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Transcript of Schizophrenia
The word schizophrenia comes from the two greek words: Schizo meaning 'Split' and Phren meaning 'mind'. So literal translation is 'split mind' which is much more akin to Multiple Personality Disorder than what Schizophrenia actually is.
Schizophrenia is actually characterised by psychosis, the partial loss of contact with reality.
Diagnosis uses a list of criteria from either the DSM or the ICD.
The prevalence of Schizophrenia is 1%.
The onset is often in late adolescence or early adulthood.
The DSM definition: Profound disruption of cognition and emotion, affecting a person's language, thought, perception, affect, and sense of self.
Positive and Negative symptoms are included within this.
+ve = an 'add on' so an excess or distortion of normal functions.
-ve = a loss or diminution of functions.
Types of Schizophrenia
There are five main types of schizophrenia, each having their own set of criteria:
Disorganised - Involves great disorganisation including delusions, hallucinations, incoherent speech and large mood swings.
Catatonic - The main feature is almost total immobility for hours at a time, with the patient simply staring blankly.
Paranoid - The involves delusions of various kinds.
Undifferentiated - A broad category that includes patient who don't belong clearly to another.
Residual - Consists of patients who don't have prominent +ve symptoms but who have various -ve symptoms.
Patients diagnosed with other types of schizophrenia whose symptoms have reduced in munber and in strength often have their diagnosis changed to become residual.
Classification + Diagnosis
Under the DSM IV, the diagnosis of schizophrenia requires at least a one-month duration of two or more positive symptoms.
However, only one positive symptom is necessary if delusions are bizarre, or hallucinations involve two or more conversing voice or a continuous commentary of the person's life.
Continuous signs of the disturbances must persist for at least 6 months.
For a significant portion of the time since the onset of the disturbance, one or more areas of functioning, such as work or interpersonal relations, are markedly below the level achieved prior to onset.
The disturbance must not be due to other disturbances or organic causes.
It is important to note that many other disorders involve similar symptoms,there are many variations involving psychosis.
Catagorisation vs. continuum approach
There is accumulating evidence to suggest that the categorisation of schizophrenia should be replaced with a continuity approach, which was considered under the new DSM talks. Here there is no sharp divide between those affected and those not. The continuity approach has been tested by using questionnaires that include items that refer to some of the +ve and -ve symptoms of schizophrenia. Such questionnaires assess 'schizotypy', which is a proneness to develop psychosis. Chapman et al (1994) found that apparently normal individuals who had a high score on the schizotypy scale were more likely than others develop a psychosis over the following 10 years.
Catagorisation and Diagnosis
A Level (A2)
Delusions - Bizarre beliefs that the person believes to be real but are not.
Experiences of Control - The belief they are under the control of an alien force, often interpreted as spirits or implanted radio transmissions.
Hallucinations - Unreal perceptions of the environment that are usually auditory, but may also be tactile or visual.
Disordered thinking - The feeling that thoughts have been inserted or withdrawn from the mind. Tangential, incoherent speech is an indicator of this.
Affective Flattening - Reduction of range and intensity of emotional expression.
Alogia - Poverty of speech, characterised by the lessening of speech fluency. This is thought to reflect slowing or blocked thoughts.
Avoliation - Reduction or inability to initiate and persist in goal-directed behaviour. This is often mistaken for disinterest.
Reliability and Symptoms
Klosterkotter et al (1994): After assessing 489 admissions to a psychiatric unit, they found positive symptoms were much more useful for the diagnosis of schizophrenia.
Mojabi and Nicholson (1995): Found problems with the definition between 'bizarre' and 'non-bizarre', with only a 0.4 inter-rater correlation when asking 50 senior psychiatrists.
There is also so many variations on schizophrenia that creates the same disorder in wildly different patients.
Rosenhan (1973) Study
Eight 'pseudopatients' presented themselves to psychiatric hospitals in the US claiming they heard unfamiliar voices in their heads saying the words 'empty', 'hollow' and 'thud'.
They were all diagnosed with schizophrenia and admitted to a psychiatric ward. Throughout their stay, they behaved as they would normally and when asked how they were they said their symptoms had gone and they felt fine. None of the staff recognised that they didn't have mental health issues.
Reliability and validity are inextricably linked within science. If scientists cannot agree who has schizophrenia, then questions of what it actually is become essentially meaningless. A comprehensive review of research into the symptoms, aetiology (causes), prognosis (outcome) and treatment concluded that schizophrenia is 'not useful' as a scientific category. (Bentall et al, 1988)
Reliability and the DSM
Reliability is the extent to which psychiatrists can agree on the same diagnosis when independently assessing the patient.
DSM III was designed to provide a much more reliable system for classifying psychiatric disorders.
However, 30 years on there is still little evidence that the DSM is routinely used with high reliability by mental health clinicians.
Whaley (2001) found inter-rater reliability correlations in the diagnosis of schizophrenia are as low as 0.11.
Benedict (1994) studied the culture of the Dobuan Islanders of Melanesia in the Western Pacific. Dobuan society was characterised by a distrust of others that verged on parania. They described one man that was pleasant and helpful that was described as 'crazy' by others.
This shows how the diagnosis of schizophrenia is biased towards the Western culture, meaning we cannot diagnose across cultures.
Copeland et al (1971) gave a description of a patient to 134 US and 194 UK psychiatrists. 69% of the US diagnosed schizophrenia but only 2% of the British made the schizophrenic diagnosis.
Validty and Prognosis
In the same way people with schizophrenia rarely have the same symptoms their prognosis differs greatly too. 20% recover their previous levels, 10% achieving significant and lasting improvements and 30% show some improvement with relapses. This suggests that we have little predictive validity, some may never recover yet many other do.
Malmberg et al (1998) suggests that gender and psychosocial influences, ie social skills, family tolerance and academic achievements (Harrison et al, 2001) may be a better indicator to recovery.
Validity and Symptoms
Schneider (1959) listed symptoms for schizophrenia that he believed distinguished it from other disorders. He called these first-rank symptoms that include delusions of being under control, their thoughts are being broadcast and hallucinary voices. However, these symptoms can also be seen in other disorders, like depression and bipolar. Ellason and Ross (1995) points out that DID people have more 'schizophrenic' symptoms than people with schizophrenia.
Evaluation of Rosenhan (1973)
IDA - Criminals may act 'insane' and therefore spend life in hospital not prison, ie Ian Brady the Moors Muderer
Small Study of only 8 hospitals
Deceptive of the staff and other patients, may harm the behaviour of patients there for a real reason, covert observation.
The study is now old and mental health care has changed dramatically, time validity.
Not generalisable from the US due to different health care system (private)