Schizophrenia: Diagnosis and Symptoms

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Questions and Answers

What is schizophrenia?

A psychotic disorder where individuals lose contact with reality and struggle to distinguish real and imagined experiences.

Why might people with schizophrenia not seek help?

They often lack insight into their condition.

How long must symptoms persist for a schizophrenia diagnosis according to ICD-11?

At least one month.

What must be ruled out before diagnosing schizophrenia?

Substance misuse, medication side effects, or physical conditions (e.g., brain tumors). Signup and view all the answers

What are the six symptom dimensions of schizophrenia in ICD-11? (Select all that apply)

Mood symptoms Signup and view all the answers

Positive symptoms are the absence of normal psychological functions.

False Signup and view all the answers

What are hallucinations?

Involuntary perceptual experiences occurring without external stimuli. Signup and view all the answers

Which of these is NOT an example of a hallucination in schizophrenia? (Choose one)

Tactile (feeling a presence or being touched) Signup and view all the answers

What are experiences of influence, passivity, or control?

The subjective feeling that thoughts, emotions, or actions are being controlled by external forces. Signup and view all the answers

What is thought withdrawal?

The feeling that one's thoughts are being removed. Signup and view all the answers

What is thought insertion?

The feeling that thoughts are being implanted in one's mind. Signup and view all the answers

What is thought broadcasting?

The feeling that one's thoughts are being transmitted to others. Signup and view all the answers

What are delusions?

Fixed beliefs that conflict with reality. Signup and view all the answers

Which of these is NOT an example of a delusion in schizophrenia? (Choose one)

Thought blocking (sudden interruption of thoughts) Signup and view all the answers

What are prodromal symptoms?

Weaker versions of core symptoms before diagnosis (e.g., suspecting people are talking about you versus being convinced of it). Signup and view all the answers

What is disorganized thinking?

Losing train of thought (derailment), incoherent speech (word salads), or creating new words (neologisms). Signup and view all the answers

What is disorganized behavior?

Actions, gestures, or postures that appear inappropriate, unexpected, or purposeless Signup and view all the answers

Negative symptoms are the presence of abnormal psychological experiences.

False Signup and view all the answers

What is flat affect?

Lack of emotional highs and lows. Signup and view all the answers

What is avolition?

Inability to perform goal-directed actions (e.g., preparing a meal). Signup and view all the answers

What is alogia?

Limited spoken language. Signup and view all the answers

What is asociality?

Social withdrawal Signup and view all the answers

What is the prevalence of schizophrenia in males and females?

~0.3-0.7% for both. Signup and view all the answers

At what age is schizophrenia typically diagnosed in males?

Early to mid-20s. Signup and view all the answers

Why is schizophrenia rarely diagnosed in children under 13?

Symptoms overlap with other disorders (e.g., autism, OCD), making diagnosis unreliable. Signup and view all the answers

Give an example of schizophrenia in a child.

Aneja et al. (2018): A 14-year-old boy exhibited clear symptoms of schizophrenia. Signup and view all the answers

Which of these was NOT a symptom experienced by the 14-year-old boy in the Aneja et al study? (Choose one)

Suspicion of his mother Signup and view all the answers

Describe the strengths of Aneja et al study.

The detailed case history provided in-depth, contextual information, increasing the validity of the schizophrenia diagnosis. The detailed case history helps validate diagnoses, especially in younger individuals where diagnosis can be challenging. Signup and view all the answers

Which of these is a weakness of the Aneja et al study? (Choose one)

All of the above. Signup and view all the answers

Give an example of an ethical or practical consideration in Aneja et al study.

Ensuring informed consent, protecting the child's well-being, and maintaining confidentiality. There may be difficulty obtaining reliable self-reports due to age and understanding. There is the potential impact of stigma on the child and their family. Signup and view all the answers

What considerations are there when using children in psychological research?

Children cannot provide informed consent due to age; proxy consent from a guardian is required. Children are also asked for their consent. Information must be adapted to ensure they understand the study, their rights to withdraw, and data usage. Researchers must prioritize the rights and welfare of vulnerable children, especially those with mental health difficulties. Signup and view all the answers

What are the strengths of ICD-11 in diagnosing schizophrenia?

ICD-11 requires symptoms to be present for one month, enabling faster access to treatment compared to DSM-5's six-month requirement. Early treatment leads to better outcomes (Patel et al., 2014). It also replaced unreliable subtypes (e.g., paranoid, catatonic) with dimensional descriptors, increasing diagnostic reliability by accounting for symptom changes over time and improving treatment specificity. Signup and view all the answers

What are the weaknesses of ICD-11 in diagnosing schizophrenia?

Symptom overlap with conditions like depression, drug withdrawal, stress, or sleep deprivation can cause misdiagnosis, reducing reliability. Subjective symptoms may lead to cultural misinterpretations; for example, people who hear voices are respected in their culture, while such experiences may be considered pathological in Western cultures. Signup and view all the answers

What was the aim of Freeman et al study?

To investigate if participants without history of mental illness have persecutory ideations/ thoughts via VR. To investigate if there are cognitive or emotional factors that predict the likelihood of persecutory ideation via VR. Signup and view all the answers

What was main hypothesis of Freeman et al?

Only a small number of the participants would have persecutory thoughts/ ideations in VR, especially those with higher levels of emotional distress & paranoia. Signup and view all the answers

Describe the sample in the Freeman et al study.

12 males & 12 females. 21 Students & 3 admin staff from University College London, UK. Mean age of 26 years. No history of mental illness. Paid for their participation. Signup and view all the answers

What was the sampling method used in the Freeman et al study?

Volunteer sampling via ads within the University. Signup and view all the answers

What research method did Freeman et al use?

Correlational study in a lab setting. Signup and view all the answers

Describe the procedure used in Freeman et al study.

Participants were trained on operating VR (lightweight headgear to track head position & orientation & handheld joystick that allows Ps to move around the virtual space). Deception used: told the aim "explore the room & try to form some impression of what you think about the people in the room & what they think about you." VR included 5 avatars in the scene- 3 sat at one desk & 2 sat at another desk. Avatars would show occasional ambiguous behavior, e.g., smiling, looking, talking to each other. Half the participants completed all the questionnaire before VR. Then, all Ps asked to enter a VR environment (a library scene) for 5 minutes. After leaving the VR, all participants answered the series of questionnaires (half of them did them twice). Lastly, semi-structured interview conducted to find out the Ps thoughts & feelings about the VR experiences. They were Video-taped. Rated for persecutory content on a 6-point scale by Freeman. Signup and view all the answers

Which of these questionnaires was NOT used in the Freeman et al study? (Choose one)

Beck Depression Inventory Signup and view all the answers

Describe the Brief Symptom Inventory (BSI)

A 53-item test measures 9 symptoms from the past 7 days- Feeling inadequate in social situations (interpersonal sensitivity). Other symptoms: physical complaints, obsessive thoughts, depression, anxiety, anger, phobias, paranoia, and psychotic behavior. Scored on a scale from 0 (none) to 4 (severe). Signup and view all the answers

Describe the Spielberger State Anxiety Questionnaire.

20-item test to measure anxiety levels. Scored on a 4-point scale (1 to 4). Higher scores indicate higher anxiety. 50% of participants completed it before entering VR to check for distress caused by VR. Signup and view all the answers

Describe the Paranoia Scale.

20-item test measuring paranoia, including ideas of persecution and reference. Scored on a 5-point scale (1 to 5). Higher scores indicate higher levels of paranoid thoughts. Signup and view all the answers

Describe the VR Paranoia questionnaire.

15-item questionnaire measuring persecutory thoughts, ideas of reference, and positive beliefs about avatars. Newly designed due to lack of existing tests for situation-specific paranoia. Scored on a 4-point scale (0 to 3). Higher scores indicate stronger endorsement of paranoid thoughts. Signup and view all the answers

Describe the Sense of Presence Questionnaire.

6 items measuring how real the virtual world feels. Assesses: Feeling of "being there" in the virtual world. Feeling of having visited a place, not just seen images. How much the virtual world affects behavior more than the real world. Scored on a 7-point scale (1 to 7). Higher scores mean a stronger sense of presence. Signup and view all the answers

What were the main results of Freeman et al study?

Strong correlation between paranoia questionnaire and interview scores. Most participants had positive views of avatars, though some showed ideas of reference and persecution. Significant correlation between VR-Persecution and VR-Reference scores. Negative correlation between VR-Persecution and VR-Positive scores. No significant gender differences in persecution scores. No significant difference in persecution scores before and after VR. No correlation between thoughts about the avatar and paranoia score. Higher VR-Persecution scores linked to higher BSI-paranoia scores. Increased BSI-Interpersonal sensitivity and anxiety linked to higher persecutory ideation in VR. Signup and view all the answers

What were the main conclusions of the Freeman et al study?

People do attribute mental states to VR characters & can be persecutory in nature. People with high levels of interpersonal sensitivity/ anxiety are more likely to show persecutory ideation. Signup and view all the answers

Study Notes

Schizophrenia: Key Characteristics and Diagnosis

Schizophrenia is a psychotic disorder characterized by a loss of contact with reality and difficulty distinguishing real from imagined experiences.
Individuals with schizophrenia may not seek help due to a lack of insight into their condition.
According to ICD-11, symptoms must persist for at least one month to diagnose schizophrenia.
Before diagnosing schizophrenia, rule out substance misuse, medication side effects, and physical conditions like brain tumors.
ICD-11 uses six symptom dimensions: positive symptoms, negative symptoms, mood symptoms, cognitive symptoms, behavioral symptoms, and their severity.

Positive Symptoms

Positive symptoms are the presence of abnormal experiences.
Hallucinations are involuntary perceptual experiences without external stimuli.
Examples include auditory (hearing voices), visual (seeing things), and olfactory (smelling nonexistent odors).
Experiences of influence, passivity, or control describe the feeling that thoughts, emotions, or actions are controlled by external forces. Specific examples include thought withdrawal, thought insertion, and thought broadcasting.
Delusions are fixed beliefs that contradict reality. Examples include delusions of grandeur (having exceptional powers), persecution (believing others want to harm or spy), and reference (believing events have personal significance).
Prodromal symptoms are weaker versions of core symptoms before diagnosis.

Negative Symptoms

Negative symptoms involve the absence of normal psychological functions.
Flat affect is a lack of emotional expression.
Avolition is the inability to perform goal-directed actions.
Alogia is limited spoken language.
Asociality is social withdrawal, and anhedonia is the inability to experience pleasure.

Prevalence and Age of Onset

Schizophrenia prevalence is approximately 0.3-0.7% in both males and females.
Males typically receive schizophrenia diagnoses in their early to mid-20s, whereas females usually receive diagnoses in their late 20s, with later onset (after age 40) being more common in females.
Diagnosing schizophrenia in children under 13 is rare due to symptom overlap with other disorders.

Aneja et al. (2018) Case Study

Aneja et al. (2018) described a 14-year-old boy with schizophrenia.
The case history indicated a troubled home environment and divorce.
The boy’s symptoms included auditory hallucinations (hearing voices), suspicion, social withdrawal, and unusual behaviors (muttering, laughing, shouting).
He initially improved with medication (e.g., sodium valproate) but later experienced aggressive outbursts, needing hospital admissions.
The study illustrated the complexity and challenges in diagnosing and treating schizophrenia in young individuals.

Ethical and Practical Considerations (Children in Research)

Obtaining informed consent from children is not possible due to their age. Proxy consent from a guardian is needed.
Information provided in research must be adaptable to ensure children understand procedures, their rights, and data handling.

Strength & Weaknesses of ICD-11

ICD-11's shorter symptom duration requirement for diagnosis (one month) leads to faster access to treatment, unlike DSM-5's six-month requirement. Early treatment tends to lead to better outcomes.
Dimensional descriptions in ICD-11 (instead of unreliable subtypes) enhance diagnostic reliability.
Overlapping symptoms with other conditions (e.g., depression, stress) can lead to misdiagnoses. Cultural differences can also impact symptom interpretation.

Freeman et al. Study (20XX) – Virtual Reality and Paranoia

Freeman et al. investigated whether people without a history of mental illness could experience persecutory ideations (thoughts) in a virtual reality (VR) environment.
The study focused on investigating cognitive and emotional factors related to potential persecutory ideation.
Participants (12 males and 12 females, mean age 26) responded to questionnaires before and after a 5 minute VR experience (library scene with avatars)
5 questionnaires used: Brief Symptom Inventory, State Anxiety, Paranoia scale, VR-Paranoia, Sense of presence questionnaire
Findings indicated a correlation between higher paranoia scores and persecutory thoughts in the VR setting, particularly among individuals with high levels of interpersonal sensitivity or anxiety,

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Description

This quiz covers the key characteristics and diagnostic criteria for schizophrenia, including the various symptom dimensions as outlined in ICD-11. Explore how positive symptoms manifest and how they differ from other types of symptoms. Test your knowledge on the complexities of this psychotic disorder.