Issues In Diagnosing Schiz Flashcards
Reliability
Can psychiatrists agree on the same diagnosis when independently assessing patients
Validity
If psychiatrists can’t agree who has schizophrenia or the outcome than is it an illness that exists at all?
3 types of schiz
Undifferentiated schizophrenia
Paranoid schiz
Why do types and subtypes make schiz difficult to diagnose
Patients rarely fall neatly into 2 category as there is clear overlap of symptoms
Beck 1961
Looked at inter - rater reliability between 2 psychiatrists considering cases of 154 patients
Does this person have schiz?
What type diagnosed?
The reliability agreement was only 54%
Cultural differences study
Copeland eat all 1971
Copeland et al 1971
Description of a patient given to 134 US psychiatrists
69% of US psychiatrists diagnosed schiz
2% of UK psychiatrists diagnosed schiz
Validity of schizophrenia
Is schizophrenia an illness at all
Schizophrenia is not a V.A.L.I.D concept
What does this acronym stand for
V - variation in outcomes
A - absence of explanation
L - lack of treatment effectivness
I - individuals diagnosed never fare better
D - disorder overlap
Morbidity v co morbidity
Morbidity refers to a medical condition or how common it is
Co morbidity is the phenomenon that2 or more conditions occurs together
Why is co morbidity an issue
If con occurs together it calls into question the validity of diagnosis and classification as they might be a single condition.
3 disorder schiz is similar to
Depression
OCD
BUCKELY 2009 - overlap of illnesses
Half of schizophrenic patients also have a diagnosis of depression
(50%) or substance abuse (47%)
PTSD in 27% of cases
OCD in 23% of cases
Challenges both the classification and diagnosis of schizophrenia
Argument of co morbidity
If Half of the schiz patients are also diagnosed with depression maybe we are bad at differentiating between the 2 conditions
In severe depression it might look like severe schiz and vice versa but they are actually a single condition
For example a schiz diagnosis after pregnancy may be post natal depression
Kettler 2005
Reported that the positive symptoms of schiz resemble episodes of mania in bipolar disorder whilst the negative symptoms resemble clinical depression
He believes that as many as 50% of cases may be misdiagnosed
Who did a study of symptom overlap
Kettler 2005
Symptoms of schiz resemeble …
Episodes of temporal lobe epilepsy’s bi polar depression and drug induced psychosis
Longnecker 2010 gender bias in diagnosis
He argued that men are more likely to be diagnosed then women
Men may be more genetically vulnerable to dev schizophrenia
More plausible explanation is that there is gender bias
Who did study on gender bias
Longnecker 2010
Gender bias - females
Female patients tend to be better at functioning in society then men
May explain why women are diagnosed later in life but men are diagnosed earlier on
There are interpersonal functioning may bias practitioners to understand diagnose schizophrenia
Either bc symptoms are masked together y good interpersonal functioning
Or bc the quality of functioning makes then case to mild to warrant a diagnosis
Cultural bias in diagnosis
African Americans and English ppl of Afro - Caribbean origin are several times more likely then white ppl to be diagnosed with schiz
If Africa a dn West Indies Rates are not that high it isn’t due to genetic vulnerability
Instead due to cultural bias
Cultural bias - African
It could be that hearing g voices is more acceptable in African cultures because of cultural beliefs in communication w ansecstors
Some psychologists argue that white psychologists may over interpret symptoms and distrust honesty of black ppl during diagnosis
