people with sz are diagnosed as such while those without sz do not receive diagnosis
What is co morbidity
What does the Buckley et al show
The occurrence of two illness or conditions together. If two illness are frequently diagnosed together then it calls to question the validity of the classification.
Concluded that around half the people diagnosed with sz also have a diagnosis of depression (50%) or substance abuse (47%)
What other illness is common in those with sz despite depression
OCD
Alone effects 1% of the population
Swets et al
Meta analysis
The two conditions appear together more often than chance would predict
12% of sz patients also fulfilling symptoms for OCD
26% displaying significant obsessive compulsive symptoms
Why might co morbidity be a problem when diagnosing
If symptoms are similar they may fit the criteria of more than one illness and Therefore be diagnosed incorrectly depending on who diagnoses when meaning they will receive the wrong treatment
What is symptom over lap
Two or more condition share the same symptoms
Eg- Sz and bipolar
According to the ICD - diagnosed with sz
DSM - diagnosed with bipolar