A2 9 – Sample Response
Psychopathology & Schizophrenia
The Activity
As a trainee clinical psychologist, you are to write and present a talk on mental health and
schizophrenia, based upon notes you have made from several websites and consideration of
an accompanying case study. Your talk will explore the symptoms, diagnosis, causes of
schizophrenia, considering whether your case study is typical of the condition.
Remember that your presentation should last between 20 and 30 minutes. Whilst this may seem like
a lot of time, you have a lot of material to get across, some of which is fairly complex in nature.
The information below is intended to a serve as a guide and is not a model answer. The work based
around Emily G should form around half of your presentation.
[Title Example]
Emily G: A Case Study of Schizophrenia
Introduction
Introduce mental health and mental health problems, giving an indication of the scope of the problem
and its epidemiology in the UK. Provide an indication of the types of disorders which are
characteristic of mental health problems, together with an appreciation of the complexity of causation
and how certain groups of individuals are considered to be at greater risk.
Acknowledge and differentiate the two main systems for classification and diagnosis, the DSM-IV-TR
and the ICD-10-CM. You may wish to read more about these diganostic systems online.
Schizophrenia
Having introduced the basics of mental illness, you should now focus on schizophrenia. You could
begin with a brief outline of the disorder and then consider its symptoms (remembering to
differentiate positive from negative) and the different types diagnosed. For the purposes of this
presentation, you will be considering the DSM-IV-TR diagnostic criteria. It may be appropriate to
briefly consider the difference between psychosis and schizophrenia, together with misdiagnosis
issues.
Next, you should address the aetiology and causes of schizophrenia. Be sure that you mention
candidate neurotransmitter substances such as glutamate and serotonin, as well as the dopamine
hypothesis (and receptor classes). Be sure to inform your audience of the complex relationship
between biology, genes and prenatal factors determining vulnerability to schizophrenia. Briefly
outline how genes and environment may contribute to schizophrenia (introducing the concept of
epigenetic interactions).
Case Study: Emily G
Briefly overview Emily’s case to the audience, including her personal history and background, as
detailed in the case study. You may present the most important points or read the entire case to
them, whatever you deem to be the most effective way of communicating the information.
1
1) What are the main cognitive and behavioural impairments associated with Emily’s schizophrenia?
Indicate Emily’s positive and negative symptoms.
Emily’s primary presenting cognitive impairments are: disturbed thinking (as suggested by her threehour rambling speech and her tangential answers to Dr Higgins’ questions); hallucinations (Emily
began to think her face was changing); delusions (something about her forehead resembled the pain
of Christ); disturbed concentration and understanding (inability to attend, or respond, to Dr Higgins’
questions).
Emily’s primary behavioural impairments are: emotional vacillation (her mood changing dramatically
throughout the course of the conversation, which was punctuated by silly giggles and heavy sighs);
behaviour inconsistent with speech content; disturbed speech; peculiar motor behaviour (eyes,
opened wide, vacant stare, rigid facial expression, altered gait, awkward movement) and rigid
posture (stiff arms by her side); change in personal appearance (her hair and clothes were in
disarray); lack of reaction to questioning.
You may decide to present these symptoms on a PowerPoint slide, followed by a list of Emily’s
positive and negative symptoms.
Emily’s Symptoms
Positive Symptoms
Negative Symptoms
Disturbed concentration and thinking
Disorganised speech
Hallucinations
Delusions
Catatonic behaviours
Gross disorganised behaviour
Emotional incongruity and
affective flattening
Alogia (poverty of speech)
Avolition (lack of attention to
personal appearance)
2) Are Emily’s symptoms typical or atypical of schizophrenia? Which type of schizophrenia does
Emily’s pattern of symptoms most likely indicate?
Emily’s symptoms are all classic symptoms of schizophrenia and can be clearly differentiated as
positive or negative.
Emily’s symptom pattern is indicative of undifferentiated schizophrenia (conditions meeting the
general diagnostic criteria for schizophrenia but not conforming to any of the subtypes, or exhibiting
the features of more than one of them without a clear predominance of a particular set of diagnostic
characteristics) or disorganised schizophrenia (in which the person is verbally incoherent and may
have moods and emotions that are not appropriate to the situation). Diagnosis can only be made on
the basis of clinical interview and ‘guesses’ at diagnosis are usually avoided!
3) What are the most likely treatment options for Emily?
Some related questions to think about whilst answering the above question. What factors would
determine whether Emily receives a typical or an atypical antipsychotic medication? What are the
relative advantages of each drug class? What factors might influence whether Emily complies with
her treatment? Would psychosocial treatment offer any potential benefits to Emily?
Remember to conclude with a summary of your case study and what you have learned from the
exercise. Ask the audience for any questions arising.
2