On the side or front of your folder: Psychology: paper 3 – issues and options Label folder dividers Schizophrenia Gender Forensic Issues & Debates Assessments

What do I need to know? Clinical characteristics of schizophrenia & diagnosis: positive & negative symptoms of schizophrenia

Discuss with the person next to you for 2 minutes Schizophrenia What do you know about Schizophrenia? Do you know any of the symptoms of this disorder? Discuss with the person next to you for 2 minutes

Examples of Schizophrenia 4 cases: https://www.youtube.com/watch?v=bWaFqw8XnpA

Schizophrenia: patient example Gerald https://www.youtube.com/watch?v=gGnl8dqEoPQ https://www.youtube.com/watch?v=i6h8Ic-I7R0

Schizophrenia and dissociative disorders https://www.youtube.com/watch?v=uxktavpRdzU

Schizophrenia definition Severe disruptions in psychological functioning and a loss of contact with reality.

Positive and negative symptoms Positive symptoms – behaviours which the patient is experiencing but should not be a distortion of normal functioning (adding something) Negative symptoms – behaviours which should be present if the patient is well; reflect a loss of normal functioning.

Create a brainstorm/mindmap of symptoms – illustrate each one with a picture to aid your memory!

Positive symptoms & Negative symptoms Highlight in booklet Write a description for each one and add a picture/image to help you remember them!

Cases- what symptoms can you see?

Mike Mike is a 33 year old divorced male with two children he rarely ever sees, ages 8 and 10. He has never been seen by a psychiatrist. His family doctor has tried to get him to see a local psychiatrist but Mike refuses to go. Mike says he knows someone has removed his brain and replaced it with someone else's. He believes that this brain is controlling him and that he is not responsible for his actions. He works everyday and has been in his current job for 15 years. He says he has lots of friends but sometimes he thinks its one of them who did this to him. He is convinced that he must protect his brain by wearing a hat (even to bed) He can speak fine and goes to work everyday. He doesn’t think his thoughts are unusual. Paranoid Schizophrenia

Tommy Tommy is 41.According to family he has always been withdrawn and at times his behaviour is inappropriate. His sister-in-law gave the example of him waking her up in the middle of the night to cook home some breakfast! Over the last year Tommy frequently talks at length and is difficult to understand. He often goes days without speaking to people . Disorganised schizophrenia

Mary Mary is 21 and was first presented to the psychiatric services as an out-patient at the age of 19.She gave a two month history of social withdrawal associated with paranoid delusions A diagnosis of probable paranoid schizophrenia was made and she was treated However, her condition continued to deteriorate. Over the next two months she became retarded and mute, and was admitted to hospital. At this time she began to have episodes of freezing and started to walk backwards. During her freezing episodes she should stand rigid for hours and ignored any instructions from nurses to move.   Catonic

Dave Dave is 24. Over the last 3 months he has been having visions of aliens walking round him when he goes to work. His speech has become rambling and often his friends cannot tell what he is saying. A few weeks ago Dave was told his old college friend had died and in response he laughed. He has stopped showering regularly and believes that his water system has been poisoned. He has lost a lot of weight as he no longer bothers to cook. His neighbor was worried about Dave when she saw him sitting on the floor in the corner shop grimacing. Disorganised

Title: classification of schizophrenia

Classification systems- what is the difference?

Classification systems *DSM – 5 Diagnostic and Statistical Manual of Mental Disorders (5th edition) American Psychiatric Association. *ICD-10 International Classification of Diseases (10th edition) World Health Organisation.

Requires symptoms to be evident for at least one month. DSM-5 ICD -10 Requires symptoms of schizophrenia to be evidence for at least 6 months: one month of active symptoms Symptoms must produce a deterioration in functions at work, in social relations and in self care. Requires symptoms to be evident for at least one month.

Highlight any terms you don’t understand. DSM-5: no subtypes ICD -10: 7 subtypes An individual must show at least two of the specified symptoms - the diagnostic criteria no longer identify subtypes. *Paranoid *Catatonic *Hebephrenic *Undifferentiated *Residual *Simple *Post-schizophrenic depression Highlight any terms you don’t understand. Which symptoms do you think go with each sub-type? Can you work it out?

Volition The faculty or power of using one's will. Hyperkenisis A disorder of marked hyperactivity and inability to concentrate.

Issues with the diagnosis of schizophrenia – first shown by Rosenhan in his famous study

Homework for next lesson Homework for next lesson! Listen to the Rosenhan podcast (link on A Psychology 2016 Moodle) and make notes on this study using the worksheet

Issues with diagnosis and classification of schizophrenia Reliability Evidence: Cheniaux et al (2009) Validity & co-morbidity Validity & culture bias Evidence: Keith et al (1991) Copeland (1971) Validity & gender bias Evidence: Loring & Powell (1988) Longenecker (2010) Validity & symptoms overlap Evidence: Ellason & Ross (1995) Validity & lack of objective testing Evidence: Rosenhan (1973)

Issues with diagnosis and classification of schizophrenia Reliability What does reliability mean? Why might there be issues with the reliability of diagnosing schizophrenia? Validity & co-morbidity What does validity mean in terms of diagnosing schizophrenia? What does co-morbidity mean? Why does this create problems for the validity of diagnosis? Validity & culture bias What does culture bias mean? Why does this create problems for the validity of diagnosis? Validity & gender bias What does gender bias mean? Validity & symptoms overlap What symptoms of schizophrenia overlap with other disorders? Validity & lack of objective testing Why is there no objective test for schizophrenia?

Issues with diagnosis and classification of schizophrenia Reliability Evidence: Cheniaux et al (2009) Make brief notes on your study: You need to include … what did they show/ find? … how does it link back to the reliability or validity of diagnosis? Validity & culture bias Evidence: Keith et al (1991) Copeland (1971) Validity & gender bias Evidence: Loring & Powell (1988) Longenecker (2010) Validity & symptoms overlap Evidence: Ellason & Ross (1995) Validity & lack of objective testing Evidence: Rosenhan (1973)

Discuss the reliability and/or validity in relation to the diagnosis and classification of schizophrenia (8 marks) Look at the banded mark scheme – what would you give this answer out of 8? Why?

4/8 Examiners comments – This is a level 2 response. The outline of reliability is sound but the focus of the answer is mainly on description. Any discussion is of limited effectiveness. There is an inaccuracy in the discussion of sub-types in the DSMV. The organisation would be aided by using paragraphing. Specialist terms are used inappropriately on occasion – DMS instead of DSMV

Discuss the reliability and/or validity in relation to the diagnosis and classification of schizophrenia (8 marks) Look at the banded mark scheme – what would you give this answer out of 8? Why? Plan an answer which would get 8/8! Extension – what would you add to your plan to get 12/12 or 16/16 (remember it stays maximum 6 for description in all questions).

Can psychiatrists now tell the sane from the insane?