Issues Surrounding Diagnosis
- Several Issues surrounding the diagnosis of Schizophrenia
- These include the issues surrounding relibility and validity of diagnosis
- The Diagnositc and Statistical Mannual of Mental Disorder (Edition 4) was last publishedin 1994
- It is produced by the American Psychiatric Association and is the most widely used.
- There is also the International Stastical Classification of Diseases
- Produced by the World Health Organisation and is currently in its 10th Series
Reliability and Validity of DSM-IV and ICD-10
- Diagnosing a mental disorder is almost always done uding the DSM-IV and the ICD-10
- Is a risk of using this professional jargon, as the wording is written for specialists
- Main issue is the reliability and validity of the diagnosis
- Beck (1961) looked at the inter-rater reliability between two psychiatrists when considering the cases of 154 patients
- Reliability was only 54% - only agreed on a diagnosis for 54% of the 154 patients
- True diagnosis cannot be made until a patient is clinically interviewed
- Psychiatrists are relying on retrospective data, given by a person whose ability to recall much relevant information is unpredictable.
Reliability of DSM and ICD
- Originally hoped that diagnostic tools could provide a standardised method of recognising mental disorders.
- Behaviour of an individual is always to some interpretation. Process is subjective.
- Rosenhan (1972) was the most famous study carried out testing the subjectivity, reliability and validity of diagnostic tools.
Rosenhan - Labelling
- Rosenhan recruited 8 people who went to a psychiatric hospital and reported only 1 symptom. A voice said only single words like, "thud", "empty" and "hollow"
- When admitted, they began to act "normally". All were diagnosed with suffering Schizophrenia
- Individualsstayed in the institutions for between 7 to 52 days
Follow up - Labelling
- Rosenhan told the institutions about is results, and warned the hospital that they could expect other individuals to try and get themselves admitted
- 41 patients were suspected as being fakes and 19 of these individuals had been diagnosed by 2 members of staff
- Tempting to label a person as a sufferer os Schizophrenia, without really knowing the extent.
- Beliefs and biases of some might mean the unnecessary labelling
- Sometimes a disorder must reach a particular level before it can be recognised
Validity of Diagnosis
- System of classification and diagnosis reflect the true nature of the problems the patient is suffering.
- The prognosis and how great a positive effect the proposed treatment will actually have.
- Many individuals do not fit into categories that have been created. Instead of acknowledging this, clinicians tend to diagnose 2 seperate disorders
- Someone who has suffered a mental disorder has to disclose that information, such as a job interview.
- Label of Schizophrenia stays with the person