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CLINICAL CHARACTERISTICS OF SCHIZOPHRENIA
Schneider's First Rank Symptoms
· Passivity experiences and Thought Disturbances
- Thought insertion (from external influences)
- Thought withdrawal (removed/externally controlled thoughts)
- Thought broadcasting (thoughts made known to others)
· Auditory Hallucinations
- Hallucinatory voices heard discussing one's thoughts/behaviour
(acting as running commentary/arguing about oneself)
- Often accusatory/obscene/derogatory and may order patient to
commit acts of violence
· Primary Delusions
- False beliefs (incompatible with reality) held with extraordinary
conviction regardless of contradictory evidence
- Patient may be so convinced of their truth, act on strength of belief
(maybe murder/rape)
These are subjective experiences only
inferred on basis of patient's verbal report…read more

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Slater and Roth
· Thought Process Disorder
- Inability to keep to point, easily distracted/side tracked
- Words thrown together based on sounds rather than meaning,
incoherent jumble of words (word salad)
- Inability to finish a sentence, sometimes stopping during a word,
inventing new words (neologisms) and interpreting language literally
· Disturbance of Affect
- Events/situations don't elicit usual emotional response
- Absence of emotional expression (flattening affect)
- Loss of appropriate emotional responses (laughing/getting angry for no
reason/giggling at bad news etc) ­ Incongruity affect
· Psychomotor Disorders
- Muscles become rigid (catalepsy)
- Grimacing of facial muscles, limb twitching, stereotyped behaviours
(constant pacing)
· Lack of Violation
- Avolition; lack of energy, lack of interest, inability to carry out routine tasks
eg. Hygiene/grooming
- Anhedonia; lack of interest in recreational activities, lack of interest in sex
- Asociality; few friends, poor social skills, little interest in others…read more

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POSITIVE SYMPTOMS
Shown by Schneider's First Rank symptoms
They are excesses or distortions of reality
For the most part are acute episodes and
are less severe
NEGATIVE SYMPTOMS
Shown by Slater and Roth
Symptoms tend to endure beyond the acute
episodes and have a profound effect on
patient's life…read more

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Issues surrounding classification and diagnosis of
schizophrenia, including reliability and validity
Reliability
Is the extent to which psychiatrists can agree on the same diagnosis
when independently assessing patients
ROSENHAN
`Normal' people presented selves in psychiatric hospitals claiming
heard unfamiliar voices saying `empty' `hollow' `thud'
All diagnosed as having schizophrenia
Follow up study: - Hospitals warned of intention to send out
pseudopatients
- 21% detection rate by hospitals although none
were actually sent out so it wasn't them being
detected…read more

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If study were to be carried out today, pseudopatients would not gain
admission to hospitals as DSM-IV would not now diagnose them as
schizophrenic
-Diagnostic criteria is now much more detailed and precise
WING ET AL
- With DSM-IV the reliability of classification is improved with use of
structured interview containing standardised diagnostic procedure with
specific criteria an a computerised scoring program
MILLER ET AL
- Reported inter-rater reliability of 93%
- However study was small and only involved 18ps
Study may bring about ethical issues as 21% of people identified as
pseuudopatients when in fact they weren't. Does this mean actual
schizophrenics were then denied treatment?
Perhaps study shows that psychiatrists cannot tell difference between
someone with a mental disorder and someone pretending to have a mental
disorder rather than inability to distinguish between someone with
schizophrenia and someone not with schizophrenia…read more

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