Classification Of Schizophrenia A.g

Front 1

What is schizophrenia?

Back 1

- Mental disorder

- 1% of world's population suffer

- commonly around the age of 15-35.

- Affects sufferer's thought processes, physical functions & perceptions of reality.

- Symptoms can vary in type & severity.

- Some sufferers only encounter symptoms sporadically, while others suffer more persistently.

Front 2

Define 'positive symptoms' & give 3 examples.

Back 2

Symptoms in addition to normal functioning.

- Hallucinations

- Delusions

- Catatonic Behaviour

Front 3

Outline Hallucinations: Positive Symptom

Back 3

Unusual perceptions of the environment stimuli unique to the individual, which no one else can perceive.

- Usually auditory but other times visual, olfactory (disgusting smells) or tactile (feeling something or someone touching you).

Front 4

Outline Delusions: Positive Symptom

Back 4

Irrational beliefs that seem real but are not true in reality.

- Paranoid delusions: individual believes they are being persecuted or spied on.

- Delusions of grandeur: exaggerated belief's about one's own abilities or importance (e.g superpowers or fame).

Front 5

Outline Catatonic Behaviour: Positive symptom

Back 5

Abnormal motor activity, where a person can experience a loss of motor skills or extreme hyperactive motor activity (rigid or frenzied).

Front 6

Define 'negative symptoms' and give examples.

Back 6

A reduction in normal functioning.

- Avolition

- Speech Poverty

- Affective Flattening

- Disorganised Thinking

- Anhedonia

- Social/Occupational Dysfunction

Front 7

Outline Avolition: negative symptom

Back 7

A reduction in, or inability to initiate or engage in goal-directed behaviours and a reduction in self-motivation.

Front 8

Outline Speech Poverty: negative symptom

Back 8

- Reduction in the amount or quality of what is spoken.

- Reduction in verbal fluency

- Delay in verbal responses

Front 9

Outline Affective Flattening: negative symptom

Back 9

A reduction in the range of their emotional expressions, for example: tone of voice, facial expressions & eye contact.

Front 10

Outline Anhedonia: negative symptom

Back 10

A general loss of interest or pleasure in everyday life & activities.

Front 11

What does reliability refer to in the context of schizophrenia?

Back 11

The consistency of symptom measurement.

Front 12

What 2 ways can the reliability of schizophrenia be assessed?

Back 12

1. Test-retest reliablitiy: Same clinician makes the same diagnosis on separate occasions from the same info provided.

2. Inter-rater reliability: Different clinicians make identical diagnosis, independently, on same patient.

Front 13

Limitation

of Reliability in Schizophrenia Diagnosis: Evidence for low inter-rater reliability

Back 13

- Cheniaux et al investigated inter-rater reliability between clinicians.

- 2 psychiatrists independently diagnosed 100 patients using DSM & ICD.

- Found poor inter-rater reliability: using DSM one diagnosed 26 patients & other 13; using ICD one diagnosed 44 & other 13.

- Poor consistency undermines the reliability of diagnosis.

Hint 13

- Who investigated the inter-rater reliability between clinicians?

- How many patients & using which 2 'manuals'?

- Results found using DSM & ICD?

Front 14

Culture Bias - Effect on Reliability

Back 14

- Tendency to over-diagnosis members of ethnic minorities.

- E.G Afro-Caribbeans several times more likely than white people to be diagnosed.

- People who create diagnostic tools (DSM) are from predominately white backgrounds w/ different set of norms & values to ethnic group.

- Culture bias may affect inter-rater-reliability of diagnosis & classification b/c individual reporting same symptoms to clinicians from different cultural backgrounds may not receive same diagnosis.

- E.G hearing voices has -ve connotations in 1 culture but may be viewed as a +ve experience in another.

- Not considered abnormal & therefore wouldn't lead to diagnosis of condition

Hint 14

- What does cultural bias lead to a tendency to do?

- E.G Afro-Caribbeans...

- What about people who created the DSM?

- Effect on inter-rater reliability and why?

- Use the example of hearing voices...

Front 15

Limitation of Reliability in Schizophrenia Diagnosis: Evidence for Cultural Bias

Back 15

- Luhrmann et al investigated 60 adults (20 each from Ghana, India & US) w/ schizophrenia.

- Used interviews to ask pps about voices they heard.

- Ghanaian & Indians reported +ve experiences whereas not one American did.

- Implies if Ghanaian & Indian patient reported hearing voices may be viewed as -ve experience by US clinician but not by one from their own culture.

- Leads to low inter-rater reliability of diagnosis between clinicians of different cultures.

Hint 15

- Who studied 60 patients?

- What symptom were the suffering from?

- How did the Ghanaians and Indians report the experience vs American?

- What does this imply about US clinician?

- Low inter-rater reliability between who?

Front 16

Limitation of Reliability in Schizophrenia Diagnosis: Labelling is a -ve consequence of cultural bias

Back 16

- Individuals who display characteristics considered abnormal by a particular culture but not their own may be labelled as 'schizophrenic'.

- May not understand why they have been given this label & makes them feel ostracised from society.

- May struggle to cope w/ being different, may lead to social withdrawal, avolition & disorganised thinking (symptoms of schizophrenia).

- Being labelled as a 'schizophrenic' a self-fulfilling prophecy has resulted in the person succumbing to the label.

Hint 16

- What may individuals who display characteristics be considered as & then labelled?

- What may this make them feel?

- Struggling to cope w/ being different may lead to...

- Self-fulfilling prophecy

Front 17

What is validity in terms of schizophrenia?

Back 17

The accuracy of a diagnosis.

- Schizophrenia should be a disorder separated from other disorders.

- This is done by using classifications systems = DSM & ICD.

Front 18

In what 2 ways can the validity of diagnosis be assessed?

Back 18

1. Concurrent Validity: ectent to which different classification systems identify symptoms of schizophrenia according to their criteria & arrive @ same diagnosis. If both agree diagnosis has concurrent validity.

2. Predictive Validity: Extent to which diagnosis leads to a successful treatment (reduces symptoms). If treatment outcome is successful shows diagnosis has predictive validity.

Front 19

What is Co-morbidity & the effect of the validity of diagnosis?

Back 19

- Co-morbidity = 2 or more disorders occurring @ the same time.

- Schizophrenia is co-morbid w/ disorders like: substance abuse, depression & OCD.

- Affects the validity of classification & diagnosis b/c leads to uncertainty about whether different disorder should be considered independently.

Front 20

Limitation

of Co-morbidity: Evidence highlighting the issue of co-morbidity in diagnosis

Back 20

- Buckley et al estimated 50% of schizophrenics had co-morbid depression, 47% substance abuse & 23% OCD.

- Highlights problem of trying to distinguish separate disorders.

- High levels of co-morbidity suggest schizophrenia consists of distinct sub-types.

- E.G. schizophrenia w/ obsessive- compulsive symptoms may be a sub-type which should be considered distinct from schizophrenia w/ substance abuse.

Hint 20

- Which researcher?

- %s of co-morbidity w/ depression, substance abuse and OCD.

- What problem does this highlight?

- What does the high levels of co-morbidity suggest & example.

Front 21

Limitation

of Co-morbidity: Schizophrenics w/ co-morbid conditions are excluded from research.

Back 21

- May be b/c a clinician may diagnose a patient w/ one of common co-morbid disorders (e.g. bipolar) and not recognise they also have schizophrenia so therefore won't be eligible.

- Means any research findings from such research may not represent sufferers of schizophrenia w/ prominent co-morbid disorder & has low internal & population validity.

Hint 21

- Why might patients not be included in research for schizophrenia.

- What happens to the findings of these studies?

- low what types of validity?

Front 22

Outline symptom overlap and its effect on validity of diagnosis.

Back 22

- Occurs b/c symptoms of schizophrenia are also found w/ other disorders.

- Affects the validity of diagnosis b/c it makes it difficult for clinicians to decide which disorder patient is suffering from.

- Symptom overlap w/ schizophrenia & bipolar, where depressed mood & hallucination are both common symptoms.

Front 23

Limitation of Symptom overlap w/ schizophrenia: evidence highlighting the issue of symptom overlap in diagnosis

Back 23

- Ophoff et al assessed genetic material from 50,000 patients.

- Found 3/7 gene locations on the genome were associated w/ both schizophrenia & bipolar.

- The common genetic basis provides possible reason for shared symptoms between disorders.

- Implication is that schizophrenia w/ manic symptoms may be classified as a sub-type of schizophrenia rather than considering schizophrenia & bipolar as distinct disorders.

Hint 23

- Which researcher assessed the genetic material of 50,000 patients.

- What was found?

- What does this prove a possible reason for?

- Implication is that schizophrenia w/ manic symptoms may be classified as a...

Front 24

Limitation of Symptom overlap w/ schizophrenia: Misdiagnosis due to symptom overlap

Back 24

- Misdiagnosis b/c when symptoms overlaps (hallucinations) they can be identified by clinician, may provide a diagnosis of 1 of the 2 possible disorder (bipolar) but other disorder (schizophrenia).

- Can lead to a course of treatment for misdiagnosed disorder which may be ineffective or in some cases exacerbate it.

- One way to deal w/ issue: examine the grey matter of the brain, as schizophrenics can experience a decrease of grey matter, while bipolar sufferers do not.

- Shows how empirical evidence can support a more subjective approach to provide a more valid diagnosis.

Hint 24

- How does misdiagnosis occur?

- What type of treatment does this lead to?

- How do you deal w/ this issue (grey matter...)?

- What does this show about empirical evidence?

Front 25

Outline how gender bias affects the validity of diagnosis.

Back 25

- Schizophrenia is statistically more prevalent in males than females.

- May be b/c of gender bias in the way clinicians interpret symptoms which causes an inaccuracy in diagnosis rather than difference between sexes.

- Female patients typically function better than males.

- When suffering from the symptom avolition, females may seek support while males are less likely.

- High interpersonal functioning may explain why some women haven't been diagnosed w/ schizophrenia when men w/ similar symptoms have been.

- Affects the validity of diagnosis as clinicians may under-diagnose schizophrenia in women b/c symptoms seem too mild to warrant diagnosis or are masked.

Front 26

Limitation of Gender Bias in schizophrenia diagnosis: evidence that females ability to function can lead to under-diagnosis

Back 26

- Kulkarni et al

- Found female sex hormone estradiol was effective in treating schizophrenia in women when added to antipsychotic therapy.

- Suggests female biology naturally helps women function better & feel less inclined to seek clinical consultation.

- Males on other hand, who lack estradiol are less able to function & visit clinician.

- Biological differences between the sexes may lead to the under diagnosis of females.

Hint 26

- Estradiol w/ antipsychotic therapy.

- Female biology naturally helps...

- What about men?

Front 27

Limitation

of Gender Bias in schizophrenia diagnosis: Evidence that females are under-diagnosed

Back 27

- Loring & Powell

- Randomly selected 290 psychiatrists & asked them to read info about 2 patients & diagnose them according to standard diagnostic criteria.

- When patients not assigned a gender 56% compared to when described as females=20%.

- Shows gender bias when interpreting symptoms.

Hint 27

- How many randomly selected 290 psychiatrists?- What the psychiatrists asked to do?- Not assigned a gender, what were the %s.