Characteristics, Diagnosis + Issues w/ diagnosis

Schizophrenia

A mental disorder that 1% of the population have. It involves severe disruption in psychological functioning (thought + emotion) and a loss of contact with external reality (psychosis). There characteristics of Schizophrenia are divided into positive characteristics and negative characteristics.

Positive characteristics

Characteristics which involve additions or exaggerations of normal function.

Negative Characteristics

Characteristics which involve a loss or reduction of normal function.

Hallucinations - PC

A positive characteristic. Involves disturbances in perception of any/all senses. The individual experiences perceptions of the environment that seem real to the individual but are not real. These hallucinations are almost always invariably unpleasant in nature. They can take the form of: auditory, visual, somatic or olfactory hallucinations. Auditory and visual hallucinations are most common. Often connected to delusions.

Example of Schizophrenia’s hallucinations

Eg) The voice of the devil speaking to you and telling you to commit suicide

Eg) Hallucinations of a crack in the floor opening up to swallow people around you

Delusions - PC

(Almost always unpleasant) false beliefs that seem real to the individual but are not real. They can take many forms, including: Delusions of Grandeur, Delusions of persecution, Delusions of Control and Delusions and Reference.

Delusions of Grandeur

Individual has inflated beliefs about their own level of power and influence (e.g. believes they are a king.

Delusions of Persecution

Individuals that believes others are plotting against them (e.g. beliefs friends are secretly plotting your death.

Delusions of Control

Individual believes that they are being controlled by an alien (different) force that invades their mind and body (e.g. a spirit or an alien

Speech Poverty - NC

The lessening of speech productivity. Marked by the: production of fewer words and less complex syntax (arrangements of words). It is believed to (at least partially) reflect slowing or blocked thoughts due to the disorder.

Avolition - NC

The inability to initiate and persist in goal-directed behaviour due to sharply reduced motivation to carry out a range of activities. Its main signs are: poor hygiene and grooming, lack of persistence e.g. work/education + lack of energy,

Diagnostic Criteria - DSM5

Criteria A: (bizarre) Delusions, hallucinations (running commentary voice or 2 voices conversing), disorganised speech, grossly disorganised or catatonic behaviour, negative symptoms.

Criteria B: Disfunction in (one or more) major areas of functioning for a significant period of time

Criteria C: Continuous signs of disturbance that persist for at least 6 months - these 6 months must include at least of 1 month of symptoms from criteria A.

Issues with Diagnosis

The key issues that come up when diagnosing Schizophrenia are: Gender bias, culture bias, symptom overlap and co-morbidity. These can contribute to misdiagnosis, overdiagnosis or underdiagnosis.

Gender Bias - Diagnosis

This is when the accuracy of diagnosis depends on the individual’s gender. For schizophrenia men are more commonly diagnosed with schizophrenia. This could be due to increased genetic vulnerability, but it is more likely that women are underdiagnosed with the disorder. Cotton et al. suggested this was due to schizophrenic women functioning at a high level as they commonly have closer relationships that act as a support system for the individual.

Culture Bias - Diagnosis

When the accuracy of an individual’s diagnosis is dependent on their cultural background. For schizophrenia black (afro-caribbean) British people are 9X more likely to be diagnosed in Britain, despite having no increased genetic vulnerability. They are victim to overdiagnosis due to clinicians overinterpreting their symptoms and distrusting honest claims made by black Britons.

Symptom Overlap - Diagnosis

This is when validity of a diagnosis is low due to similarlities between symptoms of Schizophrenia and other disorders (e.g. Bipolar Disorder - which also includes delusions and negative symptoms such as avolition. This means diagnoses may be inaccurate as other diagnoses are viable with symptoms presented.

Co-morbidity - Diagnosis

The extent to which 2 or more conditions can co-occur. This raises issues with diagnoses validity as the symptoms of the diagnoses can be from one single condition - for example Schizophrenia is commonly misdiagnosed with other conditions (e.g.. OCD, Depression, Substance abuse.

Schizophrenia Diagnosis - Con - Gender Bias

One weakness of diagnosis of schizophrenia is that there is research evidence of gender bias. In a study 290 psychiatrists were randomly selected to read two case studies of patient behaviour and then offer their judgement on the patients using standard diagnostic criteria. It was found when patients were referred to as men or their gender was not specified a higher percentage (56%) were diagnosed, where as when patients were referred to as women less were diagnosed (20%). Women psychiatrists were less likely to be affected by gender bias. Therefore, this suggests gender bias (influenced by the gender of both the patient and the clinician) is an issue for the validity of schizophrenia diagnosis.

Schizophrenia Diagnosis - Con - Cultural Bias

One weakness of diagnosis for schizophrenia is that cultural bias effects the validity of diagnosis. Patients with different cultural backgrounds can be over diagnosed (particularly afro-caribbean individuals). Moreover the cultural background of the clinician effects diagnosis too, as study found american psychiatrists were more likely to diagnose with schizophrenia than british psychiatrists when given an example with the same symptoms. Therefore, this suggests that the cultural background of the clinician as well as the cultural background of the individual influences diagnosis, which is an issue for the validity of the diagnosis of schizophrenia.