Psya 4 sc, schizophrenia 24 marker

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Jyoti Virk
Discuss the issues surrounding classification and diagnosis of schizophrenia (24marks)
There are a variety of issues surrounding the classification and diagnosis of schizophrenia. One issue
that arises is that the patient may have been misdiagnosed about their illness. This is because of
cultural context. The psychiatrist could be unfamiliar with the behaviour and belief of a certain culture.
They may see this as abnormal, so would incorrectly judge them as someone who has mental illness,
when in fact that behaviour is perfectly normal to the specific culture. Therefore according to Scheff
(1966) this would be stigmatising and the patient would be labelled as someone with schizophrenia,
but in fact wasn't. The patient would conform to the label, which would then lead to a self-fulfilling
prophecy and future long term problems- of the person living their whole life believing they had an
illness, and not being able to create relationships with others. Also in extreme cases the patient could
be wrongly institutionalised.
Moreover issues can be based around historical context. Disorders that are included in the diagnostic
criteria sometimes can be reflected upon the social and political view at that period of time. For
example homosexuality was seen as a mental disorder in early classifications; hence those people
would be seen as "abnormal". However as society has grown and developed it is now seen as
something that is normal and acceptable. Therefore we cannot fully see the classifications as reliable,
because the disorders could change in the future- as said by postmodernists who see society
changing overtime.
Another issue is the prognosis of schizophrenia, being relatively poor. People diagnosed with
schizophrenia rarely share the same symptoms; likewise they don't share the same outcomes. Due
to individual differences, as people experience schizophrenia and its symptoms in different ways, for
example some people may be able to handle it better than others, who may have to have a lot of
care. The prognosis varies; with about 10% achieving lasting improvement, 20% recovering to
previous functions and 30% showing some improvement , with relapses occurring at irregular
intervals. This means that there is difficulty of being able to predict the outcome, and the response to
the treatment. Therefore the diagnosis of schizophrenia has little predictive validity- of what the
outcome of any treatment would be, and what will happen in the future.
Furthermore another issue surrounds the cultural differences in diagnosis of schizophrenia. Copeland
et al (1971) gave a description of a patient to 134 US, and British psychiatrists. He found that 69% of
the US psychiatrists had diagnosed the patient with schizophrenia, but only 2% of the British
psychiatrists gave the same diagnosis. This suggests that there is a cultural variation in how
psychiatrists define patients with schizophrenia, in one culture opposed to the other. Therefore
there is a low reliability in the diagnosis of schizophrenia, because there are different opinions on the
diagnosis in other countries, so we would question whether we are able to trust the diagnostic
criteria in our country, or trust the one in the other.
Moreover there are problems with co-morbidity. This means there could be a presence of one or
more disorders, that aren't on the diagnostic criteria of schizophrenia. For example someone who is
in the manic state of bipolar disorder. They have similar symptoms to schizophrenia symptoms, such
as hallucinations which is a form of hearing voices and delusions which are bizarre beliefs that seem
to be real. Therefore they should be properly diagnosed, and not one who has schizophrenia.
Otherwise if they were misdiagnosed, then the patient would be given a treatment of anti psychotic
drugs. This would create permanent chemicals in the patient's body, and may not prevent the
symptoms occurring because they have been given the wrong treatment. Therefore this would be
inappropriate to give someone drugs for a long period, which has no effect and could cause further
problems such as side effects. The treatment wouldn't be effective and the patient would continue
to suffer with those symptoms, thinking that they have schizophrenia when in fact they haven't. Thus,
a specific criteria should be created to distinguish between the symptoms of schizophrenia and the
manic state of bipolar disorder, so that the patients are full diagnosed properly. The Schneider
Criteria, Research Diagnostic Criteria and the St Louis Criteria, have been developed specifically to
help clinicians diagnose only schizophrenia. These criteria's can actually further improve reliability, as

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Jyoti Virk
the clinicians come to the same conclusion about the diagnosis. However, it is confusing to have
several criteria's for schizophrenia because clinicians cannot agree on one definition of defining what
the diagnosis is, which further emphasises on the point that all definitions are large and based on
opinions.
Similarly the symptoms used in the diagnostic criteria can be unreliable. This is shown in Klosterkotter
et al study on 489 people in a psychiatric unit in Aachen, Germany.…read more

Comments

Jess

Thanks! How many marks would this get?

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