Classification and Diagnosis of Schizophrenia

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  • Classification and Diagnosis of Schizophrenia
    • Clinical Characteristics
      • Profound disruption of cognition and emotion-affects language, perception, affect and sense of self
      • Diagnosis of schizophrenia-under DSM-IVR, diagnosis requires at least a month's duration of two or more +ve symptoms
      • +VE symptoms-excess or distortion of normal symptoms e.g. delusions, experiences of control, hallucinations etc.
      • -VE symptoms- loss of normal functions, e.g. affective flattening, alogia, avolition
    • Reliability
      • Inter-rater reliability- DSM-III and later versions claim increased reliability and diagnosis.
      • Test-retest reliability- screening tests such as RBANS show high test-retest reliability.
        • Performance on measures of cogntive deficits linked with schizophrenia stable over a 6 month period
      • Inter-rater reliability- despite claims for increased reliability, there is still little evidence the DSM is routinely used with high reliability by mental health clinicians
        • 'On being sane in insane places'-demonstrated unreliability of diagnosis- Rosenhan
      • Unreliable symptoms- diagnosis based on 'bizarre' delusions not a reliable method of distinguishing between schizophrenic and non-schizophrenic patients
      • Comparing DSM and ICD- schizophrenia was more frequently diagnosed in ICD-10 than DSM-IV criteria (Cheniaux et al., 2009)
      • Reliability of diagnosis challenged by differences between US and UK
    • Validity
      • Psychiatric comorbidities are common among patients with schizophrenia and creates difficulties in diagnosis of schizophrenia
        • Comorbidity and medical complications- Weber found evidence of many comorbid non-psychiatric diagnoses among patients with schizophrenia, which affects prognosis
        • Comorbidity and suicide risk- persons with schizophrenia at risk for suicide, with comorbid depression the major cause for suicidal behaviour
      • Klosterkötter et al- found +ve symptoms more useful for diagnosis than -ve symptoms
      • Prognosis-people diagnosed as schizophrenicrarely share the same symptoms, nor the same outcomes
      • Ethnicity and misdiagnosis- rates of schizophrenia among African-Caribbeans much higher than white populations, which in part may be a product of misdiagnosis
      • Symptoms- schizophrenia symptoms also found in many other disorders, including depression and DID
  • Inter-rater reliability- despite claims for increased reliability, there is still little evidence the DSM is routinely used with high reliability by mental health clinicians
    • 'On being sane in insane places'-demonstrated unreliability of diagnosis- Rosenhan
  • Psychiatric comorbidities are common among patients with schizophrenia and creates difficulties in diagnosis of schizophrenia
    • Comorbidity and medical complications- Weber found evidence of many comorbid non-psychiatric diagnoses among patients with schizophrenia, which affects prognosis
    • Comorbidity and suicide risk- persons with schizophrenia at risk for suicide, with comorbid depression the major cause for suicidal behaviour

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