classification and diagnosis of schizophrenia plus commentary

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Due to there being two manuals, certain aspects
OF SCHIZOPHRENIA of disorders/mental illnesses may not be the
A01Classification systems; same in each one. This can lead to conflict
DSM-IV (American version. Most widely used between different psychiatrists and an individual's
manual). diagnosis. May lack reliability if different
ICD-10 (European Version ­ Less widely used) psychiatrists have different manuals that they
know. However, having the DSM-IV as the most
broadly used tries to counteract this. Reliability
and validity are discussed below.
Diagnostic subtypes; THE FIVE DIFF TYPES OF Reliability and validity are inextricably linked with Rosenhan (1973) ­ Being Sane in
SCHIZOPHRENIA science. If scientists cannot agree who has Insane Places
- Paranoid ­ delusions/beliefs schizophrenia (i.e. low reliability), then questions 8 `normal' people presented themselves
- Catatonic ­ negative symptoms of what actually is (i.e. questions of validity) to psychiatric hospitals in the US claiming
- Disorganised ­ behaviour. Irrational become essentially meaningless. A that they heard unfamiliar voices in their
- Undifferentiated ­ mixture of all symptoms comprehensive review into the symptoms, heads saying the words `empty' `hollow'
- Residual ­ milder symptoms, may be causes, prognosis (outcomes) and treatment of and `thud'. They were all diagnosed as
recovering schizophrenia (Bentall et al, 1988) concluded that having schizophrenia and were admitted
schizophrenia was `not a useful scientific to the different psychiatric hospitals.
Schizophrenia diagnosis in the DSM-IV; category'. Throughout their stay, none of the staff
At least two of the following symptoms must be recognised that they were actually
present to be diagnosed with schizophrenia ­ Schizophrenia cannot be diagnosed before the normal. They were all eventually
POSITIVE SYMPTOMS ­ TYPE 1 (episodic. Can be age of 16 because psychiatrists claim it could just discharged but the nurses commented
treated with drugs) be their imagination. Is it fair to not give a child on their `normal' behaviour as
1. Delusions (often linked to hallucinations. They treatment if they suffer with schizophrenia but `abnormal'; like writing in a diary was
are false beliefs that are often grandiose ­ the are under the `diagnostic age'? seen as jotting people's movements. This
person gives them self a bigger importance than supports the labelling theory and
they are ­ i.e. work for the FBI). ISSUES AFFECTING RELIABILITY AND VALIDITY OF questions the validity of schizophrenia.
2. Hallucinations (usually auditory = hearing voices, SCHIZOPHRENIA
or semantic = feeling like you can feel things such 1. Comorbidity ­ is the patient suffering from
as aliens) two or more mental disorders at the same
3. Disorganised speech (make no sense. Jump time? Symptoms of different mental
from one conversation to another). disorders often overlap, such as Bipolar and

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NEGATIVE SYMPTOMS ­ TYPE 2 (chronic. Hard Schizophrenia (both have grandiose
to treat with drugs/sometimes untreatable) delusions and hallucinations)
4. Disorganised or catatonic behaviour 2. Schizotypy ­The categorical approach (all
(disorganised = jump from one task to another. or nothing approach. Either have
Make no sense. Catatonic means very sedentary schizophrenia or you don't). VS continuity
don't move. No motivation. Quiet) approach (sliding scale of personality traits
5. Negative symptoms (affective flattening = lack for schizophrenia. Every person can be
of mood.…read more

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Criterion validity ­ people diagnosed with
Schizophrenia should behave differently to
those without schizophrenia.
3. Construct validity ­ test hypothesis based
on diagnosis ­ do they have higher levels of
dopamine? Genetic? Look for evidence.
4. Predictive validity ­ should be able to
predict the outcome of schizophrenia. If the
patient doesn't follow the outcome then
they are unlikely to have schizophrenia.
However, can we predict their outcome?
There are individual differences and the rule
of thirds (below left).…read more

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Shows significant difference to levels of acceptability between the two people
the lower class and other classes. i.e. a lower class person may think it acceptable to
Ethnic bias ­ 2.1% of African-Americans are go out in their pj's but a psychiatrist may see this
diagnosed with schizophrenia compared to 1.4% as an `abnormal' behaviour. May be due to a
of white Americans (but also lower class). social class barrier).…read more


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