Diagnosis and Classification of Schizophrenia
The diagnosis and classification of schizophrenia involves identifying symptoms such as delusions, hallucinations, disorganized thinking, and negative symptoms. The DSM-5 criteria are commonly used for diagnosis, requiring the presence of specific symptoms for a certain duration. Subtypes of schizophrenia, such as paranoid, disorganized, and catatonic, were previously used for classification, but the DSM-5 emphasizes a dimensional approach.
8 Key excerpts on "Diagnosis and Classification of Schizophrenia"
eBook - ePub- P. J. McKenna, P. J. McKenna(Authors)
- 2013(Publication Date)
- Routledge(Publisher)
...However, diagnosis according to presence of first rank symptoms did not distinguish between the schizophrenic and non-schizophrenic patients 13 years later. The logic of the methods that need to be used to test the validity of criterion-based approaches to diagnoses is quite convoluted, but their findings are clear. Making the diagnosis of schizophrenia according to a simple formula, presence of psychotic symptoms plus absence of manic-depressive mood change, is as accurate as a more judicious weighing of history and mental state information, experience and probably clinical intuition as well. Incorporation of the latter undoubtedly allows cases of schizophrenia to be picked up which would otherwise be missed; but even so the gains are relatively minor. Both approaches are almost certainly better than relying on the presence of first rank symptoms. Conclusion A largely unspoken distinction running through the work reviewed in this chapter has been that between two different senses in which the term ‘diagnosis’ is used. In its theoretical sense, diagnosis refers to a method of classifying disease, a way that may or may not be valid. In its practical sense, diagnosis describes an act of clinical decision-making; this cannot be either valid or invalid, it can only be performed with greater or lesser degrees of acumen. Some of the controversy that has surrounded the diagnosis of schizophrenia over the course of the twentieth century seems to have been due to the confusion between these two uses of the term. At the theoretical level, it is difficult to see what all the fuss was about. Diseases will always need to be classified according to some kind of scheme, and the one which isolated the entity of schizophrenia has clearly survived a quite searching examination of its reliability and validity...
eBook - ePubPsychotherapy for People Diagnosed with Schizophrenia
Specific techniques
- Andrew Lotterman(Author)
- 2015(Publication Date)
- Routledge(Publisher)
...It is likely that schizophrenia is a generic name we give to a heterogenous group of disorders within an even broader group of disorders called psychoses. We can imagine a continuum in which some psychotic symptoms arise primarily from disorders of brain structure or function resulting from constitutional determinates, and some from psychological causes. Many expressions of psychosis may arise from the interaction of each of these. The problem of using outcome to determine diagnosis There is a knotty problem with the diagnosis of schizophrenia that complicates the biology versus psychology dilemma. Since the time of Kraepelin (1902) it has been widely assumed that schizophrenia is associated with an inevitable downhill course. If a patient has a psychotic illness and gets progressively worse over time, then he is considered to have a schizophrenic disorder. On the other hand, if he improves, then perhaps he didn’t all along; perhaps he has an affective disorder, for example. Similarly, if a patient improves with psychological treatment, some clinicians conclude that the patient is therefore not truly suffering from a schizophrenic disorder. This leads to a tautology. Diagnosis and prognosis become collapsed into one. However, our assumptions that schizophrenia is defined by its poor outcome are contradicted by research data. Harding (1987) reported that 50–60% of patients diagnosed with schizophrenia had improved at a twenty to twenty-five-year follow-up. These were patients whose illnesses had been severe. On average, they had been totally disabled for ten years, and continuously hospitalized for an average of six years. In Harding’s study, 45% of patients previously diagnosed with schizophrenia no longer had psychiatric symptoms. Twenty-five to fifty percent of previously diagnosed patients had stopped their medications entirely and had no further symptoms of schizophrenia. A later study by Harding found similar results (Harding and Zahniser, 1994)...
- Susan Cave(Author)
- 2005(Publication Date)
- Routledge(Publisher)
...2 Classification, assessment and diagnosis Background Diagnostic and Statistical Manual of Mental Disorders (DSM) Axes I and II: Major categories International Classification of Diseases (ICD) Clinical assessment procedures Evaluation of classification and diagnosis Background One of the key features of the scientific approach to any subject is that it is systematic. The subject matter is grouped into categories of items that share similar features, or subjected to some other form of logical organisation that makes it easier to see patterns or consistencies in what is observed. The natural sciences have long employed classification systems of various sorts, such as the periodic table of the elements used in chemistry or the phylogenetic systems of the biological sciences. In the 19th century, medical science began to make progress by identifying different illnesses and providing different forms of treatment for them. By comparison, there was very little consistency in the approach to abnormal behaviour. In Britain, a classification scheme was produced by the Statistical Committee of the Royal Medico-Psychological Association, but never utilised by the members. In Paris and America similar schemes also failed to gain acceptance. One of these early schemes was that produced by Kraepelin (1883), who is often regarded as the founder of modern psychiatry. His system identified symptom groups or syndromes, which he considered to have organic causes, i.e. they were physically based. For example, severe mental illnesses were divided into dementia praecox (now known as schizophrenia), which was thought to result from a chemical imbalance, and manic-depressive psychosis, which was thought to result from metabolic irregularities. Kraepelin’s system was the basis from which modern diagnostic schemes developed. There are two major schemes in use at present...
eBook - ePub- R. H. Ettinger, R. H. Ettinger(Authors)
- 2017(Publication Date)
- Psychology Press(Publisher)
...The most distinctive, and diagnostic, features of schizophrenia, however, are the presence of psychotic delusions and hallucinations. p.130 This chapter discusses psychotic disorders with an emphasis on schizophrenia. We will examine its diagnostic criteria, its pathology, and the pharmacological approaches to its treatment. Other psychotic disorders, including schizoaffective disorder, delusional disorder, and schizophreniform disorder are not discussed separately here because their pathology and treatment do not differ significantly from that of schizophrenia. Defining and Diagnosing Schizophrenia The DSM-5 diagnostic criteria for schizophrenia require that two or more of the following symptoms be present for a significant portion of the time during the one month preceding its diagnosis: 1 Delusions. Delusions are strongly held beliefs that are quite clearly contradictory to external evidence. They often consist of misinterpretations of perceptions and everyday experiences. The most common theme in schizophrenia seems to be delusions of persecution, where the individual feels as if they are being watched, followed, or ridiculed behind their back. Another common theme is delusions of reference that might include feelings that comments by others, song lyrics, television personalities, news reports, or passages from books are purposely directed at them. Delusions may also be bizarre in that they are clearly impossible and not understandable by others who share the same religious and cultural experiences. For example, a bizarre delusion may be that one inhabits the body of another or that parts of one’s body have been exchanged with another person. Sometimes bizarre delusions include themes of control where one’s thoughts or behaviors are being manipulated by others, even aliens. 2 Hallucinations. Hallucinations are perceptual experiences that are not consistent with, or happen in the absence of, external stimuli...
eBook - ePub- Gordon Claridge, Caroline Davis(Authors)
- 2013(Publication Date)
- Routledge(Publisher)
...Third, classification serves a scientific need, by defining the guidelines for studying different types of disorder; it allows researchers interested in a particular disorder to select for investigation only those cases that share defined features of the condition they wish to study. Of course, since such research has to be done in order to help to establish the nosology in the first place, there is an element here of what is often called ‘bootstrapping’, that is, gradually refining the classification on the strength of new knowledge that accumulates from its use. It is evident from the above – and emphasized in the last point – that there is nothing that is cast in stone about current attempts to classify psychological disorders. Nosologies only represent a present state of affairs, an accumulated wisdom, as interpreted by contemporary experts in the field. This is illustrated by considering the two systems of psychiatric classification currently in use. One is the International Classification of Mental and Behavioural Disorders (ICD) (World Health Organization, 1992); the other is the Diagnostic and Statistical Manual of Mental Disorders (DSM) (American Psychiatric Association, 1994). The former, as the name implies, is a universal publication: it provides diagnostic guidelines for clinicians throughout the world and forms the basis for collating cross-national statistics on mental disorder. The DSM, on the other hand, is of North American origin but is also widely referred to outside the USA. Both the ICD and the DSM are essentially handbooks, consisting of lists of disorders, each accompanied by the defining characteristics by which the clinician arrives at a diagnosis in a particular case, Both glossaries are quite similar (or can be translated across from one to the other), but the fact that they are not identical indicates that the diagnostic categories they suggest are somewhat arbitrary and often represent compromise...
eBook - ePubSchizophrenia
A Scientific Delusion?
- Mary Boyle(Author)
- 2014(Publication Date)
- Routledge(Publisher)
...Chapter 4 The official correspondence rules for inferring schizophrenia 1 The development of diagnostic criteria Official guidelines as to what should be observed for schizophrenia to be inferred have been set out in a series of publications by the World Health Organization (WHO) and the American Psychiatric Association (APA). WHO guidelines for inferring schizophrenia are included in the medical manual, The International Statistical Classification of Diseases and Related Health Problems, previously The International Classification of Diseases, Injuries and Causes of Death. Their inclusion there implies that the concept of schizophrenia is similar to concepts used in medicine and that the activity of psychiatric diagnosis is similar to that of medical diagnosis. The guidelines for inferring schizophrenia are therefore best examined, and the problems surrounding them best understood, in the context of a general discussion of medical diagnosis. The first part of this chapter will therefore be concerned with describing the activity of medical diagnosis and its theoretical background, as well as with some of the most frequent misconceptions to be found in the literature on psychiatric diagnosis. The second part will describe and evaluate the early development of ‘official’ diagnostic criteria for inferring schizophrenia. The nature of diagnosis The word ‘diagnosis’ is derived from Greek and means to distinguish, to discern through perception. It is unfortunate that the term has come to be closely associated in the public mind with ‘finding out what is wrong with someone’ or with their functioning, and, indeed, has even been used in this way by some professionals (e.g. Silberman, 1971; Clare, 1976; Wakefield, 1999a, 1999b)...
- Christopher Donald Frith(Author)
- 2015(Publication Date)
- Psychology Press(Publisher)
...PSE-CATEGO classifies such people as schizophrenic while DSM-III-R does not. Currently, DSM-III-R uses the narrowest definition of schizophrenia and the one that is closest to Kraepelin’s original concept. In addition to mental state, DSM-III-R takes into account the time course of the illness. Patients have to show a loss of social functioning to below previous levels and to persist at this low level for at least six months. The only way to validate these essentially arbitrary definitions is to find some independent marker of schizophrenia, such as a characteristic neuropathology or a missing enzyme. Unfortunately, at present, no such marker exists. Currently there is much excitement at the prospect of finding a “schizophrenia gene”. There is abundant evidence for a genetic component in schizophrenia (Gottesman & Shields, 1982). If a gene (or genes) could be found, this would provide an ideal external validation for the diagnosis. I have already stated that one of the most intractable problems for the diagnosis of schizophrenia is that diagnosis is supposed to have implications about causal origin. In line with this approach, all the diagnostic schemes have in common a particular exclusion criterion; that there must be no obvious organic basis for the disorder. Thus, a patient with a mental state fulfilling all the criteria for schizophrenia will not be so diagnosed if there is any known possible organic cause, such as a brain tumour, porphyria (the disease from which King George III may have suffered), or drug abuse. Given that it is now widely believed that there is an organic basis to schizophrenia, I find this approach somewhat paradoxical. It has the implication that a patient can only be diagnosed schizophrenic as long as the organic cause of the illness is unknown. This problem will only be resolved if it can be shown that the majority of people diagnosed as schizophrenic have in common a specific organic aetiology...
- Amy E. Wenzel(Author)
- 2017(Publication Date)
- SAGE Publications, Inc(Publisher)
...Schizotypal personality disorder is also considered to fall within the schizophrenia spectrum. The schizophrenia spectrum disorders are organized along a gradient whereby clinicians are encouraged to first consider whether the patient’s signs and symptoms meet the threshold for a psychotic disorder and/or whether the signs and symptoms fall under a single domain. One considers the signs and symptoms of psychosis as falling on a continuum ranging from normal to abnormal mental states. Therefore, when conducting an assessment for a schizophrenia spectrum disorder, the clinician should examine whether beliefs are rigidly held or whether there is some flexibility. The clinician should examine whether perceptions (e.g., visual, auditory) accurately reflect an external stimulus (i.e., whether the auditory or visual perceptions accurately reflect the sounds or objects in the environment). Finally, the clinician should examine whether thoughts are logical, coherent, and goal directed based on the patient’s responses to questions and general verbal communication. Nonverbal observation is also important to determine whether the patient appears distracted (which could be due to the experience of hallucinations and also due to anxiety during the interview or cognitive difficulties experienced by the person). Any motor behaviors that seem odd or repetitive, as well as the range of affect presented by the person, also provide important information. There are only two conditions in the schizophrenia spectrum that fall under a single domain of psychosis: delusional disorder and catatonia. To meet the threshold for delusional disorder, the patient must have experienced delusions for 1 month in the absence of any other psychotic symptoms...
