Issues Surrounding the Classification and Diagnosis of Schizophrenia

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  • 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
    • 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
    • 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.
    • 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
      • 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
    • 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
    • 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)


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