Shizophrenia

Question 1

Define the term schizophrenia.

Answer 1

Is a mental disorder that affects about 1% of the population.
It’s described as a severe mental illness where contact with reality and insight are impaired. Typical onset is early adulthood (15-25).
Schizophrenia is more commonly diagnosed in men than women.

Question 2

What are the two major systems for the classification of mental health?

Answer 2

World Health organisation’s 10 (ICD-10)

American Psychiatric Association Diagnostic and Statistical Manual edition-5 (DSM-5)

Question 3

How is someone classified as schizophrenic according to DSM-5?

Answer 3

If they exhibit two or more of the following symptoms for a significant portion of time during a 1-month period.
Delusions
Hallucinations
Disorganized speech
Grossly disorganized or catatonic behaviour
Negative symptoms, i.e. affective flattening, alogia or avolition)

Question 4

How is someone classified as schizophrenic according to ICD-10?

Answer 4

You must have at least ONE symptom from the following:
Thought echo and thought broadcasting.
Delusions of control.
Hallucinatory voices giving a running commentary on the patient’s behaviour or discussion between voices.
Persistent delusions of other kinds that are inappropriate or implausible.
Or at least TWO of the following:
Persistent hallucinations in any form.
Breaks in the train of thought, resulting in irrelevant speech.
Catatonic behaviour, such as excitement.
Negative symptoms.
A significant change in the overall quality of some aspects of personal behaviour.
Symptoms should be present mostly during a period of 1-month or more.

Question 5

What are positive symptoms?

Answer 5

Are experiences that are additional beyond those of ordinary existence.
Hallucination
Delusions
Speech Disorganisation

Question 6

Define the term hallucination.

Answer 6

An unusual sensory experience that is related to any sense. Hallucinations can be related to the environment and others aren’t related to what the sense are picking up from the environment.

Question 7

Define the term speech disorganisation.

Answer 7

Is when the speaker switches between topics mid sentence and speech is typically jumbled (DSM-5).

Question 8

What are negative symptoms?

Answer 8

Avolition

Speech poverty

Question 9

Define the term avolition.

Answer 9

Is finding it difficult to begin or persist with goal directed activity. For example poor hygiene, lack of energy and absence of persistence in work/education.

Question 10

Define the term speech poverty.

Answer 10

Is reduction in the amount and quality of speech. Also there can be a delay in verbal responses in conversation (ICD-10).

Question 11

What are the limitations of the diagnosis of schizophrenia?

Answer 11

Lack of reliability, validity
Co-morbidity
Symptoms overlap
Gender and cultural bias

Question 12

Describe reliability.

Answer 12

Reliability - consistency.

Measure of reliability - inter-reliability - extent to which different assessors agree on their assessment.

Question 13

Why does the diagnosis of schizophrenia lack reliability?

Answer 13

In the case of diagnosis this means the extent to which two or more mental health professionals arrive at the same diagnosis for the same individual. Cheniaux et al. (2009) had two psychiatrists independently diagnose 100 people using DSM and ICD. Inter-reliability was poor, with one psychiatrist diagnosing 26 with schizophrenia according to DSM and 44 according to ICD The other diagnosed 13 using the DSM and 24 using the ICD.

Question 14

Describe validity.

Answer 14

Validity - extent to which we are measuring what we intend to measure.
Measure of validity - criterion validity - does using different classification systems produces the same diagnosis in the same patient

Question 15

Why does the diagnosis of schizophrenia lack validity?

Answer 15

Cheniaux et al. (2009) show that schizophrenia is more likely to be diagnosed using ICD than DSM - suggests schizophrenia is either over-diagnosed in ICD and under-diagnosed in DSM. Poor validity - a weakness of diagnosis.

Question 16

Define the term co-morbidity.

Answer 16

The presence of two different disorders at the same time. This calls into question the validity of their diagnoses and classification because the two disorders are actually one disorder, and perhaps should be seen as one condition (for example, schizophrenia and depression).

Question 17

What did Buckley et al (2009) find?

Answer 17

50% of schizophrenia patients also had a diagnosis of depression, 29% had a post-traumatic stress diagnosis, and 23% had an OCD diagnosis.

Question 18

Define the term symptom overlap.

Answer 18

When two or more disorder share some of the symptoms needed for classification. Schizophrenia and bipolar disorder share many symptoms (such as delusions and avolition), meaning that the same patient could receive two different diagnoses. As with co-morbidity, if disorders share many symptoms it may be more helpful to see them as one disorder.

Question 19

What does gender and cultural bias present in the diagnosis of schizophrenia

Answer 19

Men are far more likely to be diagnosed, potentially because women are able to cope better with the symptoms, and people of African origin are also more likely to be diagnosed. Perhaps this is due to the cultural significance of ‘hearing voices’, which may be seen by white Western psychiatrists as unusual or bizarre. These factors support that the classification of schizophrenia lacks validity and reliability.

Question 20

Why are men more likely to be diagnosed as schizophrenic?

Answer 20

Men may be genetically more vulnerable to developing schizophrenia than women.
Another explanation is gender bias as it appears women typically function better than men, being more likely to work and have good family relationships.