Schizophrenia
Classification and Diagnoses
Psychosis - a term used to describe a severe mental health problem where
the individual loses contact with reality (unlike neurosis where the
individual is aware that they have problems)
Classification - the process of organising symptoms into
categories
Diagnosis - refers to the assigning of a label of a disorder to a
patient.
There are two main classification systems:
1. ICD-10: two ‘negative symptoms’ are sufficient.
2. DSM-5: one ‘positive symptom’ needs to be present.
Schizophrenia does not have a single defining characteristic. It is a cluster
of symptoms some of which appear to be unrelated. According to ICD 10,
there are five main sub-types of schizophrenia disorder:
1. Disorganised Schizophrenia - The person's behaviour is generally
disorganised and not goal directed. Symptoms include thought
disturbances, lack of expressed emotion, mood swings etc.
2. Catatonic Schizophrenia - This is diagnosed if the patient has severe
motor abnormalities such as unusual gestures or total immobility for
several hours.
3. Paranoid schizophrenia - This type involves delusions of various
kinds. Patient remains emotionally responsive and tend to be
argumentative.
4. Undifferentiated schizophrenia - This is a broad category which
includes patients who do not clearly belong within any other
category.
5. Residual schizophrenia - This type consists of patients who are
experiencing mild symptoms
, Positive Symptoms appear to Negative Symptoms where
reflect an excess or distortion normal functions are limited
of normal function
Hallucinations – unusual sensory Speech Poverty: A reduction in the
experiences e.g, voices in a amount and quality of speech.
person’s head giving instructions
on how to behave. Avolition: severe loss of motivation
to carry out everyday tasks.
Delusions are false beliefs. Usually,
the person has convinced
themselves that they are someone
powerful or important, such as the
president.
A person may also be affected by secondary impairments such as
depression, because of the difficulties of living with the disorder
The illness usually occurs gradually and has 3 phases:
1. The prodromal phase - individual becomes withdrawn and loses
interest in activities
2. The active phase – more obvious symptoms begin occurring
3. The residual phase – obvious symptoms begin to subside e.g., when
treatment is given
Evaluation of classification and diagnoses
Classification systems provide practitioners with a common
language, permitting communication of research ideas and findings,
which may ultimately lead to a better understanding of the disorder
and the development of better treatments. However, it can lead to
overcomplication of some disorders.
Cheneaux et al had two psychiatrists independently diagnose 100
patients using both DSM and ICD criteria. The number of diagnoses
varied significantly showing the diagnoses of schizophrenia has low
inter-rater reliability as it’s not consistent and is either other or
under diagnosed. However diagnostic variations may stem from the
complexity of the disorder rather than shortcomings of classification
systems.
Cultural bias - People of African origin are also more likely to be
diagnosed. Perhaps this is due to the cultural significance of
‘hearing voices’, which may be seen by white Western psychiatrists
as unusual or bizarre
Classification and Diagnoses
Psychosis - a term used to describe a severe mental health problem where
the individual loses contact with reality (unlike neurosis where the
individual is aware that they have problems)
Classification - the process of organising symptoms into
categories
Diagnosis - refers to the assigning of a label of a disorder to a
patient.
There are two main classification systems:
1. ICD-10: two ‘negative symptoms’ are sufficient.
2. DSM-5: one ‘positive symptom’ needs to be present.
Schizophrenia does not have a single defining characteristic. It is a cluster
of symptoms some of which appear to be unrelated. According to ICD 10,
there are five main sub-types of schizophrenia disorder:
1. Disorganised Schizophrenia - The person's behaviour is generally
disorganised and not goal directed. Symptoms include thought
disturbances, lack of expressed emotion, mood swings etc.
2. Catatonic Schizophrenia - This is diagnosed if the patient has severe
motor abnormalities such as unusual gestures or total immobility for
several hours.
3. Paranoid schizophrenia - This type involves delusions of various
kinds. Patient remains emotionally responsive and tend to be
argumentative.
4. Undifferentiated schizophrenia - This is a broad category which
includes patients who do not clearly belong within any other
category.
5. Residual schizophrenia - This type consists of patients who are
experiencing mild symptoms
, Positive Symptoms appear to Negative Symptoms where
reflect an excess or distortion normal functions are limited
of normal function
Hallucinations – unusual sensory Speech Poverty: A reduction in the
experiences e.g, voices in a amount and quality of speech.
person’s head giving instructions
on how to behave. Avolition: severe loss of motivation
to carry out everyday tasks.
Delusions are false beliefs. Usually,
the person has convinced
themselves that they are someone
powerful or important, such as the
president.
A person may also be affected by secondary impairments such as
depression, because of the difficulties of living with the disorder
The illness usually occurs gradually and has 3 phases:
1. The prodromal phase - individual becomes withdrawn and loses
interest in activities
2. The active phase – more obvious symptoms begin occurring
3. The residual phase – obvious symptoms begin to subside e.g., when
treatment is given
Evaluation of classification and diagnoses
Classification systems provide practitioners with a common
language, permitting communication of research ideas and findings,
which may ultimately lead to a better understanding of the disorder
and the development of better treatments. However, it can lead to
overcomplication of some disorders.
Cheneaux et al had two psychiatrists independently diagnose 100
patients using both DSM and ICD criteria. The number of diagnoses
varied significantly showing the diagnoses of schizophrenia has low
inter-rater reliability as it’s not consistent and is either other or
under diagnosed. However diagnostic variations may stem from the
complexity of the disorder rather than shortcomings of classification
systems.
Cultural bias - People of African origin are also more likely to be
diagnosed. Perhaps this is due to the cultural significance of
‘hearing voices’, which may be seen by white Western psychiatrists
as unusual or bizarre
