Schizophrenia – what’s wrong with this joke?

What the Specification Says: Candidates will be expected to: develop knowledge and understanding of theories and studies relevant to the content for each area of psychology in this unit analyse and evaluate theories and studies relevant to the content for each area of psychology in this unit undertake practical research activities involving collection, analysis and interpretation of qualitative and quantitative data.

Schizophrenia Schizophrenia is not a multiple personality A psychotic disorder involving a break with reality Many different manifestations with a few shared features

Schizophrenia diagnosis At least two of the following: – Hallucinations (us. auditory or somatic) – Delusions (oft. linked to hallucinations) – Disorganised speech – Disorganised or catatonic behaviour – Negative symptoms Social & occupational dysfunction Duration of several months

Schizophrenia diagnosis Diagnostic subtypes – Paranoid – Catatonic – Disorganised – Undifferentiated Type 1 - Episodic, mainly positive symptoms Type 2 - Chronic, mainly negative symptoms

Schizophrenia prevalence 1% lifetime risk in general population Holds true for most geographical areas although rates do vary – Abnormally high in Southern Ireland, Croatia; significantly lower rates in Italy, Spain (Torrey, 2002) Risk factors include low SES, minority ethnicity, urban residence

Schizophrenia onset Source: CIHI (2001)

Schizophrenia prognosis ‘Rule of the thirds’ (rule of thumb): – 1/3 recover more or less completely – 1/3 episodic impairment – 1/3 chronic decline Confirmed in US & UK (Stevens, 1978) With treatment about 60% of patients manage a relatively normal life Prognosis better in non-industrialised societies

Diagnosis Most mental disorders are categorised into groups Diagnostic and Statistical Manual of Mental Disorders (DSM) is produced in the US International Classification of Diseases (ICD) produced in Europe Schizophrenia is major example of psychotic illness

Nature of Schizophrenia Characterised by a profound disruption of cognition and emotion which affects a person’s language, thought, perception, affect and even sense of self. Media often links to violence. However only 8% of diagnosed Schizophrenics in a year will commit a serious act of violence. This is less than the percentage of depressives or people with personality disorders who will commit an act of violence

Positive Symptoms Delusions Experiences of Control Hallucinations Disordered Thinking

Negative Symptoms Affective flattening Alogia Avolition

RELIABILITY DSM III introduced in Designed specifically to provide more reliability Subsequent revisions but still questions over reliability Recent studies found inter-rater reliability correlations as low as 0.11 (Whaley 2001) Can Scientists Agree on the same Diagnosis?

RELIABILITY Positive symptoms may be more suited for diagnosis - Klosterkotter et al (1994) Argued that Schizophrenia is too broad a category for it to be a useful diagnosis. Two patients could have completely different symptoms Mojtabi and Nicholson (1995) – 50 US psychiatrists asked to distinguish bizarre and non-bizarre delusions. Inter-rater reliability correlation of around 0.40

VALIDITY Bentall et al (1988) – comprehensive review of symptoms (aetiology), prognosis (outcome) and treatment concluded that Schizophrenia is not a useful scientific category. Schneider (1959) ‘first rank’ symptoms – designed to uniquely identify schizophrenia Ellason and Ross (1995) people with DID (dissociative identity disorder) have more first rank symptoms than schizophrenics! Can Scientists agree on what schizophrenia is?

VALIDITY Little predictive validity – prognosis varies massively c. 20% recover to previous levels of functioning, 10% achieving lasting improvement, 30% some improvement with relapses. Malmberg et al. (1998) – Prognosis is more to do with Gender Harrison et al. (2001) – Prognosis is more to do with psychosocial factors.

Rosenhan ANr8jAQ&feature=related ANr8jAQ&feature=related

Cultural Differences Copeland et al (1971) Description of a patient to 134 US and 194 British psychiatrists 69% of the US psychiatrists diagnosed schizophrenia 2% of the UK psychiatrists diagnosed schizophrenia

Questions a)Outline clinical characteristics of schizophrenia. (6 marks) b)Explain issues of reliabiility and validity associated with the classification and diagnosis of schizophrenia. (3+ 16 marks)