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        • Disordered thinking- feeling thoughts been inserted/ withdrawn from mind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
      • 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          • Not clear abnormal/ sane. 40 years old outdated would have changed / improved.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
    • 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%
    • Labelling
      • Once a patient is labelled = stigma
      • advantage = relieve anxiety/ proper treatment
      • dis- unemployment + self fulfilling P
  • 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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