Discuss issues associated with the classification and/or diagnosis of schizophrenia

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AO1 (8 marks)

  • Schizophrenia is a psychotic disorder where sufferers lose touch with reality and have difficulty expressing themselves in a way which is appropriate to the real world.
  • Sz is characterised by symptoms which are split in to positive and negative: positive = visual/auditory hallucinations, negative = avolition (general lack of drive or motivation) or alogia (inability to speak)
  • DSM-IV (diagnostic and statistical manual of mental disorders 4th edition) and ICD-10 (international statistical classification of diseases 10th edition) are both widely used diagnostic manuals.
  • DSM-IV states 2 or more positive/negative symptoms of Sz need to be present for at least 6 months for diagnosis
  • ICD-10 states that symptoms need to be present for at least 1 month
  • Main issues surrounding diagnosis of mental disorders is the reliability and validity of the diagnoses i.e. inter-rater reliability of the diagnostic tools
  • Concerns the extent to which 2 or more diagnosticians would arrive at the same conclusions when faced with the same individual.
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AO2 - Reliability

  • Fast and easy way to break down the symptoms, treatments and prognoses of the disorders.
  • Beck et al (1961) looked at inter-rater reliability between 2 psychiatrists when considering 154 patients. Inter-rater reliabilty was 54% so their diagnoses only matched 54% of the time. Therefore shows how diagnosis lacks reliability as there are inconsistencies.
  • However, in most cases the patient gave different information to the 2 diagnosticians, so shows difficulties in gaining information from patients.
  • Patient needs to be interviewed so doctor is relying on retrospective data from unreliable source
  • The process is subjective as there is scope for different interpretations
  • Rosenhan et al (1972) warned a hospital to expect pseudo-patients over a 3 month period. 41 patients were suspected of being fakes during this time and 19 of those individuals had been diagnosed with Sz by 2 members of staff. There were in fact 0 pseudo-patients.
  • Misdiagnosis may lead to unnecessary labelling of an individual which is difficult to remove
  • Blurred boundries between Sz and other mental disorders i.e. depression is co-morbid (often occurs together) with schizophrenia
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More AO2

  • Cultural relativism is also another problem with the diagnosis of Sz that sections of the newer versions of the DSM and ICD attempt to deal with.
  • Davidson and Neale (1994) explain that in asian cultures, a person experiencing emotional turmoil is praised and rewarded if they show no emotional expression (symptom similar to alogia/avolition) and in certain arabic cultures outward public expression of emotion is encouraged.
  • Without this knowledge an individual may be seen as abnormal showing such behaviours in a western culture.
  • Clinicians may not speak the same language as patients so there may be lack of understanding which could lead to inappropriate treatment or lack of treatment.
  • Schneider (1959) developed first rank symptoms (symptoms rarely found in disorders other than schizophrenia) which included thought insertion/broadcast, hearing voices and delusional perceptions.
  • However this approach is criticised for being too stringent as any one of these symptoms could indicate a person is suffereing from schizophrenia
  • Symptoms may have been brought on by other medical conditions or illegal drug abuse and brain tumours
  • Harrison et al (1988) found schizophrenia is more commonly diagnosed in african american and african caribbean populations. Difficult to determine whether this is due to greater genetic vulnerability or sociopsychological factors i.e. being part of an ethnic minority.
  • Misdiagnosis may occur when there is a misinterpretation of cultural differences in behaviour as being symptoms of schizophrenia.
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