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Classification and Diagnosis
Classification ­ Emil Kraepelin
1. Dementia praecox (his term for what we now call schizophrenia), caused by a chemical imbalance
2. Manic-depressive psychosis (now known as bipolar disorder), caused by a faulty metabolism

Kraepelin's classification helped to establish the organic or somatic (bodily) nature of mental…

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Predictive validity
The primary purpose of making a diagnosis is to enable a suitable treatment programme to be selected.
Treatment cannot be chosen randomly, but is aimed at eliminating the underlying cause of the disorder (where
it's known). But in psychiatry there's only a 50% chance of predicting correctly what…

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Crow has found it useful to distinguish between so-called positive and negative symptoms.

Positive symptoms
These are symptoms added on to the individual's personality ­ hallucinations, delusions, disorganised speech.

Delusions: bizarre beliefs that seem real. They are sometimes paranoid in nature and may also involve beliefs
relating to grandiosity. Belief…

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Are they `types' or states? Subjective accounts of psychotic experience suggest that it's doubtful whether
negative symptoms define a type of schizophrenia. It's more likely that positive and negative symptoms
represent alternating states occurring at different times within the same individual.
Are negative symptoms unique to schizophrenia? If a diagnosis…

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Describe symptoms included in the ICD or DSM manuals eg: thought control, delusions, hallucinatory voices, other persistent hallucinations, incoherent/irrelevant
speech, catatonic behaviour, and negative symptoms (such as lack of drive/motivation, flat affect, inappropriate emotional response and sudden mood swings).
Clinical characteristics of schizophrenia could also legitimately include factors such as…

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Pilgrim argues that calling madness `schizophrenia' or misery `depression' merely technicalises ordinary
judgements - What do we add by calling someone who communicates unintelligibly `schizophrenic'?
Winter also argues that `diagnostic systems are only aids to understanding, not necessarily descriptions of
real disease entities'.

Culture and gender bias in assessment and…

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Biological Explanations
Genetic explanation:
There is some evidence that schizophrenia runs in families. This may be because they share the same
disadvantaged environments. However evidence from family, twin and adoption studies does provide some
genetic link:

Family studies:
1st degree relatives (parents, siblings) share 50% of their genes 2nd degree…

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been separated from their mother before the age of 4. The study reported that 7% of the index adoptees
developed schizophrenia, compared to 1.5% of the controls.

Kety et al - `The Danish Adoption Study'
Taking a national sample from across Denmark, Kety et al found high rates of diagnosis…

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Biochemical explanations

There may be structural or biochemical abnormalities in schizophrenics' brains. Research has focused on the
action of certain neurotransmitters or chemical messengers.

The Dopamine Hypothesis:
Interest in the neurotransmitter dopamine arose when it was found that phenothiazine's (neuroleptic,
anti-psychotic drugs which reduce the symptoms of schizophrenia) work by…

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Neuroanatomical explanations:
Technological advances have enabled the medical profession to examine the live brains of people with
schizophrenia. MRI studies have shown definite structural abnormalities in the brains of many patients with

Evidence for neuroanatomical explanations:
Brown et al- found decreased brain weight and enlarged ventricles.

Flaum et…





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