Task 1: Continuum approach (DSM IV vs DSM V criteria for Schizophrenia…
Task 1: Continuum approach
Main argument: psychotic symptoms are continuosly distrubuted in general populations.
less stigmizing: no discrete illness entitiy, symptoms differ just in a quantitative way
. considers individual differences/heterogeneity when diagnosing a disorder (e.g. severity). Favors early detection (?)
opens a new pathway for research on similarities betwen disorders. It is sustained by the evidence of continuity between clinical signs and symptoms schizophrenia-like subclinical experiences. Allows advances in research. Restriction of focus to signs and symptoms measured by observations and anamnesis contrasts with the opportunities of new discoveries. Use of alternative genotype and endophenotype criteria
there is evidence for differences between disorders in terms of risk, factors, pathology and treatment response. Categories enable reliable diagnosis, based on neurobiological differences between people with psychoses and healthy control. More well known research, treatment and prescription. For e.g. more research should be done about the neurological correlated between schizophrenia and other disorders => necessary to prove it scientifcally.
There is still need for evidence that the continuum approach can benefit patients - it is necessary to have objective measures to distinguish disorders. Cattegoric view is not arbitraty, but has evolved over decades of clinical observations. Sytematic reseacrh need to be done to establish essential meassures and clinical evidence. => makes decision making more complicated, impractical, time-consuming and confusing in application.
Definitions of different ways to approach diagnosis
differences between symptoms and their normal counterpartes are considered qualitatively dichotomous (separated from the state of well being)
there is no discrete illness entity, instead psychotic symptoms differ in quantitative ways from normal experiences and behaviors. Disease at the level of the general population generally exists as a continuum of severity rather than as a all-or-none phenomenon.
It is possible to identify manifestations of schizophrenia that resemble experiences reported by individuals who do not meet criteria => appears to be exacerbations of subclinical function or subject experiences that predate the onset by months or years.
general population sample variability in manifestations may arise from graduated interpersonal differences between members of a population=> however, methodological desing affects the rates and
evidence suggests that differences between populations are not solely quantitative.
2 types of population: those who are liable, some of whom may also have the disorder, and those who are not -concept of latent structure-
phenotypes more common than the disorder: associated wiht many of the same environtmental and nongenetic risk factors as clinical phenotypes => implies continuum experience
Clinical vs non-clinical auditory hallucinations
AVH sensory experience that takes place in abscence of any external stimulation whilst in a fully conscious state
Localization, explanation of origin, loudness, childhood trauma, family history = unable to distinguid between clinical and non-clinical group. In children, the only distintion was related to emotional valence.
voices speaking in third person
higher ratings in clinical population.
clinical population less controlabillity
Number of different voices:
half of the non-clinical group only hear one voice
more frequen in clinical group
types of voices experienced
: commenting voices where the highest percentage in the clinical group.
longest duration in clinical group (40 min vs 2-3 min)
mean age at first experiencing voices
: in clinical groups 21 years, in non-clinical 14 years. Also, the non-clinical group has a higher childhood onset.
disturbance to daily functioning:
in clinical group moderate to severe distress, significant disturbances to daily functioning. For non-clinical groups, almost no discomfort or disruption.
emotional valence of voice:
majority of voices for clinical populaion are unpleasent/annoying an negative.
effect on individual:
for clinical group is frightening and upsetting, generates feelings of anxiety and depression, while for non-clnical just a small percentage felt upset.
DSM IV vs DSM V criteria
for Schizophrenia and spectrum disorders
DSM V adds the dimensional approach for considering severity:
few main symptoms that affect : the clinical manifestation of the disorder in different ways for different patients.
Subtypes are removed "over-simplification"
: elimination of paranoid, undifferentiated, disorganized, and residual subtypes -reference to first ranks symptoms was omitted because of lack of specificty.
In DSM IV, one symptoms was sufficient to fulfill A criterion. I
n DSM, two criterion A symptoms are required for diagnosis of chizophrenia
e.g. one of them being delusions, hallucinations or disorganised speech)
can now include bizarre delisuons
Schizoaffective Disorder –
major mood episode must be present for a majority of the total duration of disorde
Pay more attention to individual characteristics
Clinical staging model:
distinguishes residual symptoms or early signs in order for them to be detected more readilly n before progression to full psychopathology. This model simply states that individuals go through different stages of the disease process before they reach a clinical level. Normally there is a premorbid personality trait. Early signs for psychopathology =AVH (more frequent, random, more intrussive and less inhibtion), distress, mental health symptoms, type of help seeking behavior -more passive coping strategies- Main difference: cognitive vs emotional .emotional regulation affects the cognitive process
suggests that progression to increase impairment from psychotic like experiences occurs at a point where the individual is exposed to sufficiente environmental stressors. Genetic vulnerability is present => expression of psychotic experience //exposure to environmental risk factors// persistence of psychosis =>psychotic limitation. Occurs especially under affective dysregulation (anxiety, depression, stress).
The current view is the
where triggers, maintaining and moderating factors of AVH are incorporated, and these domains interact. This demonstrates the complexity of AVH. Factors are multifaceted and not mutually exclusive.