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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withdrawn from the mind.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
Alogia: poverty of speech, characterised by the lessening of speech fluency and
productivity, thought to reflect showing or blocked thoughts.
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Avoition: the reduction of, or inability to initiate and persist in goal-directed
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 (DSM-IV-TR)
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
iii. Disorganised speech (e.g. frequent derailment or incoherence)
iv. Grossly disorganised or catatonic behaviour
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Carson 1991 claimed that the DSM provided a reliable system for diagnosis.
Whaley (2001) found inter-rater reliability correlations in the diagnosis of
schizophrenia as low as 0.11.
There are different classification systems used for diagnosis. In the US the DSM
is used and in the UK the ICD is also used. The issue with this is that they
describe schizophrenia in different ways, which creates problems in assessing
There are cultural differences in diagnosis: Copeland et al.…read more
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Validity is what is schizophrenia?
Bental (1988) did a large review of all research into aetiology, prognosis and
treatment and found that schizophrenia wasn't a useful scientific category.
Schneider (1959) listed first rank symptoms, he believed these are only found
in schizophrenics, such as delusions and hallucinations.
However, some of these are found in other disorders, such as depression and
bipolar disorder.…read more