Diagnosis of Schizophrenia

Diagnosis

Schizophrenia is a serious mental health condition experiences by about 0.3% of the worlds population (2022).

It is more commonly diagnosed in men, city-dwellers and lower Socio-economic groups.

 

The only symptoms of schizophrenia can interfere severely with everyday tasks, so that many people with schizophrenia end up homeless or hospitalised.

Positive symptoms (1)

Positive symptoms of schizophrenia are additional experiences beyond those of ordinary exitence. They include hallucinations and delusions.

 

 (an addition to your life, something you didn’t experience before a schizophrenia diagnosis)

• Hallucinations

• Delusions

PS: Hallucinations

These are unusual sensory experiences. Some hallucinations are related to events in the environment or bear no relation tp to what the senses are picking up from the environment.

For example, voices heard either talking to or commenting on the person with schizophrenia that are coming from elsewhere, often criticising them = auditory hallucinations.

PS: Delusions (1)

Also known as ‘paranoia’, delusions are irrational beleifs. These can take a range of forms.

One type of delusion involves the individual beleiving that they are an important historical, political or religious figure such as Jesus or Napoleon.

• delusions of grandeur

• Delusions of prosecution

PS: Delusions (2)

Delusions of grandeur = makes a person believe they are a god, for example napoleon

 

Delusions of persecution =  most common and is the beleif that people are trying to kill you or harm you in any sort of way

Another type involves the person feeling persecuted, perhaps by the government or alien, or of having superpowers.

Negative symptoms (1)

Negative symptoms of schizophrenia involve the loss of usual abilities and experiences. Examples include speech poverty and avolition.

 

(a reducation, something has been taken away from your life)

• Speech poverty

• avolition

NS: Speech poverty (alogia)

Schizophrenia is characterised by changes in patterns of speech. Speech poverty is seen as a negative symptom because the emphasis is on reduction in the amount an quality of speech in schizophrenia (infrequent, cant generate speech, taciturn)

 

This is sometimes accompanied by a delay in the persons verbal repsonses during conversation.

 

Nowadays, however, more emphasis is placed on disorganised speech in which speech becomes incoherent or the speaker changes topic mid-sentence.

This is classfied in DSM as a positive symptom of shizophrenia, whilst speech poverty remains a negative symptom.

NS: Avolition

Sometimes called ‘apathy’, this can be described as finding it difficult to begin or keep up with goal-directed activity (actions performed in order to ahcieve a result)

 

People with schizophrenia often have sharply reduced motivation to carry out a range of activities - loss of drive and can be seen as related to depression

Adreasen (1982) identified 3 signs of avolition: poor hygiene and grooming, lack of persistence in work or energy, and a lack of energy.

 

Some key words

Neologism = making up new words

Echolalia = rhyming words

Catatonic = unresponsivness, remaining motionless and silent in an external environment, maintaining a posture, like a figure made of wax.

A03 - strength (reliability)

One strength of the diagnosis is it’s reliability.

 

Reliability means consistency. A psychiatric diagnosis is said to be reliable when different diagnosing clinicians reach the same diagnosis for the same person (inter-rater reliability) and when the same clinician reaches the same diagnosis for the same person on two occasions (test-retest reliability).

 

Prior to DSM-5, reliability for schizophrenia was low but it has now improved.

Flavia Osorio et al (2019) reported excellent reliability for the diagnosis of schizophrenia in 180 individuals using the DSM-5. Pairs of interviewers achieved inter-rather reliability of +.97 and test retest reliability of +.92.

This means that we can be reasonably sure that the diagnosis of schizophrenia is consistently applied.

A03 - weakness (co-morbidity)

One limitation in diagnosing schizophrenia is it’s co-morbidity with other conditions.

 

If two mental health conditons (schizophrenia and depression) occur in many different individuals, then this calls into question the validity of the diagnosis because schizophrenia and depression might actually be a single condition.

 

Schizophrenia is commonly diagnosed with other conditions. For example on review found that about half of those diagnosed with schizophrenia also had a diagnosis of depression or substance abuse. (Buckley et al 2009)

 

According to Buckley, 50% of individuals with a diagnosis of schizophrenia also have depression.

 

This is a problem for diagnosis as at least some people diagnosed with both schizophrenia and depression may simply have an unusual case of depression

A03 - weakness (gender-bias)

A further limitation of schizophrenia is the existence of gender bias.

 

Since the 1980’s, men have been diagnosed with schizophrenia more commonly than women 0- in a ratio of 1.4:1 (2020).

 

One possible explanation for this is that women are less vulnerable than men, perhaps due to genetic factors. However, it seems more likely that women are underdiagnosed because they have closer relationships and hence get support (cotton 2009).

 

This leads to women with schizophrenia often functioning better than men.

 

This underdiagnosis is a gender bias and means women may not therefore be receiving treatment and services that might benefit them.

Study! David Rosenham

1973

 

Psychologist David Rosenham tested the reliability and validity of psychiatric diagnoses.

 

Eight healthy people (including Rosenham himself) went undercover as patients.

 

They called psychiatric hospitals claiming to hear an unfamiliar voice saying three words: “empty” “hollow” and “thud”.

 

Aside from using fake names and jobs, they gave truthful life histories. All were admitted, and almost all received a primary diagnosis of schizophrenia.

 

Once inside, the participants stopped acting sick and behaved completely normally, telling staff they felt fine.

 

Length of hospitalisation ranged from 7-52 days, with an avarage of 19 days.