Schizophrenia Revision
Schizophrenia - long-term psychotic illness whereby the individual has issues with their
assessment of reality along with emotional difficulties.
Psychosis - unable to comprehend reality
The Prevalence (commonness) of Schizophrenia in the UK:
● General population: 1%
● Brother or sister has schizophrenia: 8%
● One parent has schizophrenia: 12%
● Fraternal twin has schizophrenia: 14%
● Both parents have schizophrenia: 39%
● Identical twin has schizophrenia: 47%
ONSET OF SCHIZOPHRENIA: The average age of onset is 18 in men and 25 in women.
Overview:
- Translate from Greek: split-mind
- A long-term psychosis in which thoughts and emotions are impaired and there is a
loss of contact with reality.
POSITIVE SYMPTOMS: represent an addition (having) or distortion to normal functioning
such as Hallucinations (unreal perceptions of one's environment) or Delusions (beliefs that
seem real but are not). Appear to reflect an excess or distortion of normal functions
including:
Hallucinations: distortions or exaggerations of perception in any of the senses, most notably
auditory hallucinations. Bizarre, unreal perceptions of the environment: auditory, visual,
olfactory or tactile. Many schizophrenics report hearing voice(s) that others cannot hear,
telling them to do something or commenting on their behaviour.
Delusions: bizarre, firmly held erroneous beliefs (that seem real to the schizophrenic) that
are caused by distortions of reasoning for misinterpretations of perceptions and/or
experiences. Sometimes these delusions can be paranoid in nature (involves a person
believing they are being spied on or followed, phone may be tapped or video cameras in
their home). Delusions involve inflated beliefs about a person's power/importance (e.g.
believes they are famous or have special powers or abilities). Delusions of reference = the
belief that events in the environment are directly related to them (e.g. special personal
messages are being communicated through TV or radio.
Disorganised speech: the result of abnormal thought processes , where the person has
problems organising their thoughts which gets projected through their speech. Derailment is
slipping from one topic to another in mid-sentence, and in extreme cases their speech may
be so incoherent that it sounds like gibberish - “word salad”.
1
, NEGATIVE SYMPTOMS: represents a reduction or loss of normal functions such as speech
poverty (Alogia) and lack of interest (Avolition). Appear to reflect a diminution or a loss of
functioning - “deficit functioning” - such as:
Speech poverty: characterised by the lessening of speech fluency and productivity, which
reflects slowing or blocked thoughts. There are a number of characteristics: producing fewer
words in a given time on a task of verbal fluency (tests spontaneity) and less complete
syntax. This type of speech appears to be associated with a long illness and earlier onset of
the illness.
Avolition: a reduction of interests and desires as well as an inability to initiate and persist in
goal-directed behaviour (e.g. sitting in the house doing nothing all day). It is distinct from
poor social function or disinterest. E.g. an individual may have no social contact with family
or friends because they don't communicate or it is difficult. This is not avolition, as it is not
involving activities that are available to the patient.
Diagnosing of Schizophrenia:
Diagnosed with the ‘Diagnostic and Statistical Manual’ (previous DSM-IV; DSM-V has
removed the subtypes of schizophrenia).
There are 3 Criteria:
A: Two or more of the following: Delusions, Hallucinations, Disorganised speech,
Disorganised catatonic behaviour, Negative symptoms (only 1 of these is needed if
delusions are bizarre or hallucinations are a consistent running commentary of the person's
life)
B: Social and occupational dysfunction (e.g. cannot socialise or cope with work)
C: Duration: persist for at least 6 months (unless symptom onset is incredibly severe i.e:
harm to themselves or others)
Reliability Aka: Consistency: the consistency of measurements. We would expect any measurement to
produce the same data if taken on successive occasions.
Inter-rater reliability Tests (that measure behaviour) are scored by two individual observers. The scores are then
correlated and compared to see how consistent they are. If there is a strong correlation
(Kappa score) between the two observers’ scores then we can say the results are reliable.
Validity Aka: legitimacy: refers to whether an observed behaviour is a genuine/legitimate one.
Culture Rules, Customs, Morals and ways of interacting that bind together members of a collection
of people (society)
Gender bias The differential treatment or view of men and women that is based on stereotypes and not
real difference
Symptom overlap Refers to the fact that symptoms of a disorder may not be unique to that disorder but may
also be found in other disorders, making accurate diagnosis difficult
Co-Morbidity Refers to the extent that two (or more) conditions or diseases occur simultaneously in a
patient, for example schizophrenia and depression
“Reliability issues concerning schizophrenia is related to the consistency of its diagnoses”
Knowledge:
2
, - Reliability is…
- Inter-rater is…
- Cultural example…
Inter-rater reliability:
Tests (results of a schizophrenia diagnosis using the DSM) are scored by 2 or more
independent observers (psychiatrists). The scores (of 2 psychiatrists assessing the same
patients) are then correlated and reappeared to see how consistent they are with each other.
If there is a strong correlation (0.7+) between the scores then the results are reliable.
Results show that using the DSM-V the kappa score is 0.46. If there were 2 psychiatrists
looking at someone with schizophrenia then they would get the diagnosis right 46% of the
time. This would indicate that diagnosing schizophrenia is not a reliable process.
The scores are then correlated and given a (Kappa) score from.
Good inter-rater reliability would be 0.7+
Consistency between 2 or more clinicians when diagnosing schizophrenia when presented
with the same patient.
Cultural example:
Main comparison of DSM and ICD
ICD - 10
Has 8 subtypes of schizophrenia. (i.e.: there are different types of schizophrenia that
someone could be diagnosed with – e.g: paranoid schizophrenia)
Mainly used in the UK
DSM - 5
Has no subtypes of schizophrenia and each individual is diagnosed as ‘schizophrenic’ – and
assessed on a more individual level.
Mainly used in the USA.
Reliability Evaluation:
P: A study which highlights reliability and validity issues of the diagnoses of schizophrenia
was conducted by Rosenhan (1973).
E: He got ‘healthy’ individuals to present themselves to psychiatric hospitals by saying that
they could hear voices (‘thud’). They were diagnosed as schizophrenic and were not
discharged until they admitted they were ill and were getting better. It was evident that they
3
Schizophrenia - long-term psychotic illness whereby the individual has issues with their
assessment of reality along with emotional difficulties.
Psychosis - unable to comprehend reality
The Prevalence (commonness) of Schizophrenia in the UK:
● General population: 1%
● Brother or sister has schizophrenia: 8%
● One parent has schizophrenia: 12%
● Fraternal twin has schizophrenia: 14%
● Both parents have schizophrenia: 39%
● Identical twin has schizophrenia: 47%
ONSET OF SCHIZOPHRENIA: The average age of onset is 18 in men and 25 in women.
Overview:
- Translate from Greek: split-mind
- A long-term psychosis in which thoughts and emotions are impaired and there is a
loss of contact with reality.
POSITIVE SYMPTOMS: represent an addition (having) or distortion to normal functioning
such as Hallucinations (unreal perceptions of one's environment) or Delusions (beliefs that
seem real but are not). Appear to reflect an excess or distortion of normal functions
including:
Hallucinations: distortions or exaggerations of perception in any of the senses, most notably
auditory hallucinations. Bizarre, unreal perceptions of the environment: auditory, visual,
olfactory or tactile. Many schizophrenics report hearing voice(s) that others cannot hear,
telling them to do something or commenting on their behaviour.
Delusions: bizarre, firmly held erroneous beliefs (that seem real to the schizophrenic) that
are caused by distortions of reasoning for misinterpretations of perceptions and/or
experiences. Sometimes these delusions can be paranoid in nature (involves a person
believing they are being spied on or followed, phone may be tapped or video cameras in
their home). Delusions involve inflated beliefs about a person's power/importance (e.g.
believes they are famous or have special powers or abilities). Delusions of reference = the
belief that events in the environment are directly related to them (e.g. special personal
messages are being communicated through TV or radio.
Disorganised speech: the result of abnormal thought processes , where the person has
problems organising their thoughts which gets projected through their speech. Derailment is
slipping from one topic to another in mid-sentence, and in extreme cases their speech may
be so incoherent that it sounds like gibberish - “word salad”.
1
, NEGATIVE SYMPTOMS: represents a reduction or loss of normal functions such as speech
poverty (Alogia) and lack of interest (Avolition). Appear to reflect a diminution or a loss of
functioning - “deficit functioning” - such as:
Speech poverty: characterised by the lessening of speech fluency and productivity, which
reflects slowing or blocked thoughts. There are a number of characteristics: producing fewer
words in a given time on a task of verbal fluency (tests spontaneity) and less complete
syntax. This type of speech appears to be associated with a long illness and earlier onset of
the illness.
Avolition: a reduction of interests and desires as well as an inability to initiate and persist in
goal-directed behaviour (e.g. sitting in the house doing nothing all day). It is distinct from
poor social function or disinterest. E.g. an individual may have no social contact with family
or friends because they don't communicate or it is difficult. This is not avolition, as it is not
involving activities that are available to the patient.
Diagnosing of Schizophrenia:
Diagnosed with the ‘Diagnostic and Statistical Manual’ (previous DSM-IV; DSM-V has
removed the subtypes of schizophrenia).
There are 3 Criteria:
A: Two or more of the following: Delusions, Hallucinations, Disorganised speech,
Disorganised catatonic behaviour, Negative symptoms (only 1 of these is needed if
delusions are bizarre or hallucinations are a consistent running commentary of the person's
life)
B: Social and occupational dysfunction (e.g. cannot socialise or cope with work)
C: Duration: persist for at least 6 months (unless symptom onset is incredibly severe i.e:
harm to themselves or others)
Reliability Aka: Consistency: the consistency of measurements. We would expect any measurement to
produce the same data if taken on successive occasions.
Inter-rater reliability Tests (that measure behaviour) are scored by two individual observers. The scores are then
correlated and compared to see how consistent they are. If there is a strong correlation
(Kappa score) between the two observers’ scores then we can say the results are reliable.
Validity Aka: legitimacy: refers to whether an observed behaviour is a genuine/legitimate one.
Culture Rules, Customs, Morals and ways of interacting that bind together members of a collection
of people (society)
Gender bias The differential treatment or view of men and women that is based on stereotypes and not
real difference
Symptom overlap Refers to the fact that symptoms of a disorder may not be unique to that disorder but may
also be found in other disorders, making accurate diagnosis difficult
Co-Morbidity Refers to the extent that two (or more) conditions or diseases occur simultaneously in a
patient, for example schizophrenia and depression
“Reliability issues concerning schizophrenia is related to the consistency of its diagnoses”
Knowledge:
2
, - Reliability is…
- Inter-rater is…
- Cultural example…
Inter-rater reliability:
Tests (results of a schizophrenia diagnosis using the DSM) are scored by 2 or more
independent observers (psychiatrists). The scores (of 2 psychiatrists assessing the same
patients) are then correlated and reappeared to see how consistent they are with each other.
If there is a strong correlation (0.7+) between the scores then the results are reliable.
Results show that using the DSM-V the kappa score is 0.46. If there were 2 psychiatrists
looking at someone with schizophrenia then they would get the diagnosis right 46% of the
time. This would indicate that diagnosing schizophrenia is not a reliable process.
The scores are then correlated and given a (Kappa) score from.
Good inter-rater reliability would be 0.7+
Consistency between 2 or more clinicians when diagnosing schizophrenia when presented
with the same patient.
Cultural example:
Main comparison of DSM and ICD
ICD - 10
Has 8 subtypes of schizophrenia. (i.e.: there are different types of schizophrenia that
someone could be diagnosed with – e.g: paranoid schizophrenia)
Mainly used in the UK
DSM - 5
Has no subtypes of schizophrenia and each individual is diagnosed as ‘schizophrenic’ – and
assessed on a more individual level.
Mainly used in the USA.
Reliability Evaluation:
P: A study which highlights reliability and validity issues of the diagnoses of schizophrenia
was conducted by Rosenhan (1973).
E: He got ‘healthy’ individuals to present themselves to psychiatric hospitals by saying that
they could hear voices (‘thud’). They were diagnosed as schizophrenic and were not
discharged until they admitted they were ill and were getting better. It was evident that they
3
