Schizophrenia

Classification of Schizophrenia

Biological explanations for Schizophrenia

Reliability and validity in diagnosis and classification of Schizophrenia

Drug therapies

type of pscyhcosis

thoughts and emotions impaired so contact lost with reality

affects 1% of population

mostly diagnosed between 15 and 35

Symptoms

Diagnosing schizophrenia

Criterion B- Social/occupational dysfunction

Criterion C - duration

Criterion A

Two or more of the following

  1. Delusions
  1. Hallucinations
  1. Disorganised speech
  1. Completely disorganized or catatonic behavior
  1. Negative symptoms

"for a significant portion of the time since the onset of the disturbance, the level of functioning in one or more major areas (work, self-care etc) is below the level achieved prior to the onset"

continuous signs of the disturbance persist for at least 6 months. .

must include at least 1 month of symptoms that meet criteria A

Positive symptoms- those that appear to reflect an excess or distortion of normal functions.

Negative symptoms

Delusions

Disorganised speech

Hallucinations

Grossly disorganized or catatonic behavior

  • bizarre beliefs seem real to the person with schizo but hey are not real
  • sometime delusions are paranoid, often that they’re being spied on or that their phone is bugged
  • delusions of grandeur- inflated ebliefs about a persons power adn importance e.g that ther are famous or magic
  • delusions of reference- when event in the environment appear to be directly related to them
  • unreal perceptions of the environment that are usually auditory but may be visual or olfactory (smell) or tactile (touch).
  • e.g hearing voices, seeing objects, smelling randoms smells, feeling things on your skin
  • many schizos report hearing voices or several telling them to do something like telling them to harm themseleves or someone else or commentingon their behavior
  • issues organising thoughts so shows in speech
  • may jump from one topic from another, even mid sentence
  • in extreme cases “word salad’- when words get so mixed up they’re incoherent
  • includes the inability or lack of motivation to initiate a task or complete once started leading to difficulties in daily living
  • can result in a decreasaed interest in personal hygene

Anhedonia

Alogia/ Speech poverty

Affective flattening :

Avolition

  • lessening of speech fluency and productivity- though to reflect slowing or blocked thoughts
  • produce fewer words in a given time on a task of verbal fluency (e.g name as many animals in a minute)
  • not a matter of not knowing words but inability to spontaneously produce them
  • less big words or complexity
  • reduction of interest adn desires as well as inability to initiate and persist in goal-directed behavior (e.g sitting there doing nothing all day due to no interest in anything)
  • distinct from poor social function or disinterest which can be the result of other circumstances
  • e.g individual may have no social contact with family or friends because they have none, or communication with them or difficult
  • not however considered avolition which is specified as a reduction in self-initiated involvement in activities that are available to the patient

expressionless

very monotone

loss of interest or pleasure in all or almost all activities

lack of reactivity to normally pleasureable stimuli

may be pervasive (all-embracing) or confined to just one aspect of the experience

Reliability

Validity

Diagnostic reliability

Cultural differences in diagnosis

Diagnostic reliability means that a diagnosis of schizo must be repeatable (clinicians must reach the same conclusions at two different points in time, test-retest reliability), or different clinicians reach the same conclusions (inter-rater reliability)

Symptom overlap

Co-morbidity

Gender bias? i barely know er bias

inter-rater reliability- measured by a statistic called a kappa score

a score of 1 indicated 0 agreement

a score of 0.7+ is considered good

DSM-V trials the diagnosis of schizo only had a kappa score of 0.46

research suggests significant variation between countries when it comes to diagnosing schiz i.e culture influences the diagnostic process

Copeland 1971

Luhrmann et al 2015

  • gave 134 US and 19 British psychiatrists a description of a patient
  • 69% of US psychiatrists diagnosed but 2% of Brits
  • interviewed 60 adults with schiz, 20 each in Ghana, India and the US
  • each asked about voices
  • African and Indians described voices as positive and offering advice, US described them as negative and violent
  • Durham suggests the ‘harsh violent voices so common in the west may not be an inevitable feature of schiz’

Ao3

Unreliable symptoms

Cultural differences

Lack of inter-rater reliability

little evidence that DSM is used with high reliability between different clinicians

Whaley 2001

found inter rater realiabiility of diagnosis as low as 0.11

Rosenhan found more problems with impostor study

suggets that diagnosis is subjective to each diagnoser, so causes problem for reliability

for a diagnosis only one symptoms is needed if the "delusions are bizarre" like what does that even mean?

subjective cuz like what do you even mean by that

50 senior psychiatrist had to differentiate between bizarre and not and the inter rater correlation was only like 0.4 soooooo

concluded that the diagnostic hasn't got enough reliability to be a reliable method for diagnosis

Barnes 2004 established the differences in schizo

Lurhman et al 2015

less distress with other groups

Brekke and Barrio (long lost mario brother)

184 individuals with schizo from 2 groups of ethic majority and ethnic minorities

Non minority groups were consistently more symptomatic, probably because the DSM was written for white Americans so they're more likely to fit the diagnostic mold

when accuracy of diagnosis is depndent on th egender of individual

DSM is andro centric

mentally healthy behavior is based off of studies done with men so women more likely to be considered unhealthy

stella ❤