SCHIZOPHRENIA
DIAGNOSIS + CLASSIFICATION
Schizophrenia –
A severe mental illness where contact with reality + insight are
impaired. It is a psychotic disorder
It affects thought processes + ability to determine reality
Professor Bleuler
Developed a symptomatic diagnostic for schizophrenia – the 4 A’s
Abnormal associations
Autistic behaviour + thinking
Abnormal effect
Ambivalence
Positive symptoms
Those that appear to reflect an excess or distortion of normal functions
Hallucinations
Delusions
Hallucinations
Bizarre, unreal perceptual distortions or exaggerations
Occurs when someone sees, hears, tastes, smells or feels things
that either don’t exist outside their mind or can be distorted
perceptions of things that are there
E.g. a person may see distorted facial expressions of people/animals
that are not there
Auditory – hearing voices – patients report hearing a voice telling
them to do something (like harming themselves/someone else) or
commenting on / criticising their behaviour
Visual – distorting objects / facial expressions or seeing lights,
objects or faces that others cannot see
Olfactory – smelling things that others cannot smell
Tactile – e.g. feeling that bugs are crawling on or under the skin or
something touching the skin
Delusions
False, irrational beliefs held by patient but not by other people
Caused by distortions of reasoning or misinterpretations of
perceptions or experiences that have no basis in reality
Cannot be corrected with reason or when presented w conflicting
evidence
E.g. thinking you are an important political or religious figure
Delusions often focus on paranoia + involve patient feeling
persecuted + followed / watched perhaps by government or aliens
, E.g. bizarre delusion - when an individual believes that their organs
have been replaced with someone else’s without leaving a wound or
scar
E.g. non-bizarre delusion – belief that one is under police
surveillance, despite lack of evidence
Paranoid delusions – belief that person is being spied upon or
followed e.g. tapped phone / hidden video recorders
Delusions of grandeur – involve belief about persons power +
importance
Delusions of reference – when events in environment appear to be
directly related to them e.g. personal messages being
communicated through radio
Negative symptoms
Involve loss of some usual abilities + experiences
Speech poverty
Avolition
Speech poverty
Schizophrenia often affects patterns of speech in sufferer
Negative as reduction in amount + quality of speech
Reduction in amount of speech produced leads to things like replies
to questions being short + empty and poor quality / fluency of
speech
May be delay in verbal responses during conversation
Speech poverty is similar to ‘disorganised speech’ – which speaker
changes topic mid-sentence or speech becomes jumbled
Symptom may reflect slowing / blocked thoughts
E.g. patients may produce fewer words in a given time on a task of
verbal fluency (name as many animals as you can in 1 minute)
Patients know as many words as people without schizophrenia but
have more difficulty in producing them
Avolition
Difficulty in ability to begin or keep up with goal directed + self-initiated
behaviour
Sometimes called apathy + often mistaken for disinterest
E.g. no longer interested in going out + meeting with friends or no
longer interested in previously enjoyed activities, sitting in house for
hours doing nothing, poor hygiene
Signs of avolition – Andreason 1982:
1. Poor hygiene + grooming
2. Lak of motivation + persistence in work / education
3. Lack of energy or interest shown
Diagnosis + classification
1. In order to diagnose a specific disorder we have to distinguish
between one and another
, 2. We cluster together symptoms that occur at the same time + use
this to classify that one disorder
3. So we can identify possible symptoms + use this to decide what
disorder a person has
4. 2 main diagnostic symptoms for classification of mental disorder –
1. International Classification of Disease version 10 (ICD 10)
Produced by WHO
2. Diagnostic and Statistical Manual edition 5 (DSM-5)
Produced by American Psychiatric Association
The IDC-10 + DSM-5
Both systems differ slightly in diagnosis of schizophrenia
DSM-5 – one of positive symptoms must be present for diagnosis
whereas 2 or more negative symptoms are sufficient under ICD-10
Both systems used to split schizophrenia into subtypes (e.g.
paranoid schizophrenic or catatonic schizophrenic)
These have been dropped as they’re too inconsistent + patients did
not show exact same symptoms
Reliability + validity of diagnosis
Reliability – level of agreement on the diagnosis by different
psychiatrists across time and cultures
Validity – the extent to which schizophrenia is a unique syndrome
with characteristic, signs + symptoms
Types of reliability
Diagnostic reliability – a diagnosis of schizophrenia must be
consistent or repeatable
Test re-test reliability – clinicians must be able to reach the same
conclusions at 2 different points in time from the same info
Inter-rater reliability – different clinicians must reach the same
conclusions about the same patient
there must be consistency both within + between different cultures +
genders
Types of validity
Predictive validity – if diagnosis leads to successful treatment, then
diagnosis is seen as valid
Descriptive validity – to be valid, patients w schizophrenia should
differ in symptoms from patients with other disorders
Criterion validity – whether different assessment systems arrive at
the same diagnosis for the same patient
A diagnosis cannot be valid if it is not reliable.
Comorbidity
The extent to which 2 or more conditions occur at the same time in a
patient – e.g. obesity + heart disease
DIAGNOSIS + CLASSIFICATION
Schizophrenia –
A severe mental illness where contact with reality + insight are
impaired. It is a psychotic disorder
It affects thought processes + ability to determine reality
Professor Bleuler
Developed a symptomatic diagnostic for schizophrenia – the 4 A’s
Abnormal associations
Autistic behaviour + thinking
Abnormal effect
Ambivalence
Positive symptoms
Those that appear to reflect an excess or distortion of normal functions
Hallucinations
Delusions
Hallucinations
Bizarre, unreal perceptual distortions or exaggerations
Occurs when someone sees, hears, tastes, smells or feels things
that either don’t exist outside their mind or can be distorted
perceptions of things that are there
E.g. a person may see distorted facial expressions of people/animals
that are not there
Auditory – hearing voices – patients report hearing a voice telling
them to do something (like harming themselves/someone else) or
commenting on / criticising their behaviour
Visual – distorting objects / facial expressions or seeing lights,
objects or faces that others cannot see
Olfactory – smelling things that others cannot smell
Tactile – e.g. feeling that bugs are crawling on or under the skin or
something touching the skin
Delusions
False, irrational beliefs held by patient but not by other people
Caused by distortions of reasoning or misinterpretations of
perceptions or experiences that have no basis in reality
Cannot be corrected with reason or when presented w conflicting
evidence
E.g. thinking you are an important political or religious figure
Delusions often focus on paranoia + involve patient feeling
persecuted + followed / watched perhaps by government or aliens
, E.g. bizarre delusion - when an individual believes that their organs
have been replaced with someone else’s without leaving a wound or
scar
E.g. non-bizarre delusion – belief that one is under police
surveillance, despite lack of evidence
Paranoid delusions – belief that person is being spied upon or
followed e.g. tapped phone / hidden video recorders
Delusions of grandeur – involve belief about persons power +
importance
Delusions of reference – when events in environment appear to be
directly related to them e.g. personal messages being
communicated through radio
Negative symptoms
Involve loss of some usual abilities + experiences
Speech poverty
Avolition
Speech poverty
Schizophrenia often affects patterns of speech in sufferer
Negative as reduction in amount + quality of speech
Reduction in amount of speech produced leads to things like replies
to questions being short + empty and poor quality / fluency of
speech
May be delay in verbal responses during conversation
Speech poverty is similar to ‘disorganised speech’ – which speaker
changes topic mid-sentence or speech becomes jumbled
Symptom may reflect slowing / blocked thoughts
E.g. patients may produce fewer words in a given time on a task of
verbal fluency (name as many animals as you can in 1 minute)
Patients know as many words as people without schizophrenia but
have more difficulty in producing them
Avolition
Difficulty in ability to begin or keep up with goal directed + self-initiated
behaviour
Sometimes called apathy + often mistaken for disinterest
E.g. no longer interested in going out + meeting with friends or no
longer interested in previously enjoyed activities, sitting in house for
hours doing nothing, poor hygiene
Signs of avolition – Andreason 1982:
1. Poor hygiene + grooming
2. Lak of motivation + persistence in work / education
3. Lack of energy or interest shown
Diagnosis + classification
1. In order to diagnose a specific disorder we have to distinguish
between one and another
, 2. We cluster together symptoms that occur at the same time + use
this to classify that one disorder
3. So we can identify possible symptoms + use this to decide what
disorder a person has
4. 2 main diagnostic symptoms for classification of mental disorder –
1. International Classification of Disease version 10 (ICD 10)
Produced by WHO
2. Diagnostic and Statistical Manual edition 5 (DSM-5)
Produced by American Psychiatric Association
The IDC-10 + DSM-5
Both systems differ slightly in diagnosis of schizophrenia
DSM-5 – one of positive symptoms must be present for diagnosis
whereas 2 or more negative symptoms are sufficient under ICD-10
Both systems used to split schizophrenia into subtypes (e.g.
paranoid schizophrenic or catatonic schizophrenic)
These have been dropped as they’re too inconsistent + patients did
not show exact same symptoms
Reliability + validity of diagnosis
Reliability – level of agreement on the diagnosis by different
psychiatrists across time and cultures
Validity – the extent to which schizophrenia is a unique syndrome
with characteristic, signs + symptoms
Types of reliability
Diagnostic reliability – a diagnosis of schizophrenia must be
consistent or repeatable
Test re-test reliability – clinicians must be able to reach the same
conclusions at 2 different points in time from the same info
Inter-rater reliability – different clinicians must reach the same
conclusions about the same patient
there must be consistency both within + between different cultures +
genders
Types of validity
Predictive validity – if diagnosis leads to successful treatment, then
diagnosis is seen as valid
Descriptive validity – to be valid, patients w schizophrenia should
differ in symptoms from patients with other disorders
Criterion validity – whether different assessment systems arrive at
the same diagnosis for the same patient
A diagnosis cannot be valid if it is not reliable.
Comorbidity
The extent to which 2 or more conditions occur at the same time in a
patient – e.g. obesity + heart disease
