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Schizophrenia – what’s wrong with this joke?

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

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Schizophrenia – what’s wrong with this joke?

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  1. Schizophrenia – what’s wrong with this joke?

  2. 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.

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

  4. 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

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

  6. 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

  7. Schizophrenia onset Source: CIHI (2001)

  8. 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

  9. 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

  10. 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

  11. Positive Symptoms • Delusions • Experiences of Control • Hallucinations • Disordered Thinking

  12. Negative Symptoms • Affective flattening • Alogia • Avolition

  13. RELIABILITY • DSM III introduced in 1980. 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?

  14. 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

  15. VALIDITY Can Scientists agree on what schizophrenia is? • 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!

  16. 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.

  17. Rosenhan1973 • http://www.youtube.com/watch?v=jXp-ANr8jAQ&feature=related

  18. 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

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

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