Classification and Diagnosis of Schizophrenia

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SCHIZOPHRENIA - CLASSIFICATION AND DIAGNOSIS
Clinical characteristics of SZ: (only 2 of each needed)
TYPE 1, Acute SZ, Positive symptoms (gain new behaviour):
Delusions - distorted/ false beliefs i.e. aliens or government trying to kill them (Paranoid
Delusions). Delusion of Grandeur - individual believes there are superior and of significant
importance such as being famous or having super powers.
Hallucinations - distortions of perceptions in any sense, particularly auditory such as hearing
voices, some visual.
Disorganised Behaviour- impossible to carry out simple everyday tasks, inappropriate
reaction to social situations. Disorganised Speech - ability to organise thoughts is
disturbed i.e. Loose Associations - difficulty sticking to one topic, Echolalia - repeating what
others have said.
TYPE 2, Chronic SZ, Negative symptoms (loss of a previous behaviour):
Catatonia - reduction of movement and individual may remain rigid for hours. Waxy
Flexibility - moved into different positions by others.
Disturbances of Affect/ Flat Emotions - reduction in range of expressions such as voice tone
or, eye contact, facial expressions; Flattened Affect. Inappropriate Affect - expressing
contradictory behaviour such as laughing at a funeral. Anhedonia - inability to experience
pleasure.
Impaired Self Care - Reduction in ability to care for themselves i.e. neglect of personal
hygiene or diet.
SCHIZOPHRENIA - CLASSIFICATION AND DIAGNOSIS
Issues with Classification and Diagnosis: (Definition and 2 arguments for & against each)
Reliability (consistency in diagnosis):
JACOBSEN ET AL (2005) used Operation Criteria Checklist (OPCRIT), a symptom
checklist, explicit descriptions of symptoms, agreement of diagnosis of SZ when
compared against ICD indicating high levels of reliability. Also good agreement when
ICD & DSM compared.
VARES ET AL (2006) supports with OPCRIT found to be reliable. Considered various
methods of diagnosis i.e. those diagnosed on basis of interview received same
diagnosis based on medical records.

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Differences in the DSM and ICD, NOT CONSISTENT DIAGNOSIS:
DSM IV ICD 10
Symptoms shown for 6 months Symptoms shown for 1 month
Emphasis on symptoms at the start Emphasis on course of disorder
Multi-axial (different type of info)
5 subtypes of SZ 7 subtypes of SZ
Whaley (2001) found inter-rater (between clinics) reliability correlations as low as
0.11.
Wrong diagnosis can lead to long term and tragic outcomes for the individual.
Blurred distinctions between subtypes, some symptoms may develop from others.…read more

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