Schizophrenia - Classification and Diagnosis

look at how Schizophrenia is diaganosed and the symptoms of it.

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What is Schizophrenia?

Schizophrenia is German for split, it does NOT mean split persoanlity, but split from reality.

1% of people in the UK are diagnosed with it, the Schizophrenia lable will stick to the person for life. 

There is a equal chance in occuring in males and females, but males tend to have the onset from the late teens onwards, females usually in the 20s and 30s.

Schizophrenia is most common in cities and ethnic minorities.

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The onset of Schizophrenia

Acute - The onset in sudden, usually occuring after a stressful life event.

Chronic - The onset is slow, it gradually changes a person e.g they may start to lose intrest and motivation to socialise. more serious symptom such as delusions may occur months later.

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Positive Symptoms

There are 4 postive symptoms, these are:

Delusions - Things may seem real to the person, but in fact they are not, paranoia can occur and they may seem to find themselves very important (delutions of Grandeur). They may believe the TV is talking to them alone.

Hallucinations - The person may see, hear, smelling (olfactory) and feeling (tactile) things that are not there. The voices they  hear maybe controlling, they may feel as if there is a insect crawling under the skin.

Disorganised thinking/speech - They may not initiate conversations and not say much. Alternativey they may talk quickly, muddling up what they're saying and it may seem illogical, this is known as "word salads". Rambling can occur and may talk to themselves or imagine people/voices.

Grossly Disorganised/Catatonic behaviour - Odd body postures maybe adopted, limited limb control and complete frozen immobility. The frozen mobility can last from hours to months. If someone changes the posture they're in, then the person will adopt the new position, this is know as "waxy"

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Negative symptoms

There are 3 negative symptoms are "pathological deficits":

Alogia - Lack of speech, their speech maybe repetitive and meaningless. When asked questions only short answers will be given.

Affective flattening - This is the lack of emotion within the facial expression, voice tone and may stare. The emotions may also be used incorrectly, e.g. laughing at bad news.

Avolition - The person may lack the ability to initiate and persist in goal directed behaviour/tasks. This can be mistaken for disintrest, e.g. no longer going out or meeting with friends.

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Classification systems

The International Classification of Diseases (ICD) requires that 2 or more of symptoms are present for only 1 month, while the DSM require the symptoms to be present for over 6 months. This is because many of the symptoms of schizophrenia are similar to other disorders, such as depression and manic depression.

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Types of Schizophrenia

The DSM-IV-TR (which outlines symtoms of mental disorders) lists 5 types of Schizophrenia.

Catatonic - The adoption of strange positions and the lack of control over limbs.

Paranoid - The main symptoms are delusions and hallucinations.

Disorganised - Disorganised speech e.g. rambling, incoherant behaviour. Flat or inappropriate emotions.

Residual - lack prominent positive symptoms, but have various negative symptoms.

Undiffernetiated - This catergory is for those schizophrenic patients who have too wide of a range of symptoms to be put into one of the other catergories. This catergory is also known as a "catch all" catergory.

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Issues surrounding schizophrenia

Schizophrenia is questioned whether it is infact 1 disorder or many seperate disorders because of the positive/negative symptoms and the various sub types.

Reliability raises the concern to what extent psychiatrist can agree on the same diagnosis.

Validity is concerned as there is no clear way of telling if a person has schizophrenia. Psychiatrist often do not question the diagnosis given by another psychiatrist.

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Issues of reliability

There is a need for inter-judge-reliability to ensure a correct diagnosis is give and a basic level of requirement of any classification (gelder et al 1989, 1999)

The DSM III is designed to provide greater agreement by psychiatrists when classifying a disorder. This gives a better agreement of who may or may not have schizophrenia. However, a study by Whaley (2001) found that a coorrelation of 0.11 between psychiatrist who use the DSM III (and later versions) when diagnosing someone with schizophrenia.

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Other problems

Schizophrenia has such a wide range of symptoms (paranoid and catatonic schizophrenia shares not symptoms) that it can be argued that its not one disorder, but several.

Undifferentiated schizophrenia is also questioned as patients in this catergory may have totally different symptoms, but still be labled with the same disorder, in the same catergory.

Schizophrenia also has different outcomes,1/3 of patients recover, 1/3 improve but relapse later on and 1/3 never recover.

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Rosenhan (1973)

Rosenhan argued that schizophrenia lacked reliability and validity. He had 8 people with no history of mental disorders claim to be hearing voices say "thud" to try and get into psychiatric hospitals. 7 were labled with schizophrenia and 1 with manic depression. 35 patients suspected they were sain, however none of the hospital staff realised this. The shortest stay by a Psuedo patient was 7 days. They were only discharged from the hospital if they agreed they were ill and agreed to take antipsychotic drugs.

This shows how hard it is to diagnose schizophrenia.


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Criticism of Rosenhan

Psychiatrist argue that they diagnoses people by the symptoms they say they have, therefore by giving false symptoms it is not fair to claim psycology lacks validity and reliability. Also psychiatrist don't expect healthy people to try and gain administration into mental hospitals. The mistaked made by the psycologists were made in "unsual" conditions and this does not mean that psychiatrist cannot distinguish the isane from the sane.

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Culture and social class bias

Nazroo (1997) found Afro-carrabeans living in the UK were 3 - 5 times more likely to be diagnosed with schizophrenia compared to the general population in the UK.

Mcgovern and Cope (1987) found that 2/3 of schizophrenia patients in a mental hospital in burmingham were afro-carrabean. 1/3 were asain and white.

Keith et al found 1.9% of lower class, 0.9% of middle class and 0.4% were diagnosed with schizophrenia. It is argued that these diagnosis are due to the bias and predijice as many psychiatrist are white and middle class.

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Helen Clow

You spelt Carribbean and Birmingham wrong

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