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Discuss the issues surrounding the
classification ad diagnosis of schizophrenia
Schizophrenia is a disorder characterised by distorted thinking, impaired emotional
response, poor interpersonal skills and distortion of reality. Statistics show 1% of most countries
population prevalent to have schizophrenia.
The diagnosis criteria for this disorder are very similar in The International Classification
System for Disease (ICD) and Diagnostic and Statistical Manual of Mental disorder (DSM).
The major difference is that the DCM specifies that signs of disturbance must be present for at
least six month while the ICD requires that important symptoms only for one month. This would
suggest different diagnosis would occur in different systems that would leads to lack of
predictability in diagnosis. A valid classification system should be able to predict outcome and
respond to treatment. However, it has proven very difficult to predict either of this these
accurately and there are wide individual variations.
However there are some additional tools to the ICD and DMS that help the clinicians to
diagnose of schizophrenia (e.g. Schneider criteria, Louis criteria, etc) which would increase the
level of reliability and validity of diagnosis. So reliability centres around different clinician using
the same criteria to arrive at the same diagnosis and validity means the criteria which leads to an
accurate diagnosis. But yet this would also suggest that the two systems are incomplete, lacking
in various ways in their own right and both instead requiring additional tools to increase the
validity and reliability of the diagnosis.
Thus, in regards to the above, another issue that might be problematic is that it is confusing
to have several alternative sets of diagnostic criteria for schizophrenia it emphasis the point that
all definitions are fairly arbitrary and liable to be modified or superseded. Therefore it may
weaken the level of validity of the criteria. Furthermore, different systems to diagnosis the
disorder make it difficult to compare the data for research studies, such as comparing data
based on individuals who have been diagnosis with schizophrenia using different system.
In each system the clinician is required to makes a thorough examination using interviews,
questionnaires, etc to individuals to find the accurate and reliable diagnosis. However, there may
be some bias in the examinations especially during interview and question process, leading to
demand characteristics that clinician may desire. Consequently, validity problems may occur with
the methodology of the diagnosis.
The diagnosis of schizophrenia has been widely used in the past, and prior to the 1970s
there was a significant difference in the prevalence rates in different countries. For example in the
USA 20% of patients were diagnosis with schizophrenia, but in the 1930s this rate increased to
80%. There are similar pattern, in other countries such as England in this period, suggesting that
there maybe some expectation bias from the clinicians for a more likely to diagnosis for a
specific disorder. On the other hand, it can be assumed that there are some cultural differences
that would influence the mental level of the society. Therefore it could mean there would be
some cultural influence in the USA that results the risen prevalence of this disorder rather than
the tendency of clinicians.
Szasz (1979) have questioned the whole concept of the mental illness and suggests instead,
it is just a form of politically sanctioned social control. The proof of this suggestion lies in
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Rosenhan (1973) where healthy volunteers were diagnosed with schizophrenia on the basis of a
single symptom. Once admitted to mental hospitals. `normal' behaviour such as writing notes
was interpreted by staff as further evidence of their disorder. Indicatory, that the diagnosis of the
clinician were not reliable and would not have validity as they might have been effected by bias.…read more