ICD-10 is a categorical system for diagnosing schizophrenia, it uses a "tick-box" method to diagnose, consisting of two lists: At least 1 symptom from list 1 and 2 from list 2. Symptoms in list 1 consist of thought control (withdrawal, insertion and broadcast), delusions and hallucinations. Symptoms in list 2 consist of incoherent or irrelevant speech, catatonic behaviour and negative symptoms such as apathy, mood swings and repetitive speech.
DSM-TR-IV is a dimensional or multi-axial system which measures the severity of the mental illness to determine what the disorder is and how best to treat it. For example, someone who is schizophrenic may lead a normal life due to coping strategies, giving a diagnosis could ruin their life and so may therefore be deemed unsuitable. The different axes that an individual is measured on give detailed information on social, psychological and biological aspects of a patient's condition.
Classification is only useful if based on a reliable system. The large differences between early classification systems and the vagueness of DSM led to a low reliability in diagnosis. This hampered research in the area and clinicians realised that they needed to agree on a common, working definition of schizophrenia.
Schneider (1959) attempted to make diagnosis more reliable, he identified a group of similar symptoms in schizophrenics that were rarely found in other mental disorders. 'First Rank' symptoms are seen as a valuable tool in the diagnosis and the form the basis of ICD-10. ICD and DSM are now very similar but not identical.
Types of schizophrenia
Crow (1985) identified to types of schizophrenia:
- Type 1 syndrome: acute form characterised by positive symptoms (where something is actively happening) i.e. Hallucinations or thought process issues. Can develop to Type 2.
- Type 2 syndrome: chronic form characterised by negative symptoms (where there is a lack of activity) i.e. emotional flattening, apathy and poverty of speech. Can have positive symptoms but is less common.
There are issues with this simple division because people do not always fit neatly into a category however there is still a useful distinctions despite it's simplicity. There is also a blurred distinction between the types; the fact the schizophrenia is a developmental disorder means that the reliability of a diagnosis is weakened further.
There are many similar disorders which seem like schizophrenia on the surface however they do not meet the criterea of ICD or DSM; e.g. Schizophreniform psychosis.
There are also many sub-types of schizophrenia for example: Paranoid schizhophrenia, Catatonic schizophrenia and Undifferentiated schizophrenia.
Implications of diagnosing Schizophrenia
Using the source "All in the Mind" a Radio 4 programme we can see that the disadvantage of a diagnosis is the inaccuracy of the title; there are too many variations to give the disorder one overall name; instead it can be described as a syndrome with many different symptoms.
There's also the concept that many people don't know what schizophrenia is or what it means. This can lead to ignorance and a negative stigma which can then lead on to prejudice and discrimination shown in the case study of Christian.
Other disadvantages are that some people can be misdiagnosed if they have similar disorders; for example: Schizophreniform psychosis. There is also disagreement as to wheter the diagnosis should be dimensional or categorical (ICD or DSM??)
Advantages of diagnosing Schizophrenia
Mainly from looking at case studies we can see that there are many advantages to getting a correct, positive diagnosis of schizophrenia. An advantage is that once a diagnosis is made, treatment can begin; medication can help and family and friends can begin to understand the disorder (Christian).
Support from fellow sufferes is widely available and it can help remove the sense of isolation that comes with a mental disorder (Rachel Starr). Patients can often learn to cope with the symptoms once they know what they are, help from organisations such as the Hearing Voices Network can help with strategies such as talking back to the hallucinatory voices.
Once a diagnosis is made, research can look into why the individual has schizophrenia and correlations can be seen with traumatic events and delevoping schizophrenia. Finally, if a diagnosis is made then the person is of less risk to themselves and others.