Classification Flashcards
What is Schizophrenia
Severe mental disorder disorder characterised by a intense disruption of cognition and emotion so that contact with external reality and insight are impaired. This affects a person’s language, thought, perception, emotions and even their sense of self.
More common in men, urban environments, working-class populations.
Classification vs Diagnosis
Classification = organising symptoms into categories based on which symptoms cluster together in sufferers i.e. categorising the symptoms of schizophrenia.
Diagnosis = deciding whether someone has a particular mental illness using the classifications.
What are the 2 main diagnostic manuals?
ICD-10: 2 Negative
DSM-5: 1 Positive
Positive Symptoms
Refer to an excess of usual functioning; an ‘added’ behaviour or experience.
- HALLUCINATIONS - additional sensory experiences such as hearing voices, seeing things that aren’t there, or seeing images in a distorted way
- DELUSIONS - irrational beliefs, for example delusions of persecution are thoughts that the sufferer is being watched, monitored or controlled by outside forces.
Negative Symptoms
Refer to a loss of usual functioning.
- AVOLITION - the reduction of goal-directed activity, manifested as a lack of motivation and drive, making it difficult to go to work, maintain personal hygiene, or get out of bed.
- SPEECH POVERTY - changes in speech patterns, usually a reduction in the amount and quality of speech. Speech disorganisation involves incoherence and suddenly changing topic mid-sentence
Reliability
Refers to consistency of diagnosis
Inter-rater reliability - extent to which different assessors arrive at the same conclusion when diagnosing the same patient.
If schizophrenia is diagnosed inconsistently, this could be problematic, as it may be over or under-diagnosed by psychiatrists, meaning patients will be incorrectly labelled as ‘schizophrenic’, or not diagnosed, meaning they won’t receive the treatment they need.
Validity
Extent to which the classification of ‘schizophrenia’ is a true reflection of the illness the patient is suffering from
Criterion validity - extent to which using different classification systems produces the same diagnosis in the same patient. If there are differences here, then it suggests there is a lack of agreement over what schizophrenia actually is. This issue is also made problematic by:
- Co-Morbidity
- Symptom Overlap
Co-Morbity
The presence of two different disorders at the same time.
If this is common, it may be that the two disorders are actually one disorder, and perhaps should be seen as one condition (for example, schizophrenia and depression).
Symptom Overlap
When two or more disorder share some of the symptoms needed for classification.
Schizophrenia and bipolar disorder share many symptoms (delusions and avolition), meaning that the same patient could receive two different diagnoses. As with co-morbidity, if disorders share many symptoms it may be more helpful to see them as one disorder.
4 issues with reliability and validity in the diagnosis and classification of schizophrenia:
- Symptom overlap
- Co-morbidity
- Cultural differences/cultural bias
- Gender bias
EVALUATION
LACKS RELIABAILITY & VALIDITY
Cheniaux - found inter-rater reliability amongst two psychiatrists was low.
1 - 26/100 DSM | 44/100 ICD.
2 - 13/100 DSM |24/100 ICD.
PROBLEMS WITH VALIDITY (CO-MORBIDITY)
Buckley - 50% of schizophrenia patients also had a diagnosis of depression
- 29% had a post-traumatic stress diagnosis,
- 23% had an OCD diagnosis.
GENDER BIAS
- Males more likely to be diagnosed as women able to cope better with symptoms
CULTURE BIAS
Africans more likely to be diagnosed due to the cultural significance of ‘hearing voices’, which may be seen by white Western psychiatrists as unusual or bizarre.
