Schizophrenia

Clinical characteristics and

diagnosis

Issues surrounding diagnosis and

classification
 Schizophrenia
Distorted thinking, impaired emotional responses, poor
interpersonal skills and distortion of reality.

It is the best known (and most common) of the ‘psychotic

disorders’.

Worldwide the prevalence is around 1% of the population.

The word ‘schizophrenia’ comes from the greek words meaning

‘split mind’.

This is misleading and the condition should not be confused with

‘split personality disorder’. Schizophrenia sufferers do not have ‘2
personalities’.
 Course of the illness
Generally develops in early adult life – women tend to develop
the illness around 5-10 years later than men.

Childhood schizophrenia is occasionally diagnosed but is very rare.

It is an ‘episodic’ illness in which periods of psychotic disturbance

are usually spread with phases of more normal functioning.
Sufferers often show signs of low mood, anxiety and issues
with personal relationships.

This is followed by an ‘active phase’ which may last between 1

and 6 months. This psychotic phase can last as long as a year
and the degree of disruption varies greatly from one patient to the
next.
 Prognosis
There is disagreement about the outcomes for people
suffering with the illness.

Some have argued that complete recovery from this condition

is impossible. More recent research has shown that around
2/3’s of people will go on to make a substantial improvement /
recovery.

Depression often occurs co-morbidly with schizophrenia and,

sadly, around 10-15% of people diagnosed with the illness will
go on to commit suicide.
 Issues with diagnosis and
classification
The diagnosis of schizophrenia has varied hugely from one
country to the next… this reflects issues with diagnosis and
classification.

Between the 1930’s and 1950’s the level of people diagnosed

rose from 20% to around 50% of people in the USA. During
this same period the rate in the UK remained at around 20%.

The diagnosis in the USA was much more liberal. This

difference between countries led to an effort to improve
diagnosis methods….

There are now 2 major classification systems used for the

diagnosis of mental health disorders.
 Diagnostic criteria
(What are the symptoms?)

The DSM-IV:
(The diagnositic and statistical manual of mental
disorders, 4th edition).

This is based on the idea that certain symptoms can be grouped

together as ‘syndromes’ or disorders.

There is an acceptance that these conditions and the related

symptoms can overlap and that the ‘boundaries’ are not set or
finite.

Mental disorders are viewed in the same way as physical

conditions which can be diagnosed, treated and eventually cured.
 Diagnostic criteria
(What are the symptoms?)

ICD-10
(International Classification of Diseases, 10th
Revision)

A similar system to the DSM-IV which was

developed by the WHO (World Health Organisation).
 Issues with diagnosis and
classification
There are several different sets of diagnostic criteria
in use. This is confusing and potentially unhelpful
for health professionals.

The act of labelling each type is damaging (Scheff,

1966). Can create a ‘self-fulfilling prophecy’.

It has also been suggested that, due to reliability of

the diagnosis, the label of schizophrenia isn’t
actually useful or helpful in reality.
 Issues with diagnosis and
classification
A valid classification system should be able to predict the
outcome or responses to treatments…. This is not true of
schizophrenia.

There is evidence that early diagnosis and intervention

(treatment) is linked with better long term outcomes…. This
shows the importance of having a strong diagnosis /
classification system.

There is an argument that the use of multiple diagnosis

systems could be helpful rather than unhelpful – GP’s or
psychiatrists have the option of comparing these systems of
diagnosis.
 Seto (2004)
Reported that the term ‘schizophrenia’ was re-
labelled as ‘integration disorder’ in Japan due to
issues with getting a reliable diagnosis.

This would suggest that schizophrenia as a distinct

and separate disorder does not exist.

This highlights issue with diagnosis and

classification.
 Improving picture…
Beck (1962) Found that concordance (agreement) between
classifications by practitioners was 54%.

This figure had raised to 82% in 2005 (Soderberg) which

suggests these systems have improved significantly with
improved understanding of the illness.
 Agreed language…
What the diagnosis tools and systems to provide is an agreed
language which allows practitioners to share and compare
notes and thoughts.

It is agreed that the diagnosis of mental illnesses has

improved and continues to improve with increased knowledge.

The DSM-IV has been shown by a series of studies to be the

more reliable system because it has more specific terms for
each of the disorders.
 Szasz (The myth of mental
illness)
Szasz (1973) argued that
schizophrenia was in fact not a
medical condition but rather a means
of social control, used to oppress and
control members of society who do not
conform to agreed norms of behaviour.
This could lead to sufferers
being ignored and could be
dangerous for individuals and
wider society.
 Scheff
Argued that schizophrenia is not a
mental illness but a learned social role.

Scheff argues that the condition (or

behaviour) is a response to societal
labels. This ignores a wealth of
biological (empirical)
evidence which points to
genetic, biochemical
and neuroanatomical
factors linked with
schizophrenia.