classification and diagnosis of scizophrenia
- Created by: lw121x
- Created on: 21-05-15 20:34
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- Classification and diagnosis of SZ
- About the classification systems
- DSM America + Europe
- DSM takes account individual situations as well as symptoms
- ICD UK + Europe 1 first rank or 2 second rank
- first rank: hallucinations Second rank catatonic behaviour (disturbances of movement)
- ICD better symptoms 1 month before diagnosis rather than 6
- Culture bias by Americas for Americans
- ICD advantage made by World Health Org represented 193 countries
- Positive symptoms :
- Delusions beliefs seem real to SZ delusions can be paranoid/ inflated beliefs
- Experiences of control- person may believe under control alien force
- Hallucinations unreal perceptions auditory or visual
- Disordered thinking- feeling thoughts been inserted/ withdrawn from mind
- Negative symptoms:
- affective flattening - reduction emotional expression
- alogia poverty of speech
- Avollition the reduction/ inability to strive goal driven behaviour
- Validity
- Undifferentiated sz 'rat bag' sz sufferers. Sufferers could have very different symptoms to each other
- Comorbidity
- issue when diagnosing SZ suffer 2 or more disorders at once.
- symptoms overlap ie. lack motivation
- Sim et al 142 hospitalised 32% more than 1 diagnosis and they had poorer awareness/ outcome. Validity questioned ie. low motivation subjective
- Untitled
- issue when diagnosing SZ suffer 2 or more disorders at once.
- Ethnicity rates 2x more likely afro carb because of cultural differences in class system
- Continuum approach - no sharp line between ind w or w/o disorder
- we all have symptoms ie. hearing voices after loss of loved one
- diagnosis on severity not on symptoms. Is it valid or SZ part of human existence?
- supported Chapman questionnaire alluded positive/ nef symptoms 'normal people' high test scores
- Rosenhan tested the hypothesis that the system isn't valid ie. wasn't appropriately diagnosing people
- can't tell sane from insane. 8 sane people gain admission 12 hospitals. 7/8 diagnosed SZ ( average 19 days )
- symptom issues
- Follow up ... pretended to put individuals in hospital none given 42 genuine patients
- Not clear abnormal/ sane. 40 years old outdated would have changed / improved. Would not get diagnosed now had to be 1 month ICD require 2 symp
- can't tell sane from insane. 8 sane people gain admission 12 hospitals. 7/8 diagnosed SZ ( average 19 days )
- Conclusions exaggerated 'SZ in remission' PSY not convinced
- PSY doesn't show validity if they were convincing
- no objective tesr = inevitably biased
- Not clear abnormal/ sane. 40 years old outdated would have changed / improved. Would not get diagnosed now had to be 1 month ICD require 2 symp
- Reliability
- sufferer diagnosed as one type of SZ in each classification system
- However, Jacbobsen + al operationalized criteria checklist diagnosing SZ agreement ICD + DSM
- Cultural - inter rater
- Copeland gave description patient UK and US. US 69% diagnosed UK 2%
- Cooper NY psy 2x likely diagnose SZ than LON
- Beck looked at inter rater r between 2 psychiatrists 154 patients inter rater 54%
- Inter rater
- Beck earlier models ICD did not define clearly
- + whaley interrater classification as low as 0.69%
- Beck earlier models ICD did not define clearly
- sufferer diagnosed as one type of SZ in each classification system
- Labelling
- Once a patient is labelled = stigma
- advantage = relieve anxiety/ proper treatment
- dis- unemployment + self fulfilling P
- About the classification systems
- Nicholson 50 psychiatrists in US found inter rater reliability +0.4 when asked bizarre/ non bizarre symptoms
- low reliability because delusions bizarre needed diagnosis SZ
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