Classification and Diagnosis of Schizophrenia
The symptoms of Schizophrenia can be split into two types
Positive/Type 1: These are the most recognisable and appear to affect normal functions. To be diagnosed somebody needs to have had two or more of the positive symptoms for a minimum period of one month.
- Experiences of control - Thinking they are being controlled
- Disordered Thinking - Frequent derailment from the topic or incoherence.
Negative/Type 2: These usually occur when the positive symptoms are sparse
- Affective Flattening - A reduction in emotional displays such as eye contact, body language etc..
- Alogia - Limited speech due to slowing or blocked thoughts
- Avoilition - Reduction in goal-directed behaviour or working towards something, like they have no point to their lives.
What you need to be diagnosed.
- Have to have had at least two of the positive/negative symptoms for a period of one month, however if it is just a persistent hallucination this will also count.
- Social/Occupational dysfunction, so where you show a sheer lack of functioning in a normally fully functional area of your life such as work.
- The duration of these symptoms must be over 6 months including the initial month, not persistently for the entire 6 months but over this time.
- Exclusion of mood disorders such as depression, if they patient has this it cant count. Also an exclusion of drugs or even normal medication.
There are two main methods used to diagnose somebody, The DSM and the ICD
Main differences. The DSM requires a patient to have it for 6 months, ICD only 1 month
ICD focuses mainly on First-Rank Symptoms where as DSM looks at the accompanying symptoms
Types of Schizophrenia
Paranoid Schizophrenia: This is the most well known form of schizophrenia it is where delusions and/or halucinations are the most prominant characteristics, negative symptoms can be there but much less than in other forms of schizophrenia.
Disorganised Schizophrenia: Behaviour is aimless and disorganised, speech is rambling and incoherant there is also the flattening effect.
Catatonic Schizophrenia: Motor Abnormality is the main characteristic with the individual sometimes adopting strange positions or flailing the limbs around in an uncontrolled fasion, they usual act negatively when instructed to attempted to move them.
Issues with classification and diagnosis
Because of the many different symptoms associated with schizorphrenia some of these overlap into other mental disorders which could then lead to miss diagnosis, to counter this Schnieder (1959) identified First Rank Symptoms which were symptoms of schizophrenia found rarely in other disorders.
Rosenhan (1973) Sane in insane places:
He sent 8 sane people to different mental institues and told them to report ONE symptom of hearing a same sex single word such as "Thud" or "Empty". ALL of them got taken in as schizophrenics, as soon as they were in they stopped saying they had any symptoms and acted normal, however all behaviours they now did were disregarded as symptoms of the disorder. None of the pseudo patients were detected taking between 2 and 52 days for them all to be discharged.
Follow up study:
He told the hospitals he would do it again in the next 3 months, he didn't, he found 1 in 10 people who turned up were suspected and turned away.
There is research to show that there is a cultural differnce in diagnosis
Copeland (1971) found that American Psychaitrists were quicker to itentify schizpphrenia than British ones. He gave them a descripton of a patient 69% of the Americans diagnosed schizophrenia where as only 2% of the British did.
Other research has found that Schizophrenia is more commonly found in afro-Caribbean and African American populations showing the possibility of some groups having a genetic vulnerability to it, or, their culture is misinterpreted.