Schizophrenia
• Classification of schizophrenia. Positive symptoms of schizophrenia, including hallucinations and
delusions. Negative symptoms of schizophrenia, including speech poverty and avolition.
• Reliability and validity in diagnosis and classification of schizophrenia, including reference to co-
morbidity, culture and gender bias and symptom overlap.
• Biological explanations for schizophrenia: genetics and neural correlates, including the dopamine
hypothesis.
• Psychological explanations for schizophrenia: family dysfunction and cognitive explanations,
including dysfunctional thought processing.
• Drug therapy: typical and atypical antipsychotics.
• Cognitive behaviour therapy and family therapy as used in the treatment of schizophrenia. Token
economies as used in the management of schizophrenia.
• The importance of an interactionist approach in explaining and treating schizophrenia; the diathesis-
stress model.
Classification of Schizophrenia; clinical characteristics
Schizophrenia is a type of psychosis where a patient suffers from a distorted realty. SZ affects approx. 1%
of the population and affects men and women equally. (精神分裂症)
Positive symptoms These are excess / distortion of normal functioning, symptoms that are not usually
present in a normal person. This includes delusions and hallucinations.
Delusion - a firmly held but false belief, including:
Delusions of persecution; believing that others want to harm, threaten or
manipulate you, e.g. FBI stalking them
Delusions of control; belief that they are under the control of an alien force, others
can control their thoughts which are being broadcast
Delusions of grandeur; a belief that they are God-like, e.g. believe they’re Jesus
Hallucinations – distortion of perception, experiences which are not real and
includes all senses. Auditory (hear voices), tactile (feeling animals crawling on
them), taste (tasting blood), visual (seeing people) or smells (smelling food) which
are not here.
Negative These are deficits, a lack of normal functioning, things present in the healthy
symptoms population but not in SZ patients.
Avolition - a lack of willed purposeful behaviour, difficulty in performing goal-
oriented behaviour e.g. cooking, cleaning, socialising.
Speech poverty – the inability to produce fluent language such as producing
sentences. E.g. short and empty replies to questions
,Reliability and validity in diagnosis and classification of schizophrenia
Define reliability in diagnosis and classification of schizophrenia
Diagnosis (診斷) refers to identifying the illness a person may have.
Reliability of diagnosis refers to the level of agreement by different psychiatrists across time and between
cultures. If there is a reliable diagnosis, then practitioners would be in agreement over who has
Schizophrenia. (If a patient was seen by two doctors, they should both diagnose Schizophrenia if the
diagnostic tool is reliable). Furthermore, the stability of diagnosis over time given no change in
symptoms, would indicate a reliable diagnosis.
If the diagnosis is valid, this refers to whether the measure used, in the UK the DSM5, is actually
measuring Schizophrenia.
Classification (分類) refers to the disorder itself, defining what it is.
Reliability in the classification refers to whether Schizophrenia itself is a consistent disorder or whether it
in fact changes over time.
Whereas the validity of the classification considers whether Schizophrenia is a disorder in itself, or
whether it is for example a type of depression.
AO3 – Rosenhan
This research calls into question the ability of medical staff to differentiate between those who are
healthy and those who have SZ. Suggesting the diagnostic tool is not valid but is reliable, as all patients
were diagnosed.
Medical staff could not differentiate between people who had Schizophrenia and those who were
healthy. 11 pseudo patients were admitted to hospital after claiming to hallucinate the words: hollow,
thud, empty. None of the staff in 12 different hospitals were able to spot the healthy people.
Evidence for reliable diagnosis as all patients got a similar diagnosis with SZ and all were admitted to
hospital.
Evidence for issues with validity as they did not have a mental health issue.
However – they did claim to be hallucinating which is a symptom of SZ. It could be argued that it is
beneficial to be cautious when diagnosing as it keeps sick people safe. It would be irresponsible to release
people from hospital quickly as their symptoms may just return.
AO3 – Co-morbidity – include research, WHY they AO3 – Culture bias – also discuss the implications
might be comorbid
Include both the culture of the practitioner and the
Comorbidity – more than one disorder that exist culture of the patient
alongside a primary diagnosis
Copeland et al. (1971) gave a description of a
Buckley reported - 50% of patients with SZ also patient to 134 US and 194 British psychiatrists. 69%
diagnosed with depression. of the US psychiatrists diagnosed schizophrenia but
They are unlikely to be maintaining friendships, only 2% of the British gave the diagnosis of
keeping up with family or attending work so are schizophrenia. SO WHAT? Issues with over
therefore vulnerable to getting depression as well. diagnosis – worsening of mental wellbeing/health
, WHY IS THAT IMPORTANT – treatment? Anti- e.g. deluded. Drugs that to not need – serious side
depressants CBT. Quality of life improves a lot when effects. Underdiagnose – miss illness – vulnerable
people recover from depression. hard to live with hallucinations/delusions. Not
supporting people that need help!
Substance abuse 47% – self medicating, a way of
dealing with how uncomfortable SZ is to live with. Escobar - Over-interpret symptoms of Black people
Drinking alcohol to cope with the shame around during diagnosis. Cultural differences in language
hallucinations and panicking or take stimulants to and mannerisms, difficulties in relating between
help with avolition. SO WHAT?! black patients and white therapists, and the myth
that black people rarely suffer from affective
OCD 23% -- a person may develop SZ from what disorders may be causing this problem.
starts as OCD. Their obsession begin grounding in
reality but fall into psychosis such as believing the Harrison et al – those of West Indian origin over-
number 3 is lucky and if things are not done in diagnosed with SZ by white doctors in Bristol
threes there will be very direr consequence. SO
WHAT?! When using trends medical stereotypes are
perpetuated which may lead to an overdiagnosis of
PTSD 29% – hallucinating may be so traumatic and SZ in black men. Whereas in white men an outburst
frightening for the patient that they develop PTSD would be down to stress, in his black counterparts
from this. For example, seeing people that are not this would be deemed as psychosis. The knowledge
there would be terrifying, people then may develop that this occurs is very useful as just education
flash backs of this event. SO WHAT?! alone can prevent this from happening.
AO3 – Gender bias – training for staff? AO3 – Symptom overlap – Why is this an issue?
Loring and Powell – 290 male & female Ellason & Ross – people with DID have more SZ
psychiatrists to read about patient’s behaviour and symptoms than people diagnosed as a
offer their judgement. Schizophrenic
Patient described as male/no reference à 56%.
women – 20%. SZ and bipolar disorder share positive symptoms
à Diagnosis is also influenced by the gender of the e.g. delusions & negative symptoms e.g. avolition.
clinician Using the International Classification for Disease
(ICD) a patient might be diagnosed with SZ but
Broverman et al – clinicians in the US equated might be diagnosed as bipolar when using DSM.
mentally healthy ‘adult’ behaviour with mentally
healthy ‘male’ behaviour à androcentrism Serper et al – Despite symptoms overlap in patients
with SZ and cocaine abuse, possible to make
RWA – training. Simply being made aware of this accurate diagnosis. Shows that symptom overlap
trend and the harm it might cause can prevent this doesn’t affect validity of diagnosis
occurring. This benefits female patients as they are
more likely to be given the care they need.
AO3 – implications for treatment AO3 – labelling
• Classification of schizophrenia. Positive symptoms of schizophrenia, including hallucinations and
delusions. Negative symptoms of schizophrenia, including speech poverty and avolition.
• Reliability and validity in diagnosis and classification of schizophrenia, including reference to co-
morbidity, culture and gender bias and symptom overlap.
• Biological explanations for schizophrenia: genetics and neural correlates, including the dopamine
hypothesis.
• Psychological explanations for schizophrenia: family dysfunction and cognitive explanations,
including dysfunctional thought processing.
• Drug therapy: typical and atypical antipsychotics.
• Cognitive behaviour therapy and family therapy as used in the treatment of schizophrenia. Token
economies as used in the management of schizophrenia.
• The importance of an interactionist approach in explaining and treating schizophrenia; the diathesis-
stress model.
Classification of Schizophrenia; clinical characteristics
Schizophrenia is a type of psychosis where a patient suffers from a distorted realty. SZ affects approx. 1%
of the population and affects men and women equally. (精神分裂症)
Positive symptoms These are excess / distortion of normal functioning, symptoms that are not usually
present in a normal person. This includes delusions and hallucinations.
Delusion - a firmly held but false belief, including:
Delusions of persecution; believing that others want to harm, threaten or
manipulate you, e.g. FBI stalking them
Delusions of control; belief that they are under the control of an alien force, others
can control their thoughts which are being broadcast
Delusions of grandeur; a belief that they are God-like, e.g. believe they’re Jesus
Hallucinations – distortion of perception, experiences which are not real and
includes all senses. Auditory (hear voices), tactile (feeling animals crawling on
them), taste (tasting blood), visual (seeing people) or smells (smelling food) which
are not here.
Negative These are deficits, a lack of normal functioning, things present in the healthy
symptoms population but not in SZ patients.
Avolition - a lack of willed purposeful behaviour, difficulty in performing goal-
oriented behaviour e.g. cooking, cleaning, socialising.
Speech poverty – the inability to produce fluent language such as producing
sentences. E.g. short and empty replies to questions
,Reliability and validity in diagnosis and classification of schizophrenia
Define reliability in diagnosis and classification of schizophrenia
Diagnosis (診斷) refers to identifying the illness a person may have.
Reliability of diagnosis refers to the level of agreement by different psychiatrists across time and between
cultures. If there is a reliable diagnosis, then practitioners would be in agreement over who has
Schizophrenia. (If a patient was seen by two doctors, they should both diagnose Schizophrenia if the
diagnostic tool is reliable). Furthermore, the stability of diagnosis over time given no change in
symptoms, would indicate a reliable diagnosis.
If the diagnosis is valid, this refers to whether the measure used, in the UK the DSM5, is actually
measuring Schizophrenia.
Classification (分類) refers to the disorder itself, defining what it is.
Reliability in the classification refers to whether Schizophrenia itself is a consistent disorder or whether it
in fact changes over time.
Whereas the validity of the classification considers whether Schizophrenia is a disorder in itself, or
whether it is for example a type of depression.
AO3 – Rosenhan
This research calls into question the ability of medical staff to differentiate between those who are
healthy and those who have SZ. Suggesting the diagnostic tool is not valid but is reliable, as all patients
were diagnosed.
Medical staff could not differentiate between people who had Schizophrenia and those who were
healthy. 11 pseudo patients were admitted to hospital after claiming to hallucinate the words: hollow,
thud, empty. None of the staff in 12 different hospitals were able to spot the healthy people.
Evidence for reliable diagnosis as all patients got a similar diagnosis with SZ and all were admitted to
hospital.
Evidence for issues with validity as they did not have a mental health issue.
However – they did claim to be hallucinating which is a symptom of SZ. It could be argued that it is
beneficial to be cautious when diagnosing as it keeps sick people safe. It would be irresponsible to release
people from hospital quickly as their symptoms may just return.
AO3 – Co-morbidity – include research, WHY they AO3 – Culture bias – also discuss the implications
might be comorbid
Include both the culture of the practitioner and the
Comorbidity – more than one disorder that exist culture of the patient
alongside a primary diagnosis
Copeland et al. (1971) gave a description of a
Buckley reported - 50% of patients with SZ also patient to 134 US and 194 British psychiatrists. 69%
diagnosed with depression. of the US psychiatrists diagnosed schizophrenia but
They are unlikely to be maintaining friendships, only 2% of the British gave the diagnosis of
keeping up with family or attending work so are schizophrenia. SO WHAT? Issues with over
therefore vulnerable to getting depression as well. diagnosis – worsening of mental wellbeing/health
, WHY IS THAT IMPORTANT – treatment? Anti- e.g. deluded. Drugs that to not need – serious side
depressants CBT. Quality of life improves a lot when effects. Underdiagnose – miss illness – vulnerable
people recover from depression. hard to live with hallucinations/delusions. Not
supporting people that need help!
Substance abuse 47% – self medicating, a way of
dealing with how uncomfortable SZ is to live with. Escobar - Over-interpret symptoms of Black people
Drinking alcohol to cope with the shame around during diagnosis. Cultural differences in language
hallucinations and panicking or take stimulants to and mannerisms, difficulties in relating between
help with avolition. SO WHAT?! black patients and white therapists, and the myth
that black people rarely suffer from affective
OCD 23% -- a person may develop SZ from what disorders may be causing this problem.
starts as OCD. Their obsession begin grounding in
reality but fall into psychosis such as believing the Harrison et al – those of West Indian origin over-
number 3 is lucky and if things are not done in diagnosed with SZ by white doctors in Bristol
threes there will be very direr consequence. SO
WHAT?! When using trends medical stereotypes are
perpetuated which may lead to an overdiagnosis of
PTSD 29% – hallucinating may be so traumatic and SZ in black men. Whereas in white men an outburst
frightening for the patient that they develop PTSD would be down to stress, in his black counterparts
from this. For example, seeing people that are not this would be deemed as psychosis. The knowledge
there would be terrifying, people then may develop that this occurs is very useful as just education
flash backs of this event. SO WHAT?! alone can prevent this from happening.
AO3 – Gender bias – training for staff? AO3 – Symptom overlap – Why is this an issue?
Loring and Powell – 290 male & female Ellason & Ross – people with DID have more SZ
psychiatrists to read about patient’s behaviour and symptoms than people diagnosed as a
offer their judgement. Schizophrenic
Patient described as male/no reference à 56%.
women – 20%. SZ and bipolar disorder share positive symptoms
à Diagnosis is also influenced by the gender of the e.g. delusions & negative symptoms e.g. avolition.
clinician Using the International Classification for Disease
(ICD) a patient might be diagnosed with SZ but
Broverman et al – clinicians in the US equated might be diagnosed as bipolar when using DSM.
mentally healthy ‘adult’ behaviour with mentally
healthy ‘male’ behaviour à androcentrism Serper et al – Despite symptoms overlap in patients
with SZ and cocaine abuse, possible to make
RWA – training. Simply being made aware of this accurate diagnosis. Shows that symptom overlap
trend and the harm it might cause can prevent this doesn’t affect validity of diagnosis
occurring. This benefits female patients as they are
more likely to be given the care they need.
AO3 – implications for treatment AO3 – labelling
