Issues with classification and diagnosis of schizophrenia

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  • Issues surrounding the classification and diagnosis of schizophrenia
    • schizophrenia
      • Thought process disorder characterised by disruption to a person's emotions Thought and beliefs
      • acute
        • sudden onset many symptoms present at once
      • Gradual
        • Symptoms gradually appear over a length of time
      • Affects 0.5% of the population
        • Males developing it mostly in late teens
        • Females normally develop it 4 or 5 years later
      • Type 1 and Type 2 symptoms
        • Type 1-positive symptoms - hallucinations,dellusions, thought insertion, feelings of control
        • Type 2 negative symptoms-social withdrawal apathy, inappropriate emotions-lack of motivation
      • First and second rank symptoms
      • No single agreed definition-problems with reliability and validity of diagnosis
    • Rosenhan's studies
      • Pesudo patients went into hospitals in America- reported hearing voices
      • The pseudo patients were consistently admitted to hospitals none were suspected as being pseudo patients
        • Show problems with reliability/validity
        • Diagnostic criteria could not distinguish between real and fake patients
        • Shows criteria to be to general-not individual enough
        • As the study was done along time ago many improvements have been made so findibgs may be different if study was carried out in modern day hospitals
        • There are few other disorders which could be attributed to hearing voices
          • Going to a clinic is a sign of serious mental disturbance in itself-if the clinitian had any doubts they heir on the side of caution as the results of letting a sick patients out are very serious
      • In Rosenhan's second study the hospital identified 43 fake patients when none were sent in
        • Suggests staff may have been on the look out for fake patients
          • This may only really be testing the expectation of the staff and not the accuracy of the diagnostic criteria
        • Wasn't carried out under normal conditions
        • Untitled
      • The first study also shows problems with labelling once the pseudo patients were diagnosed everything they did was seen as a symptom of their disorder.
    • Beck's study
      • compared 4 psychiatrist diagnosis of 153 patients
        • Each patient was interviewed separately by 2 different psychiatrists
      • Only agreed on the classification in 54% of cases
        • This study shows that the diagnostic criteria is low on inter-rater reliability
        • Low percentage of agreement for such a serious disorder
        • Individual opinion can never be discounted as disorder is mainly diagnosed on behaviour
    • Three main types of validity
      • Ateological (similar cause)
      • Concurrent (similar symptoms)
      • predictive (similar prognosis)
      • Best to use a criteria which stratifies al three types as most likely to be accuracte
      • Some argue that schizophrenia should be classified as a dimensional disorder and should be classified by the extent the symptoms have on their life
    • Culture
      • Howes study found that language and background differences between psychiatrist and patient may provide unwanted barriers to accurately assessing symptoms
      • Although schizophrenia occurs generally across cultures it is a consistent finding in the usa and the uk that it is diagnosed more frequently in African American and Caribbean population


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