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Diagnosis is a crucial step in the treatment of any mental illness. It should be detailed, accurate, and provide reassurance. The classification and diagnosis of schizophrenia is thus a crucial step in the treatment of schizophrenia, and various classification systems are used by psychologists. What are the different diagnosis and classification tools used in schizophrenia? How do they differ? Let's explore…
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Diagnosis is a crucial step in the treatment of any mental illness. It should be detailed, accurate, and provide reassurance. The classification and diagnosis of schizophrenia is thus a crucial step in the treatment of schizophrenia, and various classification systems are used by psychologists. What are the different diagnosis and classification tools used in schizophrenia? How do they differ?
Let's explore the two most well-known classification manuals in psychology, the ICD (International Classification of Diseases) and the DSM (Diagnostic and Statistical Manual of Mental Disorders), and how the two differ in their approach to schizophrenia.
Both the ICD (International Classification of Diseases) and the DSM (Diagnostic and Statistical Manual of Mental Disorders) provide a way to classify psychiatric disorders. It refers to grouping symptoms based on how they usually present in disorders. This classification allows for a diagnosis.
Depending on which manual a clinician or psychiatrist uses, a diagnosis and classification of schizophrenia essentially refer to a person having a mental illness affecting their thoughts, feelings, and speech, causing a loss of contact with the self and a sense of reality.
Typically, schizophrenia affects:
The ICD is a classification manual used in most countries of the world (especially in Europe) to diagnose psychiatric disorders.
It is currently in its eleventh edition and has undergone several revisions.
These revisions focus on improving the reliability and validity of the classification tool.
According to the ICD, for a patient to be diagnosed with schizophrenia:
At least two or more of the following symptoms, with at least one from the first three:
Delusional perceptions, hallucinations i.e., hearing voices, disorganised thinking, incoherent speech, affective flattening, catatonic behaviours, and avolition.
The DSM is sometimes still used as the basis for the ICD.
The DSM is a classification manual similar to the ICD, though it is used primarily by American medical professionals. The American Psychiatric Association (1980) developed it and is currently in its fifth edition, which has also been revised to improve reliability and validity.
Similar to the ICD, to receive a diagnosis of schizophrenia, a patient must meet the following requirements:
Two or more of the following symptoms for at least one month consistently, such as:
Delusions, hallucinations, disorganised speech – at least one of these symptoms must be present, and the following symptoms are also considered: disorganised behaviour, catatonic behaviour, affective flattening, and other negative symptoms.
Symptoms need to have been around for six months, with active symptoms affecting a person within one month.
Now that we have discussed the classification tools, we can clarify the symptoms of schizophrenia.
The following is not particularly relevant to the exam, but it is helpful to know the history of the disease.
The types of schizophrenia vary depending on the diagnostic manual you follow. The latest version of the DSM no longer has types (something to keep in mind), but some still refer to them. In general, these are the types you may be diagnosed with:
Famously, Bleuler established the four A's of schizophrenia (McNally, 2009):
Symptoms can be divided into two categories:
Here are examples of positive and negative symptoms of schizophrenia.
Positive symptoms can be described as symptoms that add an experience for an individual. What we mean by this is that the symptom is causing an additional experience that changes a patient's perception.
Positive symptoms are when symptoms are adding an experience to a patient's life, causing a change in behaviour. Typically, they cause reality perception problems.
Hallucinations: A sensory experience, usually auditory or visual, although not exclusively. Patients can:
See distortions, such as seeing lights and patterns that are not there.
See objects that look like faces.
Hear voices outside their head that are not their own, telling them to do things.
Delusions: Irrational beliefs and thoughts that can manifest in multiple ways:
Delusions of grandeur.
A patient believes they are someone important, for instance, the next coming of Jesus.
Paranoia usually manifests as delusions of persecution.
A patient may believe the government is persecuting them.
A patient believes they are being controlled by something outside of themselves.
Disorganised speech: Disjointed sentences, changing the subject in the middle of a sentence without thinking about it.
Psychomotor disturbances: Rocking back and forth for long periods, which may alternatively manifest as catatonia (holding still for hours or days).
Negative symptoms are the opposite of positive because they take something away from the patient. In essence, it is a loss of functioning.
Negative symptoms of schizophrenia remove experiences from a patient, usually through withdrawing from their world and losing the ability to remain involved.
Here are some examples:
Avolition is a state of apathy in which the patient has trouble working toward or maintaining goal-directed behaviour.
Andreason (1982) found that avolition manifests itself primarily in poor hygiene, lack of motivation/perseverance, and lack of energy.
Alogia (speech poverty) refers to a decrease in the quality and quantity of speech. Patients speak slower, less, and delay their responses. (If it is too disorganised, it becomes a positive symptom in the DSM-V, as mentioned above).
Affective flattening is a lack of facial expressions and reactions.
Anhedonia is the inability to feel positive emotions fully.
Classifying disorders allows clinicians to discuss patients and their symptoms and creates a consensus for effective, standardised treatment.
Without the guidelines in these manuals, disorders would not be formally recognised. A patient in one part of the world might receive a completely different diagnosis, and therefore different treatment than a patient in another part of the world.
Therefore, it is essential to assess the reliability and validity of the classification systems and the consistency of the diagnoses. It is also essential to understand the implications of using such a system to 'pigeonhole' patients.
The role of dopamine dysfunction in schizophrenia is essential, as dopamine is one of the primary neurotransmitters associated with the disorder. The dopamine hypothesis looks at this issue more in-depth.
There are various arguments out there that discuss the causes of schizophrenia, and they tend to fall into two categories:
Biological explanations for schizophrenia attribute the cause of the disorder to neural correlates, brain abnormalities, genetics, and the dopamine hypothesis.
Psychological explanations for schizophrenia focus more so on family dysfunctions and cognitive explanations.
It is worth briefly pointing out the general problem of using a classification system to 'label' patients with disorders, as we need to evaluate the classification and diagnosis of schizophrenia.
Angermeyer and Matschinger (2003) surveyed adults of German nationality and found that labelling people with schizophrenia strongly negatively impacts public opinion.
Advocating the idea that schizophrenic patients are ‘dangerous' had a strong emotional impact on the way people react emotionally to someone with schizophrenia. Calling them needy led to mixed reactions.
In comparison, people with major depression were not as stigmatised in public opinion.
When two different classification systems are used, problems with reliability and validity arise in diagnosing schizophrenia. When two classification systems are used to diagnose a disorder, clinicians may not agree on a diagnosis because one manual may not list the same symptoms as another manual.
How can a person reliably diagnose schizophrenia when the ICD states to look for one set of symptoms, and the DSM states to look for a different set of prioritised symptoms?
If a person is misdiagnosed, the treatment may not be effective and address the root cause of the symptoms directly. It would be best to keep that in mind when consulting these diagnostic and classification tools.
Issues with comorbidity also exist, in that there is not enough separation between symptoms of different mental disorders.
The classification of schizophrenia is putting the disorder into a group of shared traits and symptoms to assign it to a mental health disorder.
Diagnosing and classification come in the form of the ICD and the DSM, especially concerning the criteria for schizophrenia.
Paranoid Schizophrenia, Catatonic Schizophrenia, and Residual Schizophrenia.
Alogia, Autism, Ambivalence, and Affect blunting.
Paranoid schizophrenia, catatonic schizophrenia, schizoaffective disorder, residual schizophrenia, disorganised schizophrenia, and undifferentiated schizophrenia.
What is the definition of reliability in psychology?
Reliability is the level of agreement different psychiatrists can reach on a single diagnosis for one individual, across both time and cultures, given that there is no change in the symptoms of the disorder.
What is the definition of validity in psychology?
Validity is the legitimacy of a test, i.e., whether what the psychiatrist uses to diagnose a person measures what it purports to measure. If it is valid, the diagnosis represents something real and is different from other disorders.
Name two types of validity in psychology.
Construct validity and content validity.
What is the definition of cultural bias in psychology?
Cultural bias exists because some psychiatrists diagnose a patient differently if the patient is from a different cultural background. They judge the patient according to what they think is acceptable in their own culture, rather than looking at the patient objectively and considering the patient’s culture and what is acceptable in the patient’s cultural views.
If a disorder has issues with reliability and validity, what could that mean?
It can mean the disorder may not be justified in being a diagnosable disease.
What is schizophrenia a form of?
It is a form of psychosis/mental illness.
What are the problems of labelling someone with mental illness?
The labelling of a mental illness, especially schizophrenia, in some cases leads to stereotyping and negative public attitudes.
What did Angermeyer and Matschinger (2003) find in their study?
They found that labelling people with schizophrenia strongly negatively impacts public opinion.
What is anhedonia?
Anhedonia is the inability to feel positive emotions fully.
True or False: Schizophrenia affects more people from lower economic backgrounds or groups.
What are the types of symptoms in schizophrenia?
Positive and negative symptoms.
True or False: Hallucinations are not a symptom of schizophrenia.
Are there issues with comorbidity in diagnosing and classifying schizophrenia?
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