Diagnosis of schizophrenia

Schizophrenia

A severe mental health condition where contant with reality and insight are impaired

Positive symptoms of schizophrenia

Atypical symptoms experienced in addition to common experiences like hallucinations and delusion

Delusions

A positive symptom

Beliefs that have no basis in reality e.g. a person believes that they are someone else or that they are a victim of a conspiracy.

Hallucinations

A positive symptom

Sensory experiences that have either no basis in reality or are distorted perceptions of things that are there.

Negative symptoms of schizophrenia

Atypical experiences that represent the loss of a common experience like a loss of clear thinking or a loss of motivation.

Avolition

A negative symptom

Loss of motivation to carry out tasks which results in lowered activity levels

Speech poverty

A negative symptom

Reduced frequency and quality of speech

Co-mobordity

The occurance of 2 conditiosn together e.g. schizophrenia and a personality disorder at the same time.

In cases where 2 conditions are frequently diagnosed together it calls into question the validity of classifying the conditions separately.

Symptom overlap

Occurs when 2 or more conditions share symptoms.

Calls into question the validity of classifying the 2 conditions separately

Culture bias

A tendency to interpret all phenomena through the lens of ones’s own culture, ignoring the effects that cultural differences might have on behaviour

Gender bias

Psychological research or theory may offer a view that does not justifiably represent the experience and behaviour of men or women.

Bias

A tendency to treat one individual or group in a different way than others

W Co-morbidity

If 2 mental health conditions co-occur in many different people then it calls the validity of the diagnosis into question as schizophrenia and depression might be a single condition.

Schizophrenia is commonly diagnosed with other conditions.

Buckley found that 50% of people with schizophrenia diagnoses also have depression, 47% had a substance abuse and 23% had OCD.

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

W Culture bias

Symptoms of schizophrenia like hearing voices have different meanings and are more accepted in different cultures.

In some African-Caribbean societies people think that voices are communications from ancestors.

British people of African-Caribbean origin are 9x more likely to receive a schizophrenia diagnosis as white British people.

People of African-Caribbean origin living in African-Caribbean countries didn’t have a high level of diagnosis which rules out a genetic vulnerability.

This difference may happen as British psychiatrists misinterpret symptoms in African-Caribbean British people.

Suggests that these people may be discriminated by a culturally-biased diagnostic system.

W Gender bias

Men have been diagnosed with schizophrenia more commonly than women 1.4:1 ratio.

A possible explanation for this is that women are less vulnerable than men maybe because of genetic factors.

It seems more likely that women are undiagnosed because they have closer relationships and get better support. This leads to women with schizophrenia often functioning better than men.

The underdiagnosis is a gender bias and means women may not receive treatment or services that might benefit them.

W Symptom overlap with other conditions

Schizophrenia and bipolar disorder can involve positive symptoms like delusions. These are less severe in bipolar disorder so isn’t a requirement for diagnosis.

It can be difficult to decide whether a person with delusions should be diagnosed with schizophrenia or bipolar disorder. This calls into question the validity and value of a diagnosis.

Suggests that it might be better to focus on distinct symptoms rather than looking at conditions which aren’t that different

S Reliability

Osório

A diagnosis is said to be reliable when different diagnosing clinicians reach the same diagnosis for the same person (inter-rater reliability)

Reported excellent reliability for the diagnosis of schizophrenia in 180 people using the DSM-5. Pairs of interviewers achieved inter-rater reliability of +.97 and test-retest reliability of +.92

Suggests that we can be sure that the diagnosis of schizophrenia is consistently applied.