Schizophrenia- Symptoms, Diagnosis and Classification

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Classification and Diagnosis of Scizophrenia
Clinical Characteristics
Schizophrenics lose touch with reality.
Positive and negative symptoms- the symptoms of schizophrenia are typically divided
into positive and negative symptoms. Positive symptoms are those that appear to
reflect and excess or distortion of normal functions. Negative symptoms are those
that appear to reflect a dimution or loss of normal functions which often persist
during periods of low or absent positive symptoms. The diagnosis of schizophrenia
requires at least a one month duration of two or more positive symptoms.
Type 1: (positive symptoms) something is added to the person's personality.
Delusions- bizarre beliefs that seem to real to the person with schizophrenia, but
they aren't real. Sometimes these delusions can be paranoid e.g. persecutory in
nature. Delusions may also involve inflated beliefs about the person's power and
Experiences of control- the person may believe they are under the control of an
alien force that has invaded their mid and/or body.
Hallucinations are bizarre, unreal perceptions of the environment but they are
usually auditory (hearing voices) but may also be visual (seeing lights, objects or
faces) olfactory (smelling things) or tactile (feeling that bugs are crawling on them).
Disordered thinking- the feeling that thoughts have been inserted or withdrawn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.
Type 2: (Negative Symptoms) something is taken away ­ lack of emotion, limited use of
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. This is thought to reflect slowing or blocked thoughts.
Abolition- the reduction of or inability to initiate and persist in, goal directed
behaviour. E.g. sitting in the house for hours every day doing nothing, is often
mistaken for apparent disinterest.
Most common in mid to late teens. More frequent in urban areas and amongst
those of lower socioeconomic class.
Diagnosing Schizophrenia
To be diagnosed a person must have at least 2 of the following symptoms:

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Disorganised speech.
Grossly disorganised or catatonic behaviour.
They will also have below normal functioning in relationships and at work
Signs of disturbance must have been present for six months.
Problems with Diagnosis
Diagnosis has been inconsistent over the yrs.
In the 1950's the term was used for any kind of severe mental disorder.
Main tools for diagnosis are the DSM (Diagnostic and Statistical Manual of mental
disorders) and the ICD (International Classification System for Disease).…read more

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Reliabilitiy refers to the consistency of a measuring instrument such as a
questionnaire or scale, to assess the severity of their schizophrenic symptoms.
Reliability of such questionnaires or scales can be measured in terms of two
independent assessors to give similar diagnoses (`inter-rater' reliability) or
whether tests used to deliver these diagnoses are consistent over time ~(test
retest reliability)
Inter-rater reliability = to what extent would two health professionals come to
the same diagnosis. Beck et al found inter-rater reliability to be quite low.…read more

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The test- retest reliability (correlation of scores across the two test
periods was high at .84.
Test-retest reliability- measures of cognitive functioning are vital in the diagnosis of
schizophrenia, must have test-retest reliability to be ueful in this role.
Prescott et al 1986 analysed the test-retest reliability of several measures of
attention and information processing in 14 chronic schizophrenics. Performance on
these measures was stable over a 6 month period.…read more

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Prognosis- people diagnoses as schizophrenia rarely share the same symptoms, nor
any evidence that they share the same outcomes. Bentall at al 1988 Prognosis for
patient varies with about 20% recovering their previous level of functioning, 10%
achieving significant and lasting improvement, 30% showing some improvement with
some relapses. A diagnosis of schizophrenia, has little predictive validity some people
never appear to recover from the disorder, but many do.…read more

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Found normal people could get themselves diagnosed as Schizophrenic and put into
a psychiatric hospital just by claiming they were hearing voices.
In a follow up study the reliability of diagnosis was checked by warning hospitals to
expect fake patients during the next 3 months. 41 patients were suspected, 19 were
diagnosed by 2 members of staff. In actual fact there were no fake patients at all.
EVALUATION Cultural Relativism
What is seen as abnormal varies between cultures.…read more


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