Schizophrenia- Classification

Question 1

what is schizophrenia?

Answer 1

a mental disorder and type of psychosis whereby a sufferer loses touch with reality and has significant impairment to their thoughts and emotions

Question 2

what % of the population is affected by Sz?

Answer 2

1% at some point in their lifetime

Question 3

between what ages is Sz most often diagnosed?

Answer 3

15-35 years old

Question 4

what is the age of onset for men?

Answer 4

between 15-24 years old
-tends to be slightly earlier than for women

Question 5

what is the age of onset for women?

Answer 5

between 25-34
-slightly later than men

Question 6

what are the most characteristic symptoms of Sz?

Answer 6

hallucinations and delusions

Question 7

what are classification systems?

Answer 7

diagnostic manuals that are often used to diagnose mental disorders such as Sz

Question 8

what does ‘classification’ refer to?

Answer 8

the grouping together of symptoms that make up the mental disorder
-contain various disorders that each have their own set of symptoms

Question 9

examples of main diagnostic manuals that are used by clinicians to diagnose patients with Sz

Answer 9

DSM-5 (2013)
ICD-11 (2022)

Question 10

who created the DSM-5?

Answer 10

APA- American Psychiatric Association

Question 11

who developed the ICD-11?

Answer 11

World Health Organisation (WHO)

Question 12

what are positive symptoms of Sz?

Answer 12

psychotic behaviours not generally seen in healthy people. they are additions to ‘normal’ behaviour
-people with positive symptoms may lose touch with some aspects of reality

Question 13

what are two positive symptoms?

Answer 13

hallucinations and delusions

Question 14

what are hallucinations?

Answer 14

unusual sensory experiences that have no basis in reality, including HEARING voices or SEEING things that aren’t there

Question 15

give 2 examples of hallucinations

Answer 15

-hearing voices that instruct someone to do something or tell them they are evil
-sometimes they instruct the patient to do something that may harm themself or others

Question 16

what are delusions?

Answer 16

a fixed, false belief that is resistant to evidence and logic

Question 17

give some common types of delusions

Answer 17

-delusions of persecution (thought that others want to harm them, threaten or manipulate)
-delusions of control (believe they are under the control of an alien fore that has invaded their mind and/or body)

Question 18

what are negative symptoms of Sz?

Answer 18

disruptions to normal emotions and behaviours, aspects of normal functioning/ typical behaviour that appear to be lost or absent

Question 19

what are two negative symptoms?

Answer 19

speech poverty and avolition (apathy)

Question 20

what is speech poverty?

Answer 20

the lack of fluent speech, often requiring prompting to speak
-reflects a loss of normal speech function

Question 21

what is avolition?

Answer 21

the lack of motivation or ability to do tasks or activities that have an end goal- see no purpose to do them
e.g. paying bills, going to events

Question 22

what is reliability in the context of diagnosing and classifying Sz?

Answer 22

when a diagnosis of Sz is consistent

Question 23

how can consistency in diagnosis of Sz be affected?

Answer 23

affected by a clinician’s judgment and/or the classification system being used e.g. ICD or DSM

Question 24

what are the two types of reliability?

Answer 24

test-retest and inter-rater

Question 25

what is test-retest reliability?

Answer 25

this is evident when a clinician reaches the same diagnosis at two different points in time using the same information each time

Question 26

what is inter-rater reliability?

Answer 26

this is evident when different (two or more) clinicians reach an identical, independent diagnosis for the same patient

Question 27

how is inter-rater reliability measured?

Answer 27

by a statistic called a kappa score (coefficient). it ranges between 0 and 1 0- zero agreement 1- complete agreement a kappa score of 0.7 or above is generally considered good (strong)

Question 28

describe a research example for test-retest reliability

Answer 28

Read et al (2004) reviewed case of diagnosed Sz and found only a 37% concordance rate when it was diagnosed on two separate occasions

Question 29

describe a research example for inter-rater reliability

Answer 29

Copeland et al (1971) gave 194 British and 134 US psychiatrists the same case description of a patient. -69% of American psychiatrists diagnosed Sz -2% of British psychiatrists diagnosed Sz can argue this has improved with updated diagnostic manuals since 1971

Question 30

in the context of diagnosing and classifying Sz, what is validity?

Answer 30

the extent to which a diagnosis of Sz is accurate and distinct from other disorders -manuals should be able to accurately measure and diagnose what they claim to be able to -if Sz is a valid diagnosis for a patient, they would clearly be displaying symptoms that accurately represent the disorder

Question 31

in what three ways can validity be assessed?

Answer 31

predictive descriptive aetiological

Question 32

what is predictive validity?

Answer 32

diagnosis can be seen as valid if it leads to successful treatment

Question 33

what is descriptive validity?

Answer 33

diagnosis is seen as valid id patients with Sz differ in symptoms from patients with other disorders e.g. depression may shoe avolition too

Question 34

what is aetiological validity?

Answer 34

diagnosis is seen as valid if the cause of Sz is the same for all patients

Question 35

give a research example for aetiological validity

Answer 35

Baillie et al (2009) surveyed 154 British psychiatrists and found that they had widely differing views on the causes of Sz (other than agreeing on the influence of genetics, biochem abnormalities and substance abuse)

Question 36

briefly explain part 1 of Rosenhan (1973) study 'On being sane in insane places'

Answer 36

-tried to see if 8 sane people could get diagnosed with Sz by sending them into 12 different hospitals, across 5 USA states and of varying character -the psuedopatients reported they were hearing words 'empty, hollow, thud' upon arrival, all admitted into hospital with Sz- except one who was diagnosed with bipolar depression -Rosenhan asked them to behave 'normally' once admitted, it took on average 19 days (7-52) for all to be discharged with Sz in remission -concluded that the label given and the environment you are placed in influences the way behaviour is viewed -TYPE 1 ERROR

Question 37

briefly explain part 2 of Rosenhan (1973) study

Answer 37

he investigated if the tendency toward diagnosing the sane as insane could be reversed -each member of staff rated each patient from 1-10 (1- confident they were fake, 10- real) over 3 months -193 patients were judged as real (10), only 41 judged to be fake (1) by at least one staff member -however, he never sent anyone with Sz in, there are issues with the reliability and validity of diagnosis, suggesting it is not possible to detect the sane from the insane- inability to detect psuedo-patients

Question 38

what four factors can affect the reliability and validity of diagnosis for Sz?

Answer 38

culture gender bias co-morbidity symptom over-lap

Question 39

culture

Answer 39

the rules, customs, morals, child rearing practices etc that bind a group of people together and define how they are likely to behave

Question 40

gender bias

Answer 40

the tendency to describe the behaviour of men and women in a way that might not represent the characteristics of either one of these genders accurately

Question 41

co-morbidity

Answer 41

the extent to which two or more conditions or diseases occur simultaneously in a patient, for example , Sz and depression

Question 42

symptom over-lap

Answer 42

the idea that symptoms of a disorder, such as delusions in Sz may not be unique to that disorder but may also be found in other disorders such as bipolar disorder, making accurate diagnosis difficult

Question 43

research evidence for how can culture affect reliability of diagnosis for Sz? (amongst different clinicians)

Answer 43

inconsistencies in diagnosis between clinicians form different parts of the world Copeland (1971) -134 US psychiatrists, 69% diagnosed with Sz vs -194 British psychiatrists, 2% diagnosed with Sz

Question 44

research evidence for how can culture affect reliability of diagnosis for Sz? (consistency of symptoms between patients)

Answer 44

hearing voices is a characteristic of Sz , the nature of voices is not consistent across all patients Luhrmann (2015) interviewed 60 Sz adults, 20 in Ghana, 20 in India and 20 in US- asked about voices -Ghana and India reported positive, spiritual experiences -US reported having hateful and violent voices

Question 45

how gender bias affects VALIDITY of diagnosis for Sz (stereotypes)

Answer 45

clinicians may base their judgments on stereotypical beliefs held about males and females, affecting the accuracy of diagnosis

Question 46

how gender bias affects VALIDITY of diagnosis for Sz (patient being male or female)

Answer 46

accuracy of diagnosis could be dependent on whether an individual is male or female, due to the diagnostic criteria that may be biased towards one or the other

Question 47

how co-morbidity affects VALIDITY of diagnosis for Sz

Answer 47

many people with Sz often suffer from at least one other condition, questioning whether Sz exists as a distinct condition at all

Question 48

how co-morbidity affects VALIDITY of diagnosis for Sz (treatment of Sz)

Answer 48

it can be difficult to get someone an accurate diagnosis and therefore the right treatment if two or more conditions occur at the same time -two or more conditions may just be one singular disorder that requires its own specific treatment

Question 49

how symptom over-lap affects VALIDITY of diagnosis for Sz

Answer 49

many of the positive and negative symptoms of Sz are also found in many other disorders, such as delusions in depression and bipolar disorder -are patients with Sz given an accurate diagnosis?