clinical characteristics, issues with classification and diagnosis 2 expl

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Outline clinical characteristics of schizophrenia.
Often confused with a split personality, schizophrenia is a severe psychotic disorder that involves
abnormal thoughts and perceptions. It has been described as a disintegration of the personality.
The person loses insight, loses touch with reality and fails to realise they have a problem. It
involves a range of psychotic symptoms where there is a break from reality. There are two types
of schizophrenia, type one is characterised by positive symptoms (something that is added to the
sufferer's personality) such as bizarre delusions, hearing voices, disorganised thoughts and
speech etc. Type 2 is characterised by negative symptoms (something that takes away from the
sufferer's personality) such as apathy, stereotyped movements, withdrawal, isolation etc.
Explain issues associated with classification and diagnosis of schizophrenia (10 marks)
The two main classification systems have different diagnostic categories such as DSM-IV having 5
subtypes and requiring symptoms to be evident over six months whereas ICD-10 has 7 subtypes
and requires symptoms for only one month. This causes issues with reliability as one patient could
be diagnosed with two different subtypes of schizophrenia, or could be diagnosed as
schizophrenic by one psychiatrist yet `normal' by another. This would also cause an issue with
validity because we do not know which, if either, the true diagnosis is.
A study by Beck et al. shows that there are issues with inter-ratal reliability of diagnosing patients.
They studied the reliability of two psychiatrists examining 154 patients and found a reliability of
only 54%. Validity is also weak as the true diagnosis isn't known. This causes further issues as
there would be disagreement on a suitable treatment for about 70 patients.
Another issue is that the process of diagnosis is subjective as shown by Rosenhan et al.'s study
where 8 stooges admitted themselves to a psychiatric hospital, reporting one symptom. Once
admitted, they acted normally yet 7 were diagnosed as schizophrenic. In a follow up study, the
hospitals that were told more stooges would be sent. 41 patients were suspected of being fake,
but none were actually sent. This suggests that diagnosis may be subjective because psychiatrists
may be looking for certain behaviours in order to fulfil expectations and may be ignoring other
behaviours.
Cultural differences can also affect validity e.g. Davison and Neale explain that in Asian cultures,
people experiencing emotional turmoil are praised and rewarded when they don't express them.
This can be misinterpreted as withdrawal and therefore causes issues when diagnosing as cultural
norms can be mistaken for symptoms.
Outline and evaluate one or more explanations of schizophrenia (10 marks)
Bateson et al. proposed the Double-bind theory which suggests that children who frequently
receive contradictory messages from their parents are more likely to develop schizophrenia. The
two conflicting messages effectively invalidate each other and the child's ability to respond is
incapacitated by such contradictions. This prevents the development of an internally coherent
construction of reality and manifests itself as schizophrenic symptoms.

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The double bind explanation has support from Berger who found that schizophrenics had higher
recall of double bind statements by their mothers than non-schizophrenics. This encourages the
view that contradictory messages can cause schizophrenia, however the data may not be reliable
as recall may be impaired by schizophrenia.
Another explanation of schizophrenia is the genetic hypothesis. Genetic studies e.g.…read more

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