1. Schizophrenia

2. Objectives
The classification of schizophrenia. Positive symptoms including hallucinations and dellusions. Negative symptoms including speech poverty and avolition

3. Task 1: Identify which statements are true or false
Add the correct explanation as we go through the answers
Schizophrenia is where a person has split or multiple personalities.
Schizophrenia is where a person struggles to distinguish what is real from what is not real (or in their imagination).
People who suffer from schizophrenia are approximately 10 times more likely to commit suicide, in comparison to the general population.
Schizophrenia is far more common in women than in men

4. Task 1: Identify which statements are true or false
Most cases of schizophrenia are diagnosed when a person is years old
Schizophrenia is highly genetic and runs in families
Schizophrenia can develop due to a person’s family and issues during pregnancy
Many symptoms of schizophrenia are similar to those found in other disorders, in particular depression and bipolar.
Patients with schizophrenia are usually prescribed with drugs as their only treatment.
Schizophrenia is normally a life-long condition and there is no ‘cure’ although the symptoms can be managed through different treatments.

5. What it is like living with schizophrenia?
Overview

6. Symptoms and diagnosis
The symptoms of schizophrenia are typically divided into positive and negative
Positive symptoms (type 1) appear to reflect an excess or distortion of normal function (i.e. delusions and hallucinations)
These are rare in normal, everyday experiences
Delusions, hallucinations, disorganised speech, under the
control of an alien force, disordered thinking

7. Positive symptoms
Positive symptoms reflect an excess or distortion of normal functioning. Delusions are false beliefs that are firmly held despite being completely illogical, or for which there is no evidence. Common types of delusions in schizophrenia include the following: Delusions of persecution Delusions of grandeur Delusions of control Hallucinations involve disturbances in perception (rather than disturbances in thought). They are false perceptions that have no basis in reality. The most common hallucinations are auditory ones (hearing voices) but can include smell, touch and sight.

8. Negative symptoms which cause a decline in normal functioning.
Other symptoms are much less dramatic and can be experienced in everyday life (i.e. loss of energy, reduced personal hygiene); these are known as negative symptoms (type II)
While the negative symptoms are less dramatic, they tend to last for longer than the positive symptoms
For example, sufferers may not be able to work at a job that requires the same level of skill or concentration as the job they held before they became ill.
The illness can also affect their ability to function at home; for instance, they may be unable to complete household chores, raise their children or maintain an active social life.

9. Speech poverty is the inability to speak properly, characterised by lack of ability to produce fluent words; this is thought to reflect slowing or blocked thoughts. It can manifest itself as short and empty replies to questions.
Avolition is the reduction, difficulty, or inability to start and continue with goal-directed behaviour. It is often mistaken for apparent disinterest.
Examples of avolition include: no longer being interested in going out and meeting with friends, no longer being interested in activities that the person used to show enthusiasm for, no longer being interested in anything, sitting in the house for many hours a day doing nothing.
A person may also be affected by secondary impairments such as depression, as a result of the difficulties of living with the disorder (Davison and Neale, 2001)

10. Read through the information on pages 2-7
Task 2
Read through the information on pages 2-7
Draw a line to match the key terms on the left with the definitions on the right. Then highlight the positive symptoms of schizophrenia in one colour and the negative symptoms in another colour.
Consolidation: Complete the activity on page 10
Extension: Task 3: Answer the following exam questions

11. EVALUATION Positive symptoms Can be affected by cultural differences
Tend to have greater weight when diagnosing
Hard to measure objectively
Negative symptoms
Start before positive ones
Sometimes start years before diagnosis
Less affected by cultural factors
More objectively measured

12. Questions: find these out…
The main manuals used to diagnose Schizophrenia are?
How many of the symptoms must the patient have experienced?
How long do the symptoms need to be present for?
What are the main differences between the two manuals?

13. To meet the criteria for diagnosis of schizophrenia, the patient must have experienced at least 2 of the following:
Delusions
Hallucinations
Disorganized speech (e.g. frequent derailment or incoherence)
Disorganized or catatonic behaviour
Negative symptoms .e. affective flattening, alogia or avolition.
At least 2 of the symptoms must be the present for one month and one of these symptoms must be delusions, hallucinations, or disorganized speech.
Continuous signs of the disturbance must persist for at least 6 months,
-during which the patient must experience at least 1 month of active symptoms (or less if successfully treated),
-with social or occupational deterioration problems occurring over a significant amount of time. These problems must not be attributable to another condition.The American Psychiatric Association (APA) removed schizophrenia subtypes from the DSM-5.

14. Schizophrenia: issues surrounding diagnosis
There are several issues surrounding the diagnosis of Schizophrenia that need to be assessed.
These include addressing issues surrounding the reliability and validity of diagnosis.
What is meant by reliability
What is meant by Validity
Discuss in pairs the difference between the two.

15. RELIABILITY OF CLASSIFICATION SYSTEMS
Reliability refers to the consistency of a measuring instrument, such as a questionnaire or scale, to assess for example, the severity of the schizophrenic symptoms.
Reliability of such questionnaires or scales can be measured in terms of whether 2 independent assessors give similar diagnosis (inter-rater reliability) or whether tests used to deliver these diagnoses are consistent over time (test-retest reliability)

16. Inter-rater reliability
The inter-rater reliability of two psychiatrists diagnosing Schizophrenia is exceptionally low, e.g. less then 50%-suggests that psychiatrists do not know what they are doing. Thus people who do not have Schizophrenia may be included in research - may result in invalid conclusions about the cause of the ‘illness’ and/or treatment.
I wonder what the other bloke thinks?

17. Plenary
Create 5 questions to test a students understanding of schizophrenia so far. (1-3 marks)
Track your learning

18. Rosenhan 1973
This study highlighted the unreliability of diagnosis. However, this study was conducted over 30 years ago. Since then manuals have been improved and diagnostic practise is very different. For example, categories and definitions are more detailed and operationalised and psychiatrists now use standardised interview schedules when assessing patients. Also the ICD and DSM have been bought in line with one another so they are now very similar.