Reliability of the classification and diagnosis of schizophrenia

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  • Issues with reliabilty regarding the classification and diagnosis of sch
    • Comparison of the classification systems - DSM considers bio, psycho and social factors = more informed decision. ICD has emphasis on first rank symptoms ignoring social.
    • Cultural bias - DSm created by Americans for Americans. ICD is less culturally bias as is was created by the World Health Organisation with representatives from 193 different countries.
    • Differences - DSM 1 characteristic for 6 months. ICD 1 characteristic for 1 month.
    • Inconsistencies between early classification systems - Copeland 1971 gave 124 Us and 194 British psychiatrists the same case study.
      • 69% US diagnosed sch. Only 2% British did.
    • Inter rater reliability - of 2 psychiatrists is less than 50%.
      • Beck et al - 153 patients assessed by 2 psychiatrists were the same 54% of the time.
    • Improving reliability - Schneider tried to make the diagnosis more reliable.
      • identified 1st rank symptoms that were rarely found in other disorder.
    • Rosenhan - being sane in insane places
      • Recruited 8 - all reported 1 symptom. A voice that said thud, empty or hollow.
      • Once admitted they behaved normally. Kept between 7 and 52 days.
      • 2nd study - suspected 41 patients. Rosenhan sent 0.


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