Issues in diagnosing and classifying

• Define SZ


  a severe mental disorder in which thoughts and emotions are so impaired that contact with external reality is lost
• What can SZ Impact?

  a person's language, thoughts, perception and emotions
• What % of the world suffers from SZ at any given time?

  1%
• What is the most commonly used diagnostic manual for SZ?

  DSM-V
• Explain Delusions


  a false belief that is resistant to confrontation with the truth
• Explain Hallucinations


  the perception of something being real that does not truly exist
• Explain Negative Symptoms


  the displaying of behaviours involving disruption of normal emotions and actions
• Explain Positive Symptoms


  the displaying of behaviours involving loss of touch with reality
• Explain Speech Poverty


  a negative symptom of SZ, including brief replies to questions and minimal elaboration
• Explain Avolition


  a general lack of energy resulting in a loss of goal directed behaviour
• Explain Catatonic Behaviour


  slow and diminished movement
• Explain Grossly Disorganised Behaviour


  bizarre and confusing behaviour which can impact daily life
• List 4 Positive Symptoms of SZ

  delusions, hallucinations, disorganised speech and catatonic behaviour
• List 4 Negative Symptoms of SZ

  speech poverty, avolition, affective flattening, disturbances of effect
• Essay plan for issues with diagnosing and classifying

  What are the issues

  
  

  What is reliability

  
  

  Research support for reliability

  
  

  What is validity

  
  

  Research support for validity

  
  

  Other issues - comorbidity, gender, culture bias

  
  

  Research support for other issues
• What are the two issues in diagnosing SZ?

  Validity and reliability
• Outline validity as an issue in diagnosing SZ

  Validity refers to the extent that a diagnosis represents something that is real and distinct from other disorders and whether the ICD or DSM measure what they claim to measure.
• What is the research into validity of diagnosing SZ

  Cheniaux et al. (2009) found that when two psychiatrists assessed the same clients, using both ICD and DSM, that 68 were diagnosed with the ICD and only 39 under the DSM.
• Outline reliability in diagnosing SZ

  Inter-rater reliability refers to the extent that two clinicians will reach the same diagnosis. Test-retest reliability is whether the same diagnosis is reached for the same individual on two occasions by one clinician. Historically, reliability for diagnosis of Schizophrenia has been low but recent studies suggest higher reliability.
• What is the research into reliability for diagnosing SZ


  Osario et al. (2019) found inter-rater reliability of +.97 and +.92 for test-retest reliability in diagnosis of Schizophrenia.

  
  

  However, some would state that of reliability is still an issue in diagnosis. Whaley found that when using the DSM-IV, inter-rater reliability correlations were as low as 0.11. Also, Beck et al (1961) found that agreement on diagnosis for 153 patients (where each was assessed by two psychiatrists from a group of four) was only 54%. Therefore, the current classification systems used to diagnose schizophrenia must lack inter-reliability.

  
  

  Rosenhans study!
• Elaborate on rosenhans study as research support for reliability in diagnosing SZ


  Further supporting the idea that there are significant issues with the classification symptoms is Rosenhan's study. In his study 'Being sane in insane places', all 8 'patient's were diagnosed with mental health issues and admitted to the psychiatric wards, despite them faking their initial symptoms. This study highlighted the unreliability of the diagnostic systems being used at the time. However, this study did take place over 40 years ago and diagnostic manuals have since been updated. For example, categories and definitions are more detailed and operationalised and psychiatrists now use standardised interview schedules when assessing patients. Also the ICD and DSM have been bought in line with one another so they are now very similar, so many of the studies discussed may now be outdated.
• What are the issues in diagnosing SZ not including reliability and validity

  Additionally, the patients may have co-morbid symptoms. This is the extent to which two (or more) conditions occur at the same time in a patient. Schizophrenia is often diagnosed alongside other conditions and this makes diagnosis and treatment difficult, and schizophrenia may not even be a distinct disorder. Finally, the classification systems may be culture and/or gender bias.
• What research shows cultural bias in diagnosing SZ

  Longnecker et al. (2010) found that more men than women have been diagnosed with Schizophrenia since the 1980s. Additionally, African-Caribbean British people are 9 times more likely to be diagnosed that White British people.

  
  

  Reliability of diagnosis across cultures is also an issue for instance, Coupeland found that 69% of the US psychiatrists diagnosed Schizophrenia in patients but only 2% of British psychiatrists gave the same diagnosis for the same patients.
• Research support for gender bias in diagnosing SZ

  Cotton et al. (2009) found that more men are diagnosed with schizophrenia than women. However, this could be because women have more social support and so can function better in society. Therefore, the implication of this is that this can lead to an underdiagnosis and a lack of treatment for women.
• What is the research support for comorbidity

  In support of the issues of validity in diagnosis and classification of schizophrenia other studies have found comorbid symptoms. Swets et al. (2014) conducted a meta-analysis and found that 12% of schizophrenic patients also fulfilled the diagnostic criteria for OCD. Additionally, Buckley et al (2009) found that co-morbidity with depression is approx. 50% for those diagnosed with schizophrenia and a 47% co-morbidity with substance abuse.