2. The human face of schizophrenia http://www.youtube.com/watch?v=B1YvJWTWWEk&feature= rellist&playnext=1&list=PL0655A5F779E91DED http://www.youtube.com/watch?v=B1YvJWTWWEk&feature= rellist&playnext=1&list=PL0655A5F779E91DED

3. Recap: Current diagnostic criteria for schizophrenia Symptoms include:  Delusions (culturally inappropriate or impossible)  Hallucinations (auditory or visual)  Disorganised speech (e.g. frequent derailment or incoherence)  Thought insertion, withdrawal or broadcasting (the experience of one’s thoughts being put into or taken out of one’s head, or broadcast to others). Negative symptoms  affective flattening (lack of emotion),  alogia (lack of communication) or  avolition (lack of motivation or desire to pursue goals) or  catatonia (lack of movement)  The above symptoms must not be due to the physiological effects of a drug of abuse or medication.

4. Outline the clinical characteristics of schizophrenia (5 marks)

5. Recap: Current diagnostic criteria for schizophrenia Symptoms include:  Delusions (culturally inappropriate or impossible)  Hallucinations (auditory or visual)  Disorganised speech (e.g. frequent derailment or incoherence)  Thought insertion, withdrawal or broadcasting (the experience of one’s thoughts being put into or taken out of one’s head, or broadcast to others). Negative symptoms  affective flattening (lack of emotion),  alogia (lack of communication) or  avolition (lack of motivation or desire to pursue goals) or  catatonia (lack of movement)  The above symptoms must not be due to the physiological effects of a drug of abuse or medication.

6. Main difference between DSM and ICD DSM states a minimum duration of symptoms for 6 months. DSM also includes a deterioration of social functioning. Which classification would lead to higher level of diagnosis? Which would lead to a higher proportion of severe cases?

7. The course of schizophrenia There is a gender difference in the onset of schizophrenia: the peak age for women is 5-10 years later than in men. Schizophrenia is an ‘episodic’ disorder. This means that there are periods of psychosis, which are then followed by ‘normal’ periods. The psychotic periods are usually heralded by a few weeks of a prodromal period, where there is a noticeable change in mood and behaviour. There is debate about the recovery potential from schizophrenia. Some longitudinal studies show that two-thirds of schizophrenic patients make a ‘substantial recovery’.

8. Example of ‘disorganised speech’. http://www.youtube.com/watch?v=avbfd_OkLoU http://www.youtube.com/watch?v=WjqRYgICgdU&feature=yo utu.be http://www.youtube.com/watch?v=WjqRYgICgdU&feature=yo utu.be

9. Louis Wain http://www.youtube.com/watch?v=U5ruNIIvXo8&feature=fv wp&NR=1 http://www.youtube.com/watch?v=U5ruNIIvXo8&feature=fv wp&NR=1

10. Potential exam questions

11. Issues surrounding classification and diagnosis This is the first topic for which you could get a 24 mark question. As with physical conditions, mental disorders first have to be diagnosed; in order to do this, clinicians have classification systems. These are based on the idea that certain groups of symptoms can be classed together as a syndrome, which has an underlying cause and is separate from other syndromes. In this way, mental disorders, are perceived in a similar way to physical disorders, as mental illnesses, which can be identified (diagnosed), treated and cured.

12. Issues surrounding classification and diagnosis The main issues that you would discuss in a question on this topic are: The reliability of different classification systems, e.g. the DSM and the ICD. (More similar than previously, but key differences remain. What were the implications of these key differences?) Lack of objective tests. The reliability of diagnosis The validity of diagnosis. As well as:  Cultural differences in diagnosis.  Implications of diagnosis, such as labelling.  The ‘anti Psychiatry’ perspective

13. Issues surrounding classification and diagnosis. Lack of objective tests ‘Bizarre delusions’  The DSM assumes that this should be obvious.  However, psychiatrists show poor inter-rater reliability for ratings of bizarre beliefs.  These beliefs must be viewed in the context of the persons culture and/or peer group, e.g. paranormal belief.  Can we ever truly question someone’s perception of reality?

14. Issues surrounding classification and diagnosis RELIABILITY and VALIDITY of diagnosis. Reliability refers to the consistency of symptom measurement and affects classification and diagnosis. Types of reliability include:  Test-retest reliability – occurs when a practitioner makes the same consistent diagnosis on separate occasions from the same information.  Inter-rater reliability – occurs when several practitioners make identical independent diagnosis of the same patient.

15. Issues surrounding classification and diagnosis Reliability  Historically (prior to 1970s), large differences between countries in diagnosis rates (see booklet for difference between UK and US).  Rosenhan study (1973) cast doubt on reliability of diagnosis of schizophrenia.  More recently attempts have been made to make the different diagnostic systems, in particular ICD and DSM more similar.  However, there are many other criteria (e.g Schneider Criteria). Though some have found to be associated with high levels of reliability of diagnosis, e.g. the Present State Examination (PSE) (Farmer et al. 1988), the existence of these different criteria make it difficult to compare data.

16. Issues surrounding classification and diagnosis RELIABILITY and VALIDITY of diagnosis. Validity concerns how accurate, meaningful and useful diagnosis is. There are several ways in which it can be assessed:  Predictive Validity – if a diagnosis leads to successful treatment, the diagnosis is seen as valid.  Descriptive Validity – to be valid, patients diagnosed with different disorders should differ from each other. AO2 – Descriptive validity is reduced by comorbidity, where patients have two or more disorders simultaneously, suggesting such disorders are not actually separate.

17. Other issues of classification and diagnosis Validity of schizophrenia:  Difficult to draw boundaries between other disorders  Comorbidity (2 or more disorders existing together). Schizophrenia is often co-morbid with depression.  Mixed disorders categories (e.g. Schizo-affective disorder) try to address the overlap between disorders, but their validity is questionable.  Predictive validity: if schizophrenia is a valid disorder, we should be able to predict it’s duration and response to treatment. This proves difficult, due to individual differences and the amount of influences.  There are several sub categories of schizophrenia; there is a suggestion that schizophrenia is not a single disorder.

18. Other issues of classification and diagnosis Cultural Bias  British black people are more likely to be diagnosed as schizophrenic and more likely to be committed to a mental hospital.  Ethnic minority and working-class people are less likely to be referred for psychotherapy than middle class people.  Such bias may occur because clinicians are predominantly white, middle-class males, unfamiliar of the cultural and social situations of black and working class patients.

19. Other issues of classification and diagnosis Issue of labelling.  Pseudo-patients in Rosenhan study could not shake off the label of insanity, despite their best efforts to act normally.  Scheff (1966) believed that this labelling of mental illness, leads to a self-fulfilling prophecy. Q. What does this last term mean? Q. List all the possible consequences for someone who has been labelled ‘mentally ill’. However, evidence that early diagnosis and prompt initiation of treatment, leads to better long term outcomes for people with schizophrenia (Jackson and Birchwood, 1996).

20. Thomas Szasz – Anti- psychiatry http://www.youtube.com/watch?v=Qj7GmeSAxXo

21. Essay Preparation Discuss the findings of research into the validity and reliability of the classification and diagnosis of schizophrenia (10 marks). Use lots of elaborative and coordinating phrases, for example:  This illustrates that…  This shows that…  Suggesting that…  Similarly __________ found that  Whereas…  Contrasting results were found in ….  This is reflected in the findings of … etc. etc. You could also use the word ‘reported’ instead of ‘found’.

22. Quick check questions 1.What is meant by the symptom avolition? 2. What does co-morbidity mean? 3.What is meant by predictive validity when we’re discussing schizophrenia?

23. Essay Preparation Discuss the findings of research into the validity and reliability of the classification and diagnosis of schizophrenia (10 marks). Use lots of elaborative and coordinating phrases, for example:  This illustrates that…  This shows that…  Suggesting that…  Similarly __________ found that  Whereas…  Contrasting results were found in ….  This is reflected in the findings of … etc. etc. You could also use the word ‘reported’ instead of ‘found’.

24. Essay structure Starter: Main Course: Dessert:

25. Someone else who is ‘anti- psychiatry’ http://www.youtube.com/watch?v=HwAaHbmF5S4&feature=r elated http://www.youtube.com/watch?v=HwAaHbmF5S4&feature=r elated