4.2. Classification of Sz

Question 1

What is classification?

Answer 1

• Systems used to list symptoms
• Symptoms are grouped accordingly to mental disorders

Question 2

What is diagnosis?

Answer 2

• Giving people the label ‘schizophrenia’
• Generally need 2+ symptoms for 1+ month

Question 3

What year did Rosenhan conduct his study?

Answer 3

1973

Question 4

What were the aims of Rosenhan’s study?

Answer 4

• To investigate the experience of being hospitalised in a psychiatric ward
• To investigate whether psychiatric labels would be used in situations where they weren’t appropriate

Question 5

What was the procedure of Rosenhan’s study?

Answer 5

• 7 ppts visited 12 hospitals in 5 states
• The pseudopatients had to fake a single symptom (hearing ‘hollow, thud, empty’)
• Once they gained admission, they stopped faking the symptoms, behaved normally and asked to be released.

Question 6

What were the findings of Rosenhan’s study?

Answer 6

None were ever detected as being pseudopatients and the longest stay was 2 months

Question 7

What was the conclusion of Rosenhan’s study?

Answer 7

There were issues with the diagnosis of patients.

Question 8

What happened in Rosenhan’s follow up study?

Answer 8

More patients were sent over the next 3 months and institutions had to detect pseudopatients -> after 3 months they were confident 1/3 of patients were pseudopatients but none of them were -> poor validity of diagnosis

Question 9

What is the DSM-V?

Answer 9

• Diagnostic and Statistical Manual of Mental Disorder
• Produced by the American Psychiatric Association
• Most widely used diagnostic tool in psychiatric institutions throughout America and some parts of Europe
• 2+ symptoms for 6 months (minimum of 2 months)

Question 10

What is the ICD-10?

Answer 10

• International Classification of Diseases
• Produced in Europe by WHO
• Fit into 1 of 7 categories of Sz symptoms for at least 1 month
• Used in UK and Europe

Question 11

Strength: good reliability

Answer 11

• only if using one classification system
• a reliable diagnosis is consistent between clinicians (inter-rater) and between occasions (test-retest)
• Osorio et al reported excellent reliability for Sz diagnosis - inter-rater agreement of +.97 and test-retest reliability of +.92
• Therefore, the diagnosis of Sz is consistently applied

Question 12

Weakness: low validity

Answer 12

• Criterion validity involves seeing whether different procedures used to assess the same individuals arrive at the same diagnosis
• Cheniaux et al had 2 psychiatrists independently assess the same 100 clients -> 68 were diagnosed with Sz using ICD and 39 using DSM
• This means that SZ is either under or over diagnosed, suggesting validity is low.
• However Osorio found excellent agreement between clinicians using different procedures both derived from the DSM system -> criterion validity is good provided it takes place within a diagnostic system

Question 13

What is co-morbidity?

Answer 13

2 different disorders at the same time

Question 14

What is symptom overlap?

Answer 14

Symptoms of 1 disorder are also symptoms of another disorder, making it difficult to diagnose

Question 15

Weakness: co-morbidity

Answer 15

• If conditions often co-occur, then they might be a single condition.
• Sz is commonly diagnosed with other conditions -> e.g. Buckley concluded that Sz is co-morbid with depression (50% of cases), substance abuse (47%) or OCD (23%)
• Suggests Sz may not exist as a distinct condition

Question 16

Weakness: symptom overlap

Answer 16

• There is an overlap between the symptoms of Sz and other conditions -> e.g. both Sz and bipolar involve delusions and avolition
• Sz and bipolar may be the same condition (classification issue)
• Sz is hard to distinguish from bipolar (diagnosis issue)
• This means Sz may not exist as a condition and if it does, it’s hard to diagnose

Question 17

Weakness: gender bias

Answer 17

• Men are diagnosed with Sz more often than women in a ration of 1:4:1
• This could be because men are more genetically vulnerable, or women have better social support, masking symptoms
• This means that some women with Sz are not diagnosed so miss out on helpful treatment

Question 18

Weakness: culture bias

Answer 18

• Some symptoms e.g. hearing voices are accepted in some culutres e.g. Afro Caribbean societies ‘hear voices from Ancestors’
• Afro-Caribbean British men are up to 10x more likely to receive a diagnosis as white British men, probably due to over interpretations of symptoms by UK psychiatrists
• This means that Afro-Caribbean men living in the UK appear to be discriminated against by a culturally biased diagnostic system.