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Classification and Diagnosis of Schizophrenia
Schizophrenia is characterised by a profound disruption of cognition and emotion, which affects a
person's language, thought, perception and even sense of self.
A psychotic illness
Loss of contact with reality
Disruption of thought and emotion
Delusions: bizarre beliefs that seem real to the person with schizophrenia, but are not real.
Sometimes these delusions can be paranoid (i.e. fearful of persecution) in nature. Delusions may
also involve inflated beliefs about the person's power and importance. Delusions of reference involve
the belief that the behaviour or comments of others (even on TV) are meant for them alone.
Experiences of control: the person may believe they are under the control of an alien force that has
invaded their mind and/or body. This may be interpreted, for example, as the presence of spirits or
implanted radio transmitters.
Hallucinations are bizarre, unreal perceptions of the environment that are usually auditory (hearing
voices), but may also be visual (seeing lights, objects or faces), olfactory (smelling things), or tactile
(e.g. feeling that bugs are crawling on or under the skin).
Disordered thinking: the feeling that thoughts have been inserted or withdrawn from the mind. In
some cases the person may believe their thoughts are being broadcast so that others can hear them.
Tangential, incoherent or loosely associated speech is used as an indicator of thought disorder.
Affective flattening: a reduction in the range and intensity of emotional expression, including facial
expression, voice tone, eye contact, and body language.
Alogia: poverty of speech, characterised by the lessening of speech fluency and productivity, thought
to reflect showing or blocked thoughts.
Avoition: the reduction of, or inability to initiate and persist in goaldirected behaviour (for example,
sitting in the house for hours every day, doing nothing\0. It is often mistaken for apparent disinterest.
Diagnostic and statistical manual (DSMIVTR)
A. Characteristic Symptoms: Two (or more) of the following, each present for a significant portion of
time during a one month period (or less if successfully treated):
iii. Disorganised speech (e.g. frequent derailment or incoherence)
iv. Grossly disorganised or catatonic behaviour
v. Negative symptoms, i.e. affective flattening, Alogia or Avoition.
Note: Only one of these symptoms is required for a diagnosis of schizophrenia if delusions are bizarre, or
hallucinations consist of a voice keeping up a running commentary on the person's behaviour or thoughts, or
to or more voices conversing with each other.
B. Social/ occupational dysfunction: For a significant portion of the time since the onset of the
disturbance, one or more major areas of functioning such as work, interpersonal relations, or self
care are markedly below the level achieved prior to the onset.
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C. Duration: Continuous signs of the disturbance persist for at least six months. This six month period
must include at least one month of symptoms (or less if successfully treated) that meet criterion A.
D. Exclusion of mood disorders: No major episodes of depression or elation have occurred
concurrently with the psychotic symptoms.
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Ellason and Ross (1995) point out that people with dissociative identity disorder (DID) actually have
more `schizophrenic' symptoms than people diagnosed with schizophrenia.
20% recover their previous level of functioning.
10% have a lasting improvement.
30% have relapses.
Diagnosis has little predictive validity some people recover and some never recover.
Outcome is influenced by gender, social skills and family tolerance.
Gender differences in schizophrenia
Males are likely to develop symptoms in late teens/ early twenties.
Females are likely to show symptoms in their 20's.…read more