Schizophrenia Revision Notes
Clinical Characteristics of Schizophrenia:
Schizophrenia is characterised by a profound disruption of cognition and emotion, which
affects a person’s language, thought, perception and sense of self.
Schneider (1959) identified the first rank symptoms of Schizophrenia. These are now called Type 1 symptoms
and are positive symptoms. This means that they add to a person’s behaviour. These symptoms are not
observable and rely on a patient’s report of them to be identified.
1. Thought disturbances – Thought withdrawal, thought insertion and thought broadcasting by an
external force.
2. Hallucinations – Auditory hallucinations and command hallucinations, visual hallucinations,
tactile/somatosensory hallucinations.
3. Delusions – Grandeur and paranoia.
Slater and Roth identified Type 2 symptoms of schizophrenia. These are negative symptoms which means that
they take something away from a person’s behaviour. These symptoms are directly observable and so do not
rely on a subjective report from the patient to be identified. Instead, they rely on the objective interpretation
of the doctor.
1. Thought process disorder – Cognitive deficits/dysfunction.
E.g. Selective attention.
Sensory overload.
Attention deficit.
Loose association of thoughts.
Speech Impoverishment “word salad”.
Clang associations.
Neologisms.
2. Disturbances of affect. (Emotions and Feelings)
Blunted affect – emotional insensitivity.
Inappropriate affect – undesirable reactions.
3. Psychomotor disturbances – catatonic behaviour and agitated catatonia.
4. Lack of Volition – avolition.
Aimless/purposeless behaviour.
Lack of interest and fun/pleasure. – This can lead to social disengagement causing the person to
become unsociable.
, Issues Surrounding the Classification and Diagnosis of Schizophrenia:
When diagnosing a mental disorder, there is no objective laboratory test. It is subjective
interpretation by the psychiatrist. The classifications system used by the psychiatrists is only
useful if they agree consistently about a particular diagnosis. An ideal classification system
would be both reliable and valid. The key issues are reliability and validity.
The two most widely used classifications systems for diagnosis of schizophrenia are:
o DSM-IV – Published in 1994 by the American Psychiatric Association.
o ICD-10 – Published in 1994 by the World Health Organisation (WHO).
Benefits and Limitations of the classification system:
+ Many users of the DSM find these diagnostic criteria particularly useful, they provide a
compact discrete description of each disorder.
+ The use of diagnostic criteria had been shown to increase diagnostic reliability (i.e. likelihood
that different clinicians will assign the same diagnosis to the same disorder.)
+ It improves the chances of the patient receiving the most appropriate treatment.
- Some clinicians are concerned that the use of diagnostic labels can lead to a negative self-
fulfilling prophecy.
- The DSM has been criticised for being culturally biased. Some critics argue that it does not
consider CBS (culture-bound syndrome.).
- Standardised clinical interviews only assess the present state of the patient. If a person is at
a stage of schizophrenia where they do not currently exhibit any observable symptoms they
may not be diagnosed with the disorder. They will not receive the most suitable treatment
and this could have a negative impact on their social development.
Reliability:
Beck et al (1961) looked at the inter-rater reliability between 2 psychiatrists when considering the
cases of 154 patients. The psychiatrists only agreed on a diagnosis of 54% of the patients. Inter-rater
reliability = 54%. However, diagnostic material has been revised and “tightened up” since the study
was conducted.
Validity:
Rosenhan (1973) aimed to test the hypothesis that psychiatrists cannot reliably tell the difference
between people who are sane and those who are insane. 8 sane people attempted to gain admission
to 12 different hospitals in 5 different US states by claiming that they were hearing voices. 7 of the
participants were admitted with a diagnosis of schizophrenia and were kept in hospital for a range of
7 to 52 days (average of 19 days). Discharged with a diagnosis of “schizophrenia in remission”.
Clinical Characteristics of Schizophrenia:
Schizophrenia is characterised by a profound disruption of cognition and emotion, which
affects a person’s language, thought, perception and sense of self.
Schneider (1959) identified the first rank symptoms of Schizophrenia. These are now called Type 1 symptoms
and are positive symptoms. This means that they add to a person’s behaviour. These symptoms are not
observable and rely on a patient’s report of them to be identified.
1. Thought disturbances – Thought withdrawal, thought insertion and thought broadcasting by an
external force.
2. Hallucinations – Auditory hallucinations and command hallucinations, visual hallucinations,
tactile/somatosensory hallucinations.
3. Delusions – Grandeur and paranoia.
Slater and Roth identified Type 2 symptoms of schizophrenia. These are negative symptoms which means that
they take something away from a person’s behaviour. These symptoms are directly observable and so do not
rely on a subjective report from the patient to be identified. Instead, they rely on the objective interpretation
of the doctor.
1. Thought process disorder – Cognitive deficits/dysfunction.
E.g. Selective attention.
Sensory overload.
Attention deficit.
Loose association of thoughts.
Speech Impoverishment “word salad”.
Clang associations.
Neologisms.
2. Disturbances of affect. (Emotions and Feelings)
Blunted affect – emotional insensitivity.
Inappropriate affect – undesirable reactions.
3. Psychomotor disturbances – catatonic behaviour and agitated catatonia.
4. Lack of Volition – avolition.
Aimless/purposeless behaviour.
Lack of interest and fun/pleasure. – This can lead to social disengagement causing the person to
become unsociable.
, Issues Surrounding the Classification and Diagnosis of Schizophrenia:
When diagnosing a mental disorder, there is no objective laboratory test. It is subjective
interpretation by the psychiatrist. The classifications system used by the psychiatrists is only
useful if they agree consistently about a particular diagnosis. An ideal classification system
would be both reliable and valid. The key issues are reliability and validity.
The two most widely used classifications systems for diagnosis of schizophrenia are:
o DSM-IV – Published in 1994 by the American Psychiatric Association.
o ICD-10 – Published in 1994 by the World Health Organisation (WHO).
Benefits and Limitations of the classification system:
+ Many users of the DSM find these diagnostic criteria particularly useful, they provide a
compact discrete description of each disorder.
+ The use of diagnostic criteria had been shown to increase diagnostic reliability (i.e. likelihood
that different clinicians will assign the same diagnosis to the same disorder.)
+ It improves the chances of the patient receiving the most appropriate treatment.
- Some clinicians are concerned that the use of diagnostic labels can lead to a negative self-
fulfilling prophecy.
- The DSM has been criticised for being culturally biased. Some critics argue that it does not
consider CBS (culture-bound syndrome.).
- Standardised clinical interviews only assess the present state of the patient. If a person is at
a stage of schizophrenia where they do not currently exhibit any observable symptoms they
may not be diagnosed with the disorder. They will not receive the most suitable treatment
and this could have a negative impact on their social development.
Reliability:
Beck et al (1961) looked at the inter-rater reliability between 2 psychiatrists when considering the
cases of 154 patients. The psychiatrists only agreed on a diagnosis of 54% of the patients. Inter-rater
reliability = 54%. However, diagnostic material has been revised and “tightened up” since the study
was conducted.
Validity:
Rosenhan (1973) aimed to test the hypothesis that psychiatrists cannot reliably tell the difference
between people who are sane and those who are insane. 8 sane people attempted to gain admission
to 12 different hospitals in 5 different US states by claiming that they were hearing voices. 7 of the
participants were admitted with a diagnosis of schizophrenia and were kept in hospital for a range of
7 to 52 days (average of 19 days). Discharged with a diagnosis of “schizophrenia in remission”.
