Schizophrenia - Clinical Characteristics

Reliability

• little consistency in diagnosis = DSM was very broad before in USA
• low reliability in diagnosis = many differences in classificiation + vague DSM   = wrong treatment

First-rank Symptoms (FRS)

• Kurt Schneider (1959) - 'first rank symptoms' = symptoms only for schiz
• FRS - basis for current ICD-10

Differences between ICD-10 + DSM-TR-IV

• ICD - symptoms for 1 month, DSM - symptoms for 6 months
• ICD - more emphasis on FRS, DSM - more emphasis on course of disorder + accompanying functional impairment
• DSM - multi-axial (=various factors considered before diagnosis)
• Classification systems: ICD - 7 subtypes, DSM - 5 subtypes

Criteria for Diagnosis -many different criteras = often wrong diagnosis + treatment

Different types of Schizc (ICR)

• Paranoid schiz - mainly delusions/hallusinations
• Hebephrenic schiz - disorganised aimless behaviour, rambling incoherent speech
• Catatonic schiz - motor abnormality, strang posture etc
• Undifferentiated schiz - general category if belong to none of others
• Post-schiz depression (NOT IN DSM) - schiz behaviour within 12 months, signs of depression, no schiz
• Residual schiz - schiz behavious 12+ months ago, not now
• Simple schiz (NOT IN DSM) - slow progressive development (1+year) of social withdrawal, apathy, poverty of speech, slowly more stupid

Type 1 syndrome - acute, positive symptoms (addictions/exaggerations of normal thought/behaviour) - hallucinations, delusions, disorganised speech

Type 2 syndrome - chronic, negative symptoms, flattening of affect, apathy

• Type 1 + 2 - ppl dont fit neatly into just one, however, different types have different causes

• Blurred distinction - some ppl diagnosed with one, later develop others = weaken reliability of diagnosis

Do these different types of schiz actually exist?

Schiz-like disorders - Ppl with schiz symptoms that don't exactly meet critera, so now other variations os schiz in ICD + DSM 

Dimensional or Categorical Disorder? - Should be graded on number of symptoms to determine degree of schiz, not just the category

Schiz as a multiple disorder - if just 2 very random symptoms needed to be schiz = no casual underlying factor = so should make each type of schiz its own disorder and treatment

Differential diagnosis - Symptoms of temporal lobe epilepsy - very similar to schiz, easy to diagnose wrong condition completely

Dual diagnosis - If schiz + depressed, both schiz + depression need to be diagnosed + treated - however, wrong diagnois if classed as one disorder

Cultural variations - More common in black ppl - ? due to genetic vunerability, psychosocial factors because small minority, or misdiagnosis? ...or because clinicans think cultural differences are schiz behaviour