Schizophrenia - Diagnosis

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  • Schizophrenia - Diagnosis
    • Criteria - Kurt Schneider (1959)
      • Positive Criteria
        • Delusions
        • Experiences of control
        • Hallucinations
        • Disordered thinking
      • Negative Criteria
        • Affective flattening
        • Alogia
        • Avolition
    • Differences between DSM-IV-TR and ICD-10
      • DSM - symptoms for 6 months but ICD for 1 month
      • ICD - more emphasis on 1st rank symptoms, DSM - course of disorder and functional impairment
      • DSM - MULTIAXIAL (various factors taken into account before diagnosis)
      • ICD lists 7 subtypes, DSM only 5
    • Validity of Category
      • Schizophrenia is too broad - may be more accurate to diagnose by subtypes
      • + and - symptoms are contradictory e.g. affective flattening and hyperactivity. Can an excess and lack of behaviour be the same disorder?
      • ICD - 4 types in 1st section, 4 in 2nd and subtypes to these - there are too many behaviours and different combinations in each case, behaviours should be categorised
      • Subtypes can be more accurate but can conflict with major types - it may be better to just have subtypes as seperate disorders
      • The nature of the disorder is contradictory - therefore symptoms may be valid
      • Like a cold it could still be valid to classify the types as one category
      • Culture Bias - problem of misreading behaviour as abnormal due to preconceptions - this behaviour may be normal for that country
      • Conclusion - Not valid category because major diagnostic manuals written by brilliant minds cannot agree. However, still useful as it allows for effective diagnosis and treatment in most cases
    • Realiability of diagnosis
      • Carson (1991) - DSM had fixed problems of diagnosis but no evidence
      • Whaley (2001) - found inter rater reliability correlations in diagnosis of schizophrenia as low as 0.11
      • Klosterkotter et al. (1994) - Found that positive symptoms were more suited for diagnosis of schizophrenia
      • Mojtabi and Nicholson (1995) - Asked 50 senior psychiatrists to distinguish between bizarre and non-bizarre solutions - had low inter-rater reliability.
      • Rosenhan (1973) - 'Normal' people presented as schizophrenics, were all diagnosed. None of the staff realised they were 'normal'
        • Follow up study - Rosenhan warned hospitals of more pseudopatients and detection rose to 21%, but there were no pseudopatients
      • Copeland et al. (1971) - Huge culture differences between countries, gave description of patient to 194 British psychiatrists and 134 US psychiatrists - 69% of US diagnosed schizophrenia, British only 2%
      • Conclusion - Not reliably diagnosed - Mojtabi and Nicholson's evidence is important, reliability is poor if senior psychiatrists cannot agree - Whaley's evidence shows extremely low inter rater reliability - The huge gap between USA & UK diagnosis further reinforces this.



this is really useful, thank you!

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