Schizophrenia
Schizophrenia A psychosis characterised by a profound disruption of cognitive and emotion
- Affects 1% of the world’s population
- Those with the illness believe what they see is normal
- More commonly diagnosed in: males than females; cities than countryside, working class than middle class
- Can severely impact someone's ability to function and can lead to hospitalisations and homelessness
- Diagnosing schizophrenia: using DSM (US) and ICD (European)
Classification:
Negative symptoms – a loss of normal functioning, it is also sometimes be referred to as the ‘deficit syndrome’.
1. Speech poverty: the lessening of speech fluency and productivity (slowing or blocked thoughts). They may produce
fewer words due to the spontaneous need to produce them.
2. Avolition: Apathy – the difficulty/inability to initiate and persist in goal-directed behaviour, often mistaken for
apparent disinterest. Ex. sitting at home all day and doing nothing.
3. Affective flattening: a reduction in the range and intensity of emotional expression (facial expression, voice tone,
eye contact, body contact).
4. Anhedonia: a loss of interest or pleasant in all or almost all activities, or a lack of reactivity to normally pleasurable
stimuli. Physical anhedonia is restricted movement. Social anhedonia is the disinterest in social contact
Positive symptoms – an excess/distortion of normal functioning
1. Hallucinations: Distortions/exaggerations of perception in any of the senses, mostly auditory hallucinations
o auditory (hearing imaginary voices)
o visual (seeing non-existent lights, objects or faces)
o olfactory (smelling imaginary things)
o tactile (feeling something that isn’t actually there)
2. Delusions: Irrational beliefs caused by distortions of reasoning or misinterpretations of perceptions
o paranoia (ex. feeling like the government is watching)
o delusions of grandeur (inflated beliefs about the person’s power/importance)
o delusions of reference (when events in the environment appear to be directly related to them)
3. Disorganized speech is the result of abnormal thought process, slipping from one topic to the next mid-sentence or
speaking in gibberish (word salad)
4. Very disorganized/catatonic behaviour such as motor rigidness, purposeless excitement etc., including the inability
to initiate a task or complete it once started (can lead to bad personal hygiene).
Diagnosis:
1. Reliability – refers to the consistency of a classification system (DSM) or a measuring instrument.
- Inter-rater reliability is measured by a statistic called a kappa score. 1 = perfect inter-rater agreement, 0 = no
agreement. A score of around 0.7 is considered good. In the DSM (Regier et al. 2013) found that the diagnosis of
schizophrenia had a kappa score of 0.46
Culture The rules, morals, childrearing practices that bind a group of people together and predict their behaviour.
- Copeland 1971 gave 134 US and 194 British psychiatrists a description of a patient. 69% of the US doctors diagnosed
the patient with schizophrenia, whereas only 2% of the British said the same.
- Luharmann et al. 2015 interviewed 60 schizophrenics (20 each in Ghana, India and US). Each was asked about the
voices they heard. The Africans and Indians reported positive experiences while, while the Americans reported to
have negative experiences. This suggests that hearing voices isn’t a certain symptoms of diagnosis for schizophrenia.
Evaluation:
- There’s little evidence that DSM is used with high reliability.
o Ex. Whaley 2001 found inter-rater reliability correlations in diagnosis of schizophrenia as low as 0.11. The
psychiatric diagnosis lacks objective measures, therefore inter-rater reliability is challenged.
o Rosenhan 1973 study: ‘normal’ people presented themselves to psychiatric hospitals in the US claiming they
heard an unfamiliar voice in their head. They were all diagnosed with schizophrenia and admitted to the
hospital. Throughout their stay, none of the staff recognized that they weren’t actually displaying symptoms of
schizophrenia. In a follow-up study, Rosenhan warned hospitals of his intention to send out more ‘pseudo
patients’, but he didn’t. This resulted in a 21% detected rate.
Schizophrenia A psychosis characterised by a profound disruption of cognitive and emotion
- Affects 1% of the world’s population
- Those with the illness believe what they see is normal
- More commonly diagnosed in: males than females; cities than countryside, working class than middle class
- Can severely impact someone's ability to function and can lead to hospitalisations and homelessness
- Diagnosing schizophrenia: using DSM (US) and ICD (European)
Classification:
Negative symptoms – a loss of normal functioning, it is also sometimes be referred to as the ‘deficit syndrome’.
1. Speech poverty: the lessening of speech fluency and productivity (slowing or blocked thoughts). They may produce
fewer words due to the spontaneous need to produce them.
2. Avolition: Apathy – the difficulty/inability to initiate and persist in goal-directed behaviour, often mistaken for
apparent disinterest. Ex. sitting at home all day and doing nothing.
3. Affective flattening: a reduction in the range and intensity of emotional expression (facial expression, voice tone,
eye contact, body contact).
4. Anhedonia: a loss of interest or pleasant in all or almost all activities, or a lack of reactivity to normally pleasurable
stimuli. Physical anhedonia is restricted movement. Social anhedonia is the disinterest in social contact
Positive symptoms – an excess/distortion of normal functioning
1. Hallucinations: Distortions/exaggerations of perception in any of the senses, mostly auditory hallucinations
o auditory (hearing imaginary voices)
o visual (seeing non-existent lights, objects or faces)
o olfactory (smelling imaginary things)
o tactile (feeling something that isn’t actually there)
2. Delusions: Irrational beliefs caused by distortions of reasoning or misinterpretations of perceptions
o paranoia (ex. feeling like the government is watching)
o delusions of grandeur (inflated beliefs about the person’s power/importance)
o delusions of reference (when events in the environment appear to be directly related to them)
3. Disorganized speech is the result of abnormal thought process, slipping from one topic to the next mid-sentence or
speaking in gibberish (word salad)
4. Very disorganized/catatonic behaviour such as motor rigidness, purposeless excitement etc., including the inability
to initiate a task or complete it once started (can lead to bad personal hygiene).
Diagnosis:
1. Reliability – refers to the consistency of a classification system (DSM) or a measuring instrument.
- Inter-rater reliability is measured by a statistic called a kappa score. 1 = perfect inter-rater agreement, 0 = no
agreement. A score of around 0.7 is considered good. In the DSM (Regier et al. 2013) found that the diagnosis of
schizophrenia had a kappa score of 0.46
Culture The rules, morals, childrearing practices that bind a group of people together and predict their behaviour.
- Copeland 1971 gave 134 US and 194 British psychiatrists a description of a patient. 69% of the US doctors diagnosed
the patient with schizophrenia, whereas only 2% of the British said the same.
- Luharmann et al. 2015 interviewed 60 schizophrenics (20 each in Ghana, India and US). Each was asked about the
voices they heard. The Africans and Indians reported positive experiences while, while the Americans reported to
have negative experiences. This suggests that hearing voices isn’t a certain symptoms of diagnosis for schizophrenia.
Evaluation:
- There’s little evidence that DSM is used with high reliability.
o Ex. Whaley 2001 found inter-rater reliability correlations in diagnosis of schizophrenia as low as 0.11. The
psychiatric diagnosis lacks objective measures, therefore inter-rater reliability is challenged.
o Rosenhan 1973 study: ‘normal’ people presented themselves to psychiatric hospitals in the US claiming they
heard an unfamiliar voice in their head. They were all diagnosed with schizophrenia and admitted to the
hospital. Throughout their stay, none of the staff recognized that they weren’t actually displaying symptoms of
schizophrenia. In a follow-up study, Rosenhan warned hospitals of his intention to send out more ‘pseudo
patients’, but he didn’t. This resulted in a 21% detected rate.
