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Diagnosis and Classification of Schizophrenia

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Diagnosis and Classification of Schizophrenia

Diagnosis is a crucial step in the treatment of any mental illness. It should be detailed, accurate, and provide reassurance. In this article, we describe and evaluate the classification and diagnosis of schizophrenia by examining the various classification systems psychologists use and the problems associated with them.

Let us first recapitulate the definition of schizophrenia.

Schizophrenia is a psychosis characterised by positive (adding an experience) and negative (taking something away) symptoms.

According to the World Health Organisation (1992), schizophrenia affects approximately 20 million people worldwide.¹ We will look at the diagnosis and classification of schizophrenia.

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:

  • People between the ages of 15 and 45.
  • More men than women.
  • More people in cities.
  • More people from lower economic backgrounds or groups.

Clinicians or psychiatrists use either the ICD (International Classification of Diseases) or the DSM (Diagnostic and Statistical Manual of Mental Disorders) to diagnose a patient.

Diagnosis and classification of schizophrenia: ICD versus DSM

Both the ICD and the DSM 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.

What is the ICD (International Classification of Diseases)?

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, having 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:

  • Negative symptoms for at least one month consistently, with one or more of the following:

    • Incoherent speech, catatonic behaviours, avolition, and some positive symptoms, such as delusional perceptions and hallucinations, i.e., hearing voices.

The DSM is sometimes still used as the basis for the ICD.

What is the DSM (Diagnostic and Statistical Manual of Mental Disorders)?

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:

  • Positive symptoms for at least one month consistently, such as:

    • Delusions, hallucinations, disorganised speech – these are prioritised in the diagnosis, and the following symptoms are also considered (although the first three must be present), disorganised behaviour, catatonic behaviour.

Diagnosis and Classification of Schizophrenia Diagnosis of schizophrenia StudySmarterDiagnosis of schizophrenia, Canva

Now that we have discussed the classification tools, we can clarify the symptoms of schizophrenia.

What are the types 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:

  • Paranoid Schizophrenia.

  • Catatonic Schizophrenia.

  • Schizoaffective disorder.

  • Disorganised Schizophrenia.

  • Residual Schizophrenia.

  • Undifferentiated Schizophrenia.

Famously, Bleuler established the four A's of schizophrenia (McNally, 2009):

  • Affect blunting.

  • Alogia.

  • Ambivalence.

  • Autism.

What are the symptoms of schizophrenia?

Symptoms can be divided into two categories:

  1. Positive.

  2. Negative.

Here are examples of positive and negative symptoms of schizophrenia.

What are the positive symptoms of schizophrenia?

Something is added to the patient's experience with positive symptoms, which does not mean something good. Instead, the patient now has symptoms that cause reality perception problems.

For example:

  • 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 manifesting as delusions of persecution.

      A patient may believe the government is persecuting them.

    • External control.

      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).

What are the negative symptoms of schizophrenia?

Negative symptoms are the opposite of positive because they take something away from the patient. In essence, it is a loss of functioning.

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.

Diagnosis and Classification of Schizophrenia Positive and negative symptoms of schizophrenia StudySmarter

Positive and negative symptoms of schizophrenia, Tyler Smith, StudySmarter Originals

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.

The problem with using classification tools

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.

  • Scheff (1999) also considered that mental illness labelling profoundly affected the stigmatised patients and almost created a self-fulfilling prophecy, i.e. patients began to behave as they were 'expected' to as schizophrenic or mentally ill people after being labelled.

Diagnosis and Classification of Schizophrenia Stigma in schizophrenia StudySmarter

Stigma in schizophrenia, Tyler Smith, StudySmarter Originals

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 dictates to look for negative symptoms, and the DSM dictates to look for positive 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.


Diagnosis and Classification of Schizophrenia - Key Takeaways

  • The main classification tools used by professional diagnosticians are the ICD and the DSM. The ICD is used worldwide, while the DSM is mainly used in America. However, the DSM provides a good foundation for the ICD.
  • The ICD requires the presence of negative symptoms, whilst the DSM involves the presence of positive symptoms. Both must last at least one month for a diagnosis.
  • Schizophrenia has POSITIVE and NEGATIVE symptoms. Positive symptoms give the patient new, additional experiences in their perception of reality, whilst negative symptoms take experiences away from the patient.
  • Classification tools are essential so that doctors worldwide can make consistent diagnoses. Two patients with the same condition could receive different diagnoses and treatments from different doctors without them.
  • There is a problem of stigma when using classification tools. The labelling of a mental illness, especially schizophrenia, in some cases leads to stereotyping and negative public attitudes.

¹World Health Organization, Schizophrenia, 2021.

Frequently Asked Questions about Diagnosis and Classification of Schizophrenia

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.

Final Diagnosis and Classification of Schizophrenia Quiz

Question

What is the definition of reliability in psychology?

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Answer

​​​​​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.

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Question

What two tests can be used to test reliability?

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Answer

The test-retest and the inter-rater reliability tests can be used to determine reliability.

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Question

What did Cheniaux (2009) find in their study?

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Answer

In Cheniaux (2009), two psychiatrists had to assess 100 patients using the DSM and the ICD. They found that inter-rater reliability was poor, as one psychiatrist diagnosed 26 patients with schizophrenia using the DSM while diagnosing 44 patients with schizophrenia using the ICD.

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Question

What is the definition of validity in psychology?

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Answer

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.

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Question

Name two types of validity in psychology.

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Answer

Construct validity and content validity.

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Question

What is the definition of comorbidity?

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Answer

Comorbidity is when two or more disorders coincide in a person.

Show question

Question

What did Buckley et al. (2009) find in their study?

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Answer

Buckley et al. (2009) found that comorbid depression occurs in 50% of patients with schizophrenia.

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Question

What is the definition of symptom overlap?

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Answer

Symptom overlap is the significant overlap between the symptoms of schizophrenia and other disorders.

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Question

What did Bambole et al. (2013) find in their study?

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Answer

Bambole et al. (2013) noted that patients diagnosed with schizophrenia and bipolar disorder have both positive and negative symptoms, making it difficult to distinguish between them.

Show question

Question

What is the definition of gender bias?

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Answer

Gender bias in the classification and diagnosis of schizophrenia occurs when the diagnosis is dependent on the patient’s gender. What symptoms they display and explain is usually irrelevant, as judgments are made based on their gender.

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Question

What did Longenecker (2010) find in their study?

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Answer

Longenecker (201) found that, since 1980, more men have been diagnosed with schizophrenia than women. This finding raises issues both in the diagnosis of women (whether under or overdiagnosed) and the overdiagnosis of men.

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Question

What is the definition of cultural bias in psychology?

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Answer

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.

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Question

What did Tortelli et al. (2015) find in their study?

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Answer

Tortelli et al. (2015) noted that despite improved study methods over time, there has been a higher rate of psychotic disorders in black, Caribbean ethnic groups in England over the past 60 years.

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Question

If a disorder has issues with reliability and validity, what could that mean?

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Answer

It can mean the disorder may not be justified in being a diagnosable disease.

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Question

What happens if a patient is misdiagnosed?

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Answer

Treatment may not be effective and will not address the root cause of the symptoms directly.

Show question

Question

What is schizophrenia a form of?

Show answer

Answer

It is a form of psychosis/mental illness.

Show question

Question

What are the classification manuals mental health professionals use?

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Answer

The ICD (International Classification of Diseases) and the DSM (Diagnostic and Statistical Manual of Mental Disorders).

Show question

Question

Where is the DSM (Diagnostic and Statistical Manual of Mental Disorders) primarily used?

Show answer

Answer

In America. The ICD is used worldwide but uses the DSM as a base.

Show question

Question

In the ICD (International Classification of Diseases), what must a patient show symptom wise to be diagnosed with schizophrenia?

Show answer

Answer

According to the ICD, for a patient to be diagnosed with schizophrenia, they have to have negative symptoms for at least one month consistently, with one or more of the following: incoherent speech, catatonic behaviours, avolition, and some positive symptoms, such as delusional perceptions and hallucinations, i.e., hearing voices.

Show question

Question

In the DSM (Diagnostic and Statistical Manual of Mental Disorders), what must a patient show symptom-wise to be diagnosed with schizophrenia?

Show answer

Answer

Positive symptoms for at least one month consistently, such as: Delusions, hallucinations, disorganised speech – these are prioritised in the diagnosis, and the following symptoms are also considered (although the first three must be present), disorganised behaviour, catatonic behaviour.

Show question

Question

Name three positive symptoms of schizophrenia.

Show answer

Answer

Hallucinations, delusions, and disorganised speech.

Show question

Question

Name three negative symptoms of schizophrenia.

Show answer

Answer

Avolition, speech poverty (alogia), and affective flattening. 

Show question

Question

How does avolition present itself, according to Andreason (1982)?

Show answer

Answer

Through poor hygiene, lack of motivation/perseverance, and energy.

Show question

Question

What are the problems of labelling someone with mental illness?

Show answer

Answer

The labelling of a mental illness, especially schizophrenia, in some cases leads to stereotyping and negative public attitudes.

Show question

Question

What does DSM stand for?

Show answer

Answer

Diagnostic and Statistical Manual of Mental Disorders.

Show question

Question

What does ICD stand for?

Show answer

Answer

International Classification of Diseases. 

Show question

Question

What did Angermeyer and Matschinger (2003) find in their study? 

Show answer

Answer

They found that labelling people with schizophrenia strongly negatively impacts public opinion.

Show question

Question

What did Scheff's study (1999) suggest?

Show answer

Answer

Scheff (1999) suggested that mental illness labelling profoundly affected the stigmatised patients and almost created a self-fulfilling prophecy, i.e. patients began to behave as they were 'expected' to as schizophrenic or mentally ill people after being labelled.

Show question

Question

What is alogia?

Show answer

Answer

Alogia (speech poverty) refers to a decrease in the quality and quantity of speech. Patients speak slower, less, and delay their responses.

Show question

Question

What is anhedonia? 

Show answer

Answer

Anhedonia is the inability to feel positive emotions fully.

Show question

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