Outline Issues With Classification And Diagnosis Of Schizophrenia

An essay with examples and studies fo support issues

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Explain Issues With Classification And Diagnosis Of Schizophrenia
It is impossible to define all symptoms of schizophrenia reliably because there are over seven
sub-types of the illness and all individuals have different combinations of symptoms which can still be
classified as schizophrenia. Patients may have different disorders with different characteristics. There
is evidence to support this by Motjabi and Nicholson who studied 50 different psychiatrists in the US
and found an inter-rater reliability of +0.4 when asked to differentiate between bizarre and
non-bizarre symptoms. This is a low reliability and means that if delusions are bizarre this is the only
symptom needed for diagnosis of schizophrenia. This lacks sufficient reliability so cannot be a reliable
method for distinguishing between schizophrenic and non-schizophrenic patients. This means there
are implications for mis-diagnosis, there fore using methods to treat incorrectly diagnosed patients
may be in effective because they may not be schizophrenic.
Inter-rater reliability is another issue in the classification of schizophrenia. This is when two individual
assessors give similar a similar diagnosis. Beck stated that early versions of classification manuals such
as ICD (used in the UK) did not define key terms clearly and clinicians still often used different
interview techniques when assessing patients. Whaley's study supports Beck. The researcher found
an inter-rater reliability of schizophrenia classification as low as +0.69. Although Beck's claim could be
criticised for historical bias, recent studies still claim to find low inter-rater reliability of diagnosis
despite changes. This means that because two clinicians cannot agree on diagnosis, the patient may
not be schizophrenic. Mis diagnosis is unethical because it comes with a negative stigma in our society
(drawn from films such as `Schizo' and media sensationalisation) which could make the patient feel
even more unhappy, bewildered and isolated.
Validity is another issue when diagnosing schizophrenia. Many schizophrenics have comorbid illnesses
which can make it difficult to define boundaries between other illnesses and schizophrenia. This is
supported by Buckley et al who found that comorbid depression occurs in 50% of all schizophrenics
and 47% have a life time diagnosis of substance abuse. This can lead to difficulties deciding which
disorder the patient has and appropriate course of treatment, for example to treat schizophrenic or
depressed symptoms? If the patient is diagnosed with schizophrenia and other comorbid conditions,
this may cause confusion and they could be treated with a lower standard of care which could worsen
the illness. This means that some diagnosis or treatment of schizophrenia may not be valid because
they are confused with other illnesses.
Many diagnoses of schizophrenia may not be reliable because they can be affected by cross cultural
influences. For example, American psychiatrists are more likely to diagnose patients with
schizophrenia than other countries which may be due to the type of training they receive. There is
evidence to support this claim by Copeland who studied over 100 US and over 100 British
psychiatrists. When presented with the patient symptoms, 69% of the psychiatrists from the US
diagnosed schizophrenia, however only 2% of British psychiatrists diagnosed the same patient with
schizophrenia. This means that diagnosis may be unreliable according to cultural influences, and not a
true diagnosis of the illness. Although, this research was conducted in 1971 and is out-dated because
WHO and APA have produced the DSM V to improve reliability of data.

Comments

MrsMacLean

This is really clear and expanded, thanks 

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