Issues Surrounding the Classification and Diagnosis of Schizophrenia
- Created by: Lisgoe
- Created on: 04-11-14 14:16
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- Issues Surrounding the Classification and Diagnosis of Schizophrenia
- Disorders similar to Sz
- Cross-overs in symptoms
- MPD's and Depression
- e.g. Hallucinatory voices and Negative symptoms such as emotional bluntness
- Cause misdiagnosis
- Unnecessary treatment
- MPD's and Depression
- Cross-overs in symptoms
- Different diagnostic criteria, (DSM and ICD)
- Difficulty choosing which manual to use for diagnosis
- DSM
- Updated in 2013
- Sz is now an "umbrella" term for various behaviours
- At least 1 symptom of delusions, hallucinations, or disorganised speech
- 6 Months
- ICD
- Retains differentiation between different subtypes
- Requirements: one very clear symptom that has lasted for at least 1 month
- Paranoid
- Delusions and Hallucinations
- Disorganised speech and flatness are absent
- Catatonic
- Unusual motor activity, either agitation or complete immobility
- Extreme nagativism and peculiar posture (very rare)
- Hebephrenic
- begins at early age.
- Incoherent and disorganised speech
- flat and/or inappropriate affect and bizarre behaviour
- Hallucinations and delusions, but not as structured as Paranoid Sz
- Undifferentiated
- Diagnosed when someone is showing symptoms of Sz, but aren't easily categorised.
- Seen as early formations of another subtype
- Residual
- At least one episode of Sz experienced in the past
- No longer showing strong signs of the disorder
- Retains differentiation between different subtypes
- DSM
- Difficulty choosing which manual to use for diagnosis
- Critics of diagnosis
- Suggested that it is stigmatising to label an individual "Schizophrenic"
- Scheff (1966) believed the label made the individuals unconsciously conform to their given label.
- Suggested that it is stigmatising to label an individual "Schizophrenic"
- Cultural differences
- Harrison et al (1988) found that Sz is more frequently diagnosed in African Americans and African-Carribean populations
- May be due to genetic vunerability or psychosocail factors (part of an ethnic minority)
- Misinterpretation of cultural differences in behaviour as being a symptom of Sz
- E.g. believing in spiritual guardians whom the person talks to for guidance
- Misinterpreted as delusions or hallucinations
- E.g. believing in spiritual guardians whom the person talks to for guidance
- High % of diagnosed Sz's in Southern Ireland and Croatia, compared to low diagnosis in Italy and Spain
- Cultural differences in display and diagnosis of symptoms
- E.g. believing in spiritual guardians whom the person talks to for guidance
- Misinterpreted as delusions or hallucinations
- Seen as an example of abnormal behaviour to some, but it is classed as a social notm to other cultures
- E.g. believing in spiritual guardians whom the person talks to for guidance
- Cultural differences in display and diagnosis of symptoms
- Harrison et al (1988) found that Sz is more frequently diagnosed in African Americans and African-Carribean populations
- Reliablitity of diagnosis and classification
- Recent studies found inter-rater reliability correlation in the diagnosis of Sz is as low as 0.11
- Suggests no official diagnosis
- Individuals can be misdiagnosed at being Sz when not, and vice versa
- Mojtabi and Nicholson (1995) 50 US psychiatrists asked to distinguish bizarre and non-bizarre delusions.
- Results: inter-rater reliability around 0.4
- No consistent agreement in the classification
- Misdiagnosis of patients
- No consistent agreement in the classification
- Results: inter-rater reliability around 0.4
- Recent studies found inter-rater reliability correlation in the diagnosis of Sz is as low as 0.11
- Validity issues
- Comprehensive review of aetiology, prognosis and treatment (Bentall et al) concluded Sz is not a useful category
- Prognosis varies vastly, so little predictive validity
- This means psychiatrists have little predictive validity in order to allow the prediction of future behaviours and their transformation (into chronic state)
- Prognosis varies vastly, so little predictive validity
- Comprehensive review of aetiology, prognosis and treatment (Bentall et al) concluded Sz is not a useful category
- Disorders similar to Sz
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