Psychopathology. Schizophrenia. Basic.

Basics of Schizophrenia.Diagnostic criteria. Subtypes. Reliability and Validity.

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Schizophrenia

A psychotic disorder characterised by distorted thinking, impaired emotional responses, poor interpersonal skills and a distortion of reality.

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Diagnostic Criteria

GROUP 1:

  • THOUGHT WITHDRAWL: unwanted insertion of thoughts
  • THOUGHT BROADCAST: broadcast of private thoughts
  • THOUGHT ECHO/ INSERTION.
  • DELUSIONS OF CONTROL/INFLUENCE/PASSIVITY: don't believe in control of own thoughts etc.
  • HALLUCINATORY VOICES: seemingly real voices.

GROUP 2:

  • PERSISTANT HALLUCINATIONS: perceptions occurring without external stimuli.
  • INCOHERENT SPEECH/ NEOGLISMS: made up words, jumbled speech.
  • CATATONIC BEHAVIOUR: unusual body movements.
  • NEGATIVE SYMPTOMS: loss of emotion/ interest/ motivation.

1 symptom in Group 1 or at least 2 symptoms in Group 2 must be present for:

DSM (USA) - 6 months.           ICD (UK) - 1 month.

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Subtypes of Schizophrenia

PARANOID:

 Characterised by DELUSIONS,HALLUCINATIONS, DISORGANISED SPEECH

CATATONIC:

Unusual MOTOR ACTIVITY, AGITATION, extreme NEGATIVISM

DISORGANISED:

Evident from early age.DISORGANISED speech, INAPPROPRIATE effect

UNDIFFERENTIATED:

When schizo symptoms PRESENT but do not fit in to any category

RESIDUAL:

1 ep of Schizo experienced in the past. But no longer exhibiting signs

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Course of disorder.

Schizophrenia is marked by GRADUAL WITHDRAWL from society and GRADUAL LOSS of PLEASURE in activities and FLAT AFFECT.

AGE OF ONSET:  Usually EARLY ADULT LIFE. (peak age for women 5-10 years later than men)

EPISODIC ILLNESS:

Periods of PSYCHOTIC DISTURBANCE with NORMAL periods.

PRODROMAL PERIOD:

Changes in MOOD/ BEHAVIOUR evident.

ACTIVE PHASE:

Psychotic stage lasting 1-6 months to a year.

Inter-episode functioning has INDIVIDUAL DIFFERENCES.

BETTER inter-episode functioning = BETTER prognosis.

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Reliability in Classification and Diagnosis.

Classification of an illness is only useful if its based on a RELIABLE system:

(In the US in 1930s only 20% diagnosed, rose to 80% in 1950s showing INCONSISTENCIES)

Differences in ICD and DSM:

  • DSM requires 6 months. ICD only 1 month
  • ICD emphasises SYMPTOMS. DSM focuses on COURSE of disorder.
  • DSM is multi-axal
  • DSM = 5 subtypes. ICD = 7 subtypes

DIFFCULT TO COMPARE DATA ON INDIVIDUALS DIAGNOSED WITH DIFF CRITERIA. could have diff disorders altogether.

BRITISH PSYCHOLOGISTS DISTINGUISH BETWEEN:

TYPE I syndrome: ACUTE disorder with POSITIVE symptoms

TYPE II syndrome: CHRONIC disorder with NEGATIVE symptoms

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Validity of Classification and Diagnosis

Large number of CATEGORIES of Schizophrenia raises issue of VALIDITY.

DIMENSIONAL DISORDER?

argued Schizo should be seen as a dimensional disorder - reflecting DEGREES of problem.

MULTIPLE DISORDERS?

BENTALL: term Schizo should be abandoned and each symptom viewed as a disorder in its own right.

DIFFERENTIAL DIAGNOSIS:

difficult to distinguish between SUBTYPES and other disorders.

DUAL DIAGNOSIS:

CO-MORBIDITY - diagnosed with one disorder but show symptoms of another.

CULTURAL VARIATIONS:

diff rates among diff cultures.

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I D A's

ETHNOCENTRIC:

Classification system almost enitrley based on WHITE MIDDLE CLASS SOCIAL NORMS

BOYLE & BENTALL:

Concept of Schizo is neither RELIABLE nor VALID. So diagnosis is NOT CLINICALLY or SCIENTIFICALLY  useful.

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