SCHIZOPHRENIA: CLASSIFICATION, DIAGNOSIS, RELIABILITY AND VALIDITY

mind map of schizophrenia, characteristics, symptoms, classification, reliability, validity and bias

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  • Created by: alice
  • Created on: 13-12-12 11:27
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  • SCHIZOPHRENIA
    • Diagnosis
      • Symptoms
        • DMS-IV-RT criteria for a diagnosis of schizophrenia. for a diagnosis to be made 2 criteria must be met
          • Temporal criteria: must occur before the age of 45, symptoms must have induced a notable deteriation in functioning at work, socially or in self-care and symptoms must persist for 6 months
          • Substantial criteria: gross impairment of reality (psychosis) and disturbances affect osychological thought, perception, emotion and communication
        • Characteristic symptoms of schizophrenia, (2 or more must be present) ---(i)Delusions, (ii)Hallucinations, (iii)Disorganised speech, (e.g. frequent derailment or incoherence), (iv) grossly disorganised catatonic behaviour, (v) Negative symptoms, i.e. affective flattening, alogia or avolition.  ---only 1 symptom is required if the delusions are bizarre, or hallucinations consists of voice running a consistent commentary on the persons behaviour and thoughts or 2 or more voices conversing with eachother
      • Types of schizophrenia
        • Paranoid schizophrenia: suffers delusions of persecution or grandeur. sufferers aren't incoherent and don't display inappropriate emotion, they are extremely formal and quite intense
        • Disorganise schizophrenia (Hebephrenic) : Absence of affect or inappropriate affect in display of emotions. Marked by indifference and insensitivity to social surroundings. Characterised by silliness, incoherence, often a disregard for bathing and grooming and sometimes eating their own body products and other dirt
        • Catatonic schizophrenia: Sailent feature is that motor behaviour is either a) enormasly excited, the individual is very energetic, quite agitated,wild and vigerously resisting control, or b) frozen, individual becomes immobile, adopting very uncomfortable possitions for hours
        • Residual schizophrenia: Absense of prominant symptoms, but the individual displays odd behaviour, e.g. magical bizarre thinking, marked by social isolation or withdrawal. This category is saying the schizophrenia can't be identified now, but it is there and will return, a very condeming label
        • Undifferentiated schizophrenia: dustbin category, no consistent pattern of behaviour, not classified by other categories
    • Classification
      • We classify disorders because it improves reliability between physicians, enables people to obtain a diagnosis so help and support can be given. Its regualarly monitored, reviewed and updated giving a forum for psychiatrists to come together to discuss and share new issues or problems as they arise
      • Disadvantages
        • Based on the medical model of health which assumes there is a method of reliably and consistently measuring mental health -some people dispute this is possible
        • May contain ethnocentric bias and cultural bias.
        • Wide range of individual difference in mental health and as the disease can't be reliably scientifically tested this has led to more categories making the system more and more complex to use
        • Does not avoid doctor bias in the interpretation of the symptoms presented because of the environmental conditions in which the diagnosis took place
      • Issues (affect validity of the classification)
        • Maybe the classification of schizophrenia simply isn't different enough to another disorder (e.g. schizophrenia shares symptoms with depression), questioning whether schizophrenia really exsists
        • Maybe the classification of schizophrenia does not predict treatment outcomes
      • Rosenhan (1973) ---pseudo-patients
        • Rosenhan and 7 accomplices went to mental health hospitals with the complaint that they herd an unfamiliar voices in their head saying 'thud' 'hollow' and 'empty'. They were told to act normal/sane once committed
        • They were labeled as 'abnormal', this change how they were understood. Normal behaviours were misinterpreted. Minor disagreements became indicators of emotional problems; boredom was interpreted as anxiety
        • The psychiatrists were angry and demanded that Rosenhan send more pseudo-patients so they could show they could discover them. Over the next few months 41 out of the 193 incoming patients were thought to be pseudo-patients by psychiatrists - but none were sent
        • Showed that sane people could be judged insane, and vice versa. Therefore it is important that we make our classifcation systems, and the diagnosises that we make using them as reliable as possible
    • Reliability
      • When DSM III was published in 1980, it was supposed to improve the reliability of diagnoses. Carson (1991) said that this improved DSM was a more reliable classification system
        • Whaley (2001) ---found that inter-rater reliability correlations for diagnosing schizophrenia were as low as 0.11
      • The symptom of 'bizarre delusions' is a major symptom of schizophrenia. But when 50 US psychiatrists were asked to tell between 'bizarre' and 'not bizarre' delusions, the inter-rater reliability correlations were only 0.4
    • Validity
      • The classification of schizophrenia is 'too diffuse'. Multiple patients can come in with entirely diffrent symptoms and both get a diagnosis of shcizophrenia
      • Bentall et al. (1988) ---concluded that schizophrenia was 'not a useful scientific category' for 2 reasons: problems in symptoms and problems in outcomes from treatment ('prognosis')
      • In terms of treatment, the outcomes vary too much. We can't predict whether patients will recover (10% do this) or only improve to then relapse (30%). There is a low predictive validity for recovery after diagnosis
      • In terms of symptoms, there are 'first-rank symptoms' which are seen as particularly linked to schizophrenia. However these 'first-rank symptoms are also found in other disorders (e.g. depression)
      • People diagnosed with schizophrenia rarely share symptoms or outcomes from treatment. Maybe schizophrenia is not 1 big disorder but lots of little ones lumped together
    • Bias
      • Cultural
        • Copeland et al. (1977) ---described a patient to over 100 US and UK psychiatrists. 69% of US psychiatrists diagnosed schizophrenia; only 2% of the UK ones did
        • Over diagnosis of schizophrenia in West Indian and Asian immigrants (Cochrane 1977, Carpenter and Brockington 1980, Dean et al .1981)
        • Shaikh (1985) --- oversuse of ECT for Asian in-patients in Leicester.  Littlewood and Cross (1980) ---overuse of ECT in black immigrant patients in East London
        • Diagnosed more in African American and Afro Caribbean populations
      • Gender
        • Broverman et al. (1981) ---asked mental health professionals to rate characteristics of a healthy man, woman and adult. In light of their study they suggest that a double standard of mental health exists within clinical diagnosis with certain behavioral characteristics thought to be pathological in members of one gender but not the other
        • Worrell and Remer (1992) ---claim that sexism occurs in assessment and diagnosis in 4 ways: disregarding environmental context, differential diagnosis based on gender, therapist misjudgement and theoretical orientation gender bias

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