schizophrenia - classification Flashcards
(71 cards)
1
Q
SPEC: classification & diagnosis of schizophrenia
A
2
Q
what is schizophrenia?
A
a severe and chronic mental illness characterised by impaired perception of reality
3
Q
schizophrenia & symptoms:
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-schizophrenia is a cluster of symptoms → it doesn’t have a single feature that every sufferer experiences
-the two major systems for the
classification of mental disorder are
the DSM-5 and ICD-11
4
Q
what does classification involve?
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the identification of patterns of behaviour or mental symptoms that reliably occur together to form a type of disorder
5
Q
what does diagnosis involve?
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determining the condition that is causing the symptoms that a person is currently experiencing
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Q
how do classification and diagnosis link?
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in order to diagnose a specific disorder, we need to distinguish disorders from eachother
7
Q
what is schizophrenia?
(according to the DSM)
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a psychosis, as the sufferer has no concept of reality
8
Q
usually, when is the onset of schizophrenia?
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typically in late adolescence and early adulthood
men: 18–25 years
women: 25–35 years
9
Q
how is schizophrenia diagnosed?
A
-schizophrenia is a cluster of symptoms - it doesn’t have a single feature that every sufferer experiences
-the two major systems for the
classification of mental disorder are
the DSM-5 and ICD-11
10
Q
what are the two key symptoms for schizophrenia?
A
-positive symptoms
-negative symptoms
11
Q
what are positive symptoms?
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symptoms are an excess or distortion of normal functions
12
Q
examples of positive symptoms:
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-hallucinations
-delusions
-catatonic/disorganised behaviour
13
Q
what is a hallucination?
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a sensory experience that has no basis in reality
14
Q
examples of different types of hallucinations:
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can affect all senses…
auditory: hearing voices that others can’t (often critical)
visual: seeing lights, objects or faces others can’t
olfactory: smelling things others can’t
tactile: feeling things others can’t (e.g. bugs crawling over your skin)
[REMEMBER ONE EXAMPLE]
15
Q
what are delusions?
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irrational beliefs that seem real to the person with schizophrenia but have no basis in reality
16
Q
examples of the delusions that schizophrenic people often experience:
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-paranoid delusions
-delusions of grandeur
17
Q
what are paranoid delusions?
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an individual believes that they are being persecuted (e.g. something, or
someone, is deliberately trying to spy on, mislead, hurt or kill them)
18
Q
what are delusions of grandeur?
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an individual believes that they have some imaginary power or authority
19
Q
what is catatonic/unpredictable behaviour?
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an individual behaves in ways that seem inappropriate or strange to the norms of society
20
Q
what are negative symptoms of schizophrenia?
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a diminution or loss of functioning
21
Q
examples of negative symptoms:
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-avolition
-speech poverty
-social & physical anhedonia
22
Q
what is avolition?
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a reduction in goal-orientated behaviour & the inability to begin and persist with tasks
23
Q
examples of avolition:
A
schizophrenics will often sit for hours doing nothing → they have a lack of motivation to follow through any plans and neglect household chores, such as washing the dishes or cleaning their cloth
24
Q
what is speech poverty?
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deficits in verbal fluency and speech production, it may be difficult to produce words or coherent sentences
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what is speech poverty thought to reflect?
thought to reflect slowing or blocked thoughts
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differences in the diagnosis of schizophrenia using the DSM vs ICD:
DSM: one of the positive symptoms must be present for diagnosis
ICD: two or more negative symptoms are sufficient for a diagnosis to be made, **signs of disturbance** must’ve persisted for at least 6 months
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what is social anhedonia?
social withdrawal, where they find it hard or become reluctant to speak to people.
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what is physical anhedonia?
an inability to enjoy things that they used to enjoy, food or physical contact
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Note the symptoms of schizophrenia and their examples:
Mr X believed that other people could read his thoughts through telepathy. This belief started when a woman looked at him in a supermarket and said to her companion ‘I can read his thoughts’. Mr X was convinced that other people had this power but would not admit to it. He was afraid that people would attack him because of what he was thinking, and tended to avoid situations that would bring him into contact with others (Kuipers et al. 1996).
Delusions - ‘believed that other people could read his thoughts through telepathy.’
Paranoid Delusions - ‘He was afraid that people would attack him because of what he was thinking,’
Social anhedonia - ‘tended to avoid situations that would bring him into contact with others’
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Note the symptoms of schizophrenia and their examples:
Damien has alienated a lot of his friends by telling them that he is working as a spy for the government. After they stopped speaking to him, he grew suspicious and wondered if they actually were foreign agents who were actually checking up on his movements for his enemies. He sits at his window at night and claims that he can see them all hiding behind the bushes even though his mother regularly confirms to him that there is nothing there. His mum tells him to stop but he prefers to listen to the voices in his head that tell him to ‘continue to look out for enemy threats’.
Delusions of grandeur - ‘Damien has alienated a lot of his friends by telling them that he is working as a spy for the government.’
Paranoid delusions - ‘he grew suspicious and wondered if they actually were foreign agents who were actually checking up on his movements for his enemies’
Auditory hallucinations - ‘he prefers to listen to the voices in his head’
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Note the symptoms of schizophrenia and their examples:
Richard has problems with his speech. Take the example of his mum asking him if he wants a drink. The first time she asks him he replies with the phrase ‘clink, dink, link’. She tries again a few minutes later and the sentence is more coherent until the last word where he accuses her of being a real ‘plebspurrer’. She tries one final time later on again but this time the right words are said ‘drink, a, want, don’t, I’ but are given in the wrong order
Speech Poverty - he accuses her of being a real ‘plebspurrer
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Note the symptoms of schizophrenia and their examples:
Nick has a different type of schizophrenia. It is as if the person he once was has disappeared. He no
longer smiles when his favourite cartoon is on or cries or gets unhappy at sad things (e.g. when his pet cat died). He makes no effort to go outside and play with his friends like he used to and has no desire to get out of bed. He does not brush his hair or wash his face and clearly does not care for his own appearance. Lately he has taken to standing in the same position for hours on end, like a statue.
Psychical anhedonia - ‘He no
longer smiles when his favourite cartoon is on or cries or gets unhappy at sad things’
Avolition - ‘has no desire to get out of bed. he does not brush his hair or wash his face’ / ‘he has taken to standing in the same position for hours on end, like a statue.’
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Note the symptoms of schizophrenia and their examples:
A patient complained that communists were flying over his house in planes, shooting him with invisible rays that caused abdominal churning, tension and heart palpitations
(Turkington and Kingdon 1996)
Paranoid delusions - ‘communists were flying over his house in planes, shooting’
Tactile hallucinations - ‘abdominal churning, tension and heart palpitations’
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Issues in diagnosis and classification of Schizophrenia
-reliability & validity
-co-morbidity
-culture
-gender bias
-symptom overlap
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what is reliability?
the consistency of a diagnosis
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which ways can reliability be tested?
-test retest reliability
-inter rater reliability
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test retest reliability & schizophrenia:
when a clinician **makes** the same
diagnosis for the same person on separate occasions **from** the same information (given no change in symptoms)
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inter rater reliability & schizophrenia:
when different clinicians reach the same diagnosis for the same individual → their diagnoses are then correlated / where there is a correlation coefficient of around +0.8 or higher (suggests high reliability as there is at least 80% agreement)
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… is needed for validity
reliability is needed for validity → a diagnosis cannot be made if it is not reliable
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evidence against reliability:
Cheniaux et al (2009)
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Cheniaux et al (2009) study:
had two psychiatrists independently diagnose 100 patients using both DSM and ICD criteria → found inter-reliability was poor
psychiatrist 1:
diagnosed 26 with SZ according to the DSM-5 / 44 according to ICD-10
psychiatrist 2:
diagnosed 13 according to the DSM-5 / 24 according to ICD-10
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what is validity?
the extent to which we are **measuring** what we are intending to measure
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how does validity link to schizophrenia?
CLASSIFICATION
**-a valid classification system of SZ (ICD & DSM) ensures that the disorder exists independent from others (no overlap)**
DIAGNOSIS
-a valid diagnosis for SZ means an accurate diagnosis / the symptoms of the patient should be matched to the correct mental disorder → the treatment would **effectively** reduce the symptoms of the disorder
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how can validity be assessed?
concurrent validity
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concurrent validity & schizophrenia:
classification
assesses if clinicians arrive at the same diagnosis for the same patient when using different classification systems (the DSM and ICD)
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evidence for validity:
Cheniaux et al (2009)
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Cheniaux et al (2009) findings…
cheniaux et al (2009) had two psychiatrists independently diagnose 100 patients using both DSM and ICD criteria
↳ SZ is either over-diagnosed using the ICD (68/100) or under-diagnosed using the DSM (39/100)
this is poor validity which is **an issue** for the diagnosis
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what is culture bias?
when a patient’s ethnicity makes it more or less likely that they will be diagnosed with schizophrenia
there is significant variation in the diagnosis of schizophrenia between
different countries, suggesting that **cultural differences** may play a part
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examples of culture bias in the UK:
Pinto (2008) reported that black caribbeans in the UK were 9x more likely to be diagnosed with schizophrenia than white people
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what could be a reason for black caribbean’s being over-diagnosed?
doctors may misinterpret particular symptoms (e.g. emotional responses and hallucinations or religious experiences) which are seen as positive in some Caribbean cultures
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evidence for culture bias:
Copeland et al (1971)
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Copeland et al (1971) study:
there is evidence of a lack of consistency between fairly similar cultures → Copeland et al
-gave a description of a patient to 134 American and 196 British psychiatrists / 69% of the US psychiatrists diagnosed the patient as schizophrenic compared to only 2% of UK psychiatrists
[this calls into question the reliability of the diagnosis of schizophrenia as there was inconsistent diagnosis across cultures]
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ao3 / evaluation of culture bias:
P - one of the main characteristics of schizophrenia, ‘hearing voices,’ appears to be **influenced by cultural environment**
E - luhrman et al (2015) compared the experiences of schizophrenics in Ghana, India, and the US, all of whom reported hearing voices as a main symptom
↳ the patients from India and Ghana reported the voices as a positive, while schizophrenics from the US were more likely to report the voices as violent or hateful
↳ when reported to a psychiatrist from a different culture these experiences might be seen as irrational as the psychiatrists are culturally biased towards what is
‘normal’ in their culture
L - this **suggests that schizophrenia has a lack of consistent characteristics across different cultures** **which questions the reliability of a diagnosis of SZ**
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what is gender bias?
instances of a person being diagnosed according to their gender, rather than their symptoms
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how does gender bias link to schizophrenia?
if women/men are under/over-diagnosed then this suggests that the validity of the diagnosis of schizophrenia is poor, because the procedures for diagnosis only apply to **patients of** one gender
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schizophrenia & diagnosis between genders:
SZ is more prevalent in males than females which could be a result of bias (more males are diagnosed with the disorder than females)
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explanation for gender bias in the diagnosis of schizophrenia:
(Cotton et al, 2009) suggests that females with schizophrenia may be better able to function more normally than men / their symptoms may be masked by good quality of functioning which may make the case seem too mild to warrant a diagnosis
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ao3 / supporting evidence for gender bias in diagnosis
Loring and Powell (1988)
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Loring and Powell (1988) study:
P - 290 male and female psychiatrists were randomly selected and asked to make judgements on case studies of two patients
E - 56% of psychiatrists gave a diagnosis of schizophrenia when the patient was diagnosed as male / only 20 % when the patient was described as female
↳ this difference was much higher with male psychiatrists, suggesting that gender bias can occur dependent on the gender of the clinician, as well as the patient
L - this underdiagnosis is a gender bias & means women may not therefore be receiving treatment and services that might benefit them (this affects the validity of the classification systems)
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what is symptoms overlap?
when disorders share the same symptoms, this **reduces validity** because it’s hard to distinguish between the disorders
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examples of symptom overlap:
both schizophrenia and bipolar disorder include positive symptoms (such as delusions) and negative symptoms (such as avolition)
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what does symptom overlap of bipolar disorder & schizophrenia suggest about classification?
schizophrenia and bipolar may not be two different conditions but variations of a single condition
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what does symptom overlap suggest about diagnosis?
schizophrenia is hard to distinguish from bipolar disorder, this calls into question the validity of both the classification and diagnosis of schizophrenia
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evidence of symptom overlap:
Ellason & Ross (1995)
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Ellason & Ross (1995) study:
Ellason & Ross (1995) point out that people with dissociative identity disorder (previously known as multiple personality disorder) actually show more symptoms of schizophrenia than many schizophrenics do (which may help us understand why people so often incorrectly believe that schizophrenia and multiple personality are the same thing)
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ao3 / strength for validity in symptom overlap
P - evidence for validity in symptom overlap
E - serper (1999) assessed three groups of patients:
one group with co-morbid schizophrenia and cocaine abuse /
one group with cocaine intoxication on its own /
one group with schizophrenia on its own
↳ they found that despite there being considerable symptom overlap in patients with SZ and cocaine abuse, it was actually possible to make accurate diagnoses → symptom overlap did not affect the validity of a diagnosis
L - this suggests that the classification systems for schizophrenia are high in validity
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what is co-morbidity?
when two or more illnesses occur at the same time
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example of co-morbidity in real life?
schizophrenia and depression, often occur in patients at the same time
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how does co-morbidity relate to validity or reliability?
co-morbidity raises issues of validity, having two disorders at the same
time suggests that schizophrenia might not be a separate disorder
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evidence of co-morbidity:
Buckley et al (2009)
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Buckley et al (2009) study:
Buckley et al (2009) concluded that around half of patients with a diagnosis of schizophrenia also have a diagnosis of depression (50%) or substance abuse (47%)
↳ shows that schizophrenia commonly occurs alongside other mental illnesses and the disorders are co-morbid
