Schizophrenia revision
Classification of schizophrenia
Schizophrenia is a mental health disorder that affects 1% of the population, onset of the
first symptoms is around 15-45 years. Men are more likely to develop the disorder, with
males also having an earlier onset
The diagnostic and statistical manual (DSM) is most often used for classification. However
the international classification of disease (ICD) can also be used. Two of the following
symptoms need to be present for at least a month, one being positive
Positive symptoms are experiences that are in addition to normal experiences
1. Hallucinations: additional sensory experiences such as seeing distortions in objects
that look like faces, or hearing critical voices
2. Delusions: irrational beliefs about themselves or the world
Negative symptoms are a loss of normal experiences and abilities
1. Avolition: a lack of purposeful, willed behaviour. No energy, sociability affection or
attempt at personal hygiene
2. Speech poverty: brief verbal communication style. Loss of quality and quantity of
verbal responses. Can be classified as a positive symptom is speech is excessively
disorganised, with suffers wondering off point
Inter-rater reliability is the measure of how two observers agree. FOr example two doctors
giving the same diagnosis. Test-retest reliability is the same doctor giving the same
diagnosis over time with the same symptoms
- Beck in a review of 153 patients who had been diagnosed by multiple doctors found
only a 54% concordance rate between the doctors assessments. This suggests that
there is low inter-rater reliability in the diagnosis of schizophrenia. This also
suggests may people have been diagnosed incorrectly, potentially having
inappropriate treatments
The accuracy of the diagnosis of schizophrenia can be questioned in individual cases, and
there is a question as to if schizophrenia is actually a unique syndrome. Meaning it has its
own characteristics symptoms and causes
Comorbidity: schizophrenia is often diagnosed with other disorders. This could be leading
to inaccurate diagnosis of schizophrenia, when it could be a severe case of depression. Or
as these diagnoses often occur together they are perhaps not separate disorders
, - Buckly found the following co morbidity rates with schizophrenia. Depression 50%,
drug abuse 47%, PTSD, 29%. As well as complicating treatment plans, this suggests
that the original diagnosis of schizophrenia may be in error if the disorders share
symptoms
Symptom overlap: bipolar disorder also has hallucinations and delusions as a positive
symptom. If the two disorders are so similar it may be they are not actually distinct and
they should be redefined
Gender:
- Over a lifetime men and women are equally likely to be diagnosed, however men's
average age of diagnosis is 25, 5 years sooner than women
- Men are more likely to have drug abuses as comorbidity, have worse social
functioning and suffer negative symptoms
- Women are more likely to display positive symptoms
Gender bias:
- It's suggested that women's experience of schizophrenia is taken less seriously and
underdiagnosed compared to women. Cotton suggests this is due to women's
better social coping strategies leading to being less likely to seek treatment
Culture:
- People with african-caribbean heritage in the UK and African americans are up to
nine times more likely to be diagnosed with schizophrenia compared to 1% of the
general population
Culture bias:
- As schizophrenia rates are also 1% in countries of origin the rise in diagnosis rates
are likely due to cultural bias, or category failure, western definitions of mental
illness are applied to other cultures. A specific example is how hearing the voices of
angels would be defined as an auditory hallucination in the UK but a religious
experience in the west indies
Loring and Powell sent 290 psychiatrists two identical case studies, the psychiatrists
however the gender and race of the case studies were changed to either a white male, a
black male, a white female or black female, or no gender or race disclosed. The
researchers found overdiagnosis of the black case studies and underdiagnosis of the
female case studies. THe most accurate diagnosis was when the gender and race of the
psychiatrist was not the same as the case study. This suggests the existence of both
gender and culture bias in psychiatrist's diagnosis of schizophrenia
Classification of schizophrenia
Schizophrenia is a mental health disorder that affects 1% of the population, onset of the
first symptoms is around 15-45 years. Men are more likely to develop the disorder, with
males also having an earlier onset
The diagnostic and statistical manual (DSM) is most often used for classification. However
the international classification of disease (ICD) can also be used. Two of the following
symptoms need to be present for at least a month, one being positive
Positive symptoms are experiences that are in addition to normal experiences
1. Hallucinations: additional sensory experiences such as seeing distortions in objects
that look like faces, or hearing critical voices
2. Delusions: irrational beliefs about themselves or the world
Negative symptoms are a loss of normal experiences and abilities
1. Avolition: a lack of purposeful, willed behaviour. No energy, sociability affection or
attempt at personal hygiene
2. Speech poverty: brief verbal communication style. Loss of quality and quantity of
verbal responses. Can be classified as a positive symptom is speech is excessively
disorganised, with suffers wondering off point
Inter-rater reliability is the measure of how two observers agree. FOr example two doctors
giving the same diagnosis. Test-retest reliability is the same doctor giving the same
diagnosis over time with the same symptoms
- Beck in a review of 153 patients who had been diagnosed by multiple doctors found
only a 54% concordance rate between the doctors assessments. This suggests that
there is low inter-rater reliability in the diagnosis of schizophrenia. This also
suggests may people have been diagnosed incorrectly, potentially having
inappropriate treatments
The accuracy of the diagnosis of schizophrenia can be questioned in individual cases, and
there is a question as to if schizophrenia is actually a unique syndrome. Meaning it has its
own characteristics symptoms and causes
Comorbidity: schizophrenia is often diagnosed with other disorders. This could be leading
to inaccurate diagnosis of schizophrenia, when it could be a severe case of depression. Or
as these diagnoses often occur together they are perhaps not separate disorders
, - Buckly found the following co morbidity rates with schizophrenia. Depression 50%,
drug abuse 47%, PTSD, 29%. As well as complicating treatment plans, this suggests
that the original diagnosis of schizophrenia may be in error if the disorders share
symptoms
Symptom overlap: bipolar disorder also has hallucinations and delusions as a positive
symptom. If the two disorders are so similar it may be they are not actually distinct and
they should be redefined
Gender:
- Over a lifetime men and women are equally likely to be diagnosed, however men's
average age of diagnosis is 25, 5 years sooner than women
- Men are more likely to have drug abuses as comorbidity, have worse social
functioning and suffer negative symptoms
- Women are more likely to display positive symptoms
Gender bias:
- It's suggested that women's experience of schizophrenia is taken less seriously and
underdiagnosed compared to women. Cotton suggests this is due to women's
better social coping strategies leading to being less likely to seek treatment
Culture:
- People with african-caribbean heritage in the UK and African americans are up to
nine times more likely to be diagnosed with schizophrenia compared to 1% of the
general population
Culture bias:
- As schizophrenia rates are also 1% in countries of origin the rise in diagnosis rates
are likely due to cultural bias, or category failure, western definitions of mental
illness are applied to other cultures. A specific example is how hearing the voices of
angels would be defined as an auditory hallucination in the UK but a religious
experience in the west indies
Loring and Powell sent 290 psychiatrists two identical case studies, the psychiatrists
however the gender and race of the case studies were changed to either a white male, a
black male, a white female or black female, or no gender or race disclosed. The
researchers found overdiagnosis of the black case studies and underdiagnosis of the
female case studies. THe most accurate diagnosis was when the gender and race of the
psychiatrist was not the same as the case study. This suggests the existence of both
gender and culture bias in psychiatrist's diagnosis of schizophrenia
