Classification and diagnosis of schizophrenia

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  • Classification and diagnosis of schizophrenia (SC)
    • schizophrenia is a disorder characterized by; disorientated thinking, impaired emotional response, poor interpersonal skills, and distortion of reality
    • SC occurs in 1% of the world
    • classification
      • diagnostic criteria is very similar in the DSM-IV-R and the ICD-10, but the DSM states symptoms must be present for at least 6 months wheras the ICD states only 1 month
      • definition is: the individual must display one of list (1) of two of list (2) symptoms.: (1) Thought echo, withdrawal or broadcast, Delusions of control, Hallucinatory voices, Persistent delusions; or (2) Persistant hallucinations, Neologism, Catatonic behavior, Negative symptoms
      • Crow- distinguished between the positive and negative symptoms, the positive usually attribute to the persons behavior but negative ones involve loss of emotion or pleasure
    • Issues with the classification and diagnosis of SC
      • pre1970 there was cultural differences in the interpretation of the diagnosis, it was used liberally in the US but more broadly elsewhere
        • Cooper et al- in the US diagnosis of patients with SC rose to 80% in the 50's whilst the 20% rate of diagnosis remained constant in London
          • Attempts are being made to bring the DSM and ICD more in line
      • various criteria has been developed to help diagnose patients alongside the DSM & ICD:
        • Farmer et al- found using the criteria more reliable and useful
          • however the fact that there are so many variations in additional criteria makes it difficult to draw comparisons from research evidence
      • Szaz- questioned the concept of mental health and stated diagnosis is really political effort to control sociaty
      • Scheff- labeling mental health carries a stigma and becomes a self-fulfilling prophecy as the individual conforms to the label
      • Boyle and Bentall- the concept of SC is invalid so diagnosis is useless
      • it is difficult to define the boundaries of SC and other disorders such as mood disorders e.g. depression is often co-morbid (simultaneous) with schizophrenia
        • the DSM & ICD have tried to solve this through mixed disorder categories (e.g. post-psychotic depression) but the validity of these categories has been questioned
      • the wide variability in symptoms of SC has suggested that it is not one singular disease and researchers have developed various sub-types of schizophrenia, however their validity has been questioned as most patients are later rediagnosed
      • Jackson and Birchwood- early diagnosis and accurate treatment is the key to a long term positive outcome for SC patients, however the wide variability in symptoms and diagnosis makes the classification systmm invalid


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