PSYA4 Schizophrenia

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Diagnostic Criteria for Schizophrenia
ICD Diagnosis
Symptoms should be present for most of the time lasting for at least one month at some time during most
(1) At least one of the following must be present:
(a) thought echo, thought insertion or withdrawal, or thought broadcasting
(b) Delusions of control, influence, or passivity delusional perceptions
(c) Hallucinatory voices: running commentary, discussion on patients, or coming from some other part of the
(d) Persistent delusions of other kinds that are culturally inappropriate or impossible
(2) Or at least two of the following:
(a) Persistent hallucinations in any modality accompanied by halfformed delusions or overvalued ideas
(b) Neologisms, breaks, or interpolations in the train of thought, resulting in incoherence or irrelevant speech
(c) Catatonic behaviour
(d) Negative symptoms apathy, paucity of speech, blunting or incongruity of emotional responses (it must be
clear that these are not due to depression or to neuroleptic medication).
Exclusion clauses:
If showing manic or depressive episodes criteria must be met before the mood disturbance developed.
Not due to substances.
DSM Diagnosis
(A) Characteristic symptoms: Two or more of the following, each present for a significant portion of time during
a 1month period:
Disorganised speech (e.g. frequent derailment or incoherence)
Grossly disorganised or catatonic behaviour
Negative symptoms, i.e. affective flattening, alogia or avolition
Only one Criterion A is required if delusions are bizarre or hallucinations consist of a voice keeping up a
running commentary on the person's behaviour or thoughts, or two or move voices conversing with each
(B) Social/ occupational dysfunction: For a significant portion of time since the onset of the disturbance, one or
more areas of functioning such as work, interpersonal relations, or selfcare are markedly below the level
achieved prior to the onset, or failure to achieve expected levels of achievement.
(C) Duration: Continuous signs of the disturbance persist for at least 6 months, which must include at least 1
month of symptoms that meet Criterion A and may include periods of prodromal or residual symptoms. During
these periods, the signs of the disturbance may be manifested by only negative symptoms or two or more
symptoms listed in Criterion A present in an attenuated form.
(D) Exclusion of Schizoaffective and Mood Disorders.
(E) Exclusion of substance effects of a general medical condition.
(F) Relationship to a Pervasive Developmental Disorder: If there is a history of Autistic Disorder or another
Pervasive Developmental Disorder, the additional diagnosis of Schizophrenia is made only id prominent
delusions or hallucinations are also present for at least a month.
Type 1: Episodic, mainly positive
Type 2: Chronic, mainly negative
Positive symptoms Positive symptoms reflect and excess or distortion of normal functions. They are an
addition to the individuals behaviour.

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Negative symptoms Negative symptoms appear to reflect a diminution or loss of normal functions. They
are associated with social withdrawal, apathy and indifference to personal welfare and hygiene.
Delusions Bizarre beliefs that seem real to the person, but are not real. These can sometimes be
paranoid in nature. They may involve inflated beliefs about the person's power and importance. Delusions of
reference involve the belief that the behaviour or comments of others are meant for them alone.…read more

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Prescott et al., 1986) analysed testretest reliability of several measures of attention and information
processing in 14 chronic schizophrenics. Performance on these measures was stable over a 6month period.
Issues of validity
Validity refers to the extent that a diagnosis represents something that is real and distinct from other disorders
and the extent that a classification system such as the ICD or DSM measures what it claims to measure.
Diagnosis cannot be valid if it is not reliable.…read more

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However, many researchers now accept that the fact that schizophrenia appears to run in families may
be more to do with common rearing patterns or other factors that have nothing to do with heredity e.g. EE.
Twin studies
These offer a unique opportunity for researchers to investigate the relative contributions of genetic and
environmental influences.…read more

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Thus, they reject feedback and develop delusional beliefs that others are manipulating
persecuting them.
(+) (MeyerLindenberg et al., 2002) link between excess dopamine in the prefrontal cortex and working
memory, which suggests a physical basis for the cognitive deficits associated with S.
(+) (Yellowlees et al., 2000) produced a machine which produces virtual hallucinations, with the intention to
show schizophrenics that their hallucinations are not real. 'Madness' is a consequence of disbelieving others.
No evidence it will be successful.…read more

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Biological Therapies for Schizophrenia
Antipsychotic medication
Treat forms of psychotic illness. They help the person with the disorder to function as well as possible in their
life and, as well as increasing their feelings of subjective wellbeing.
Conventional antipsychotic drugs
Reduce the effects of dopamine and so reduce the symptoms of schizophrenia.
They are dopamine agonists They bind to dopamine receptors but do not stimulate them, thus blocking
their action. By reducing stimulation of the dopamine system, these drugs can eliminate the hallucinations and
delusions.…read more

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They night also be set behavioural assignments with the aim of improving their general level of
During CBT the therapist lets the patient develop their own alternatives to these previously maladaptive
beliefs, by looking for alternative explanations and coping strategies that are already present in the patients
(+) (Gould, 2001) All 7 studies in their metaanalysis reported a statistically significant decrease in all the
+ve symptoms after treatment.…read more

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It's expense prevents it being adopted on a large scale. Because it does not appear more effective than
antipsychotics, it is not worth the extra expense. However, there is evidence to suggest that the overall cost of
treatment decreases with therapy because they are less likely to seek inpatient treatment and more likely to
gain employment.…read more


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