Issues in the diagnosis of Schizophrenia Flashcards
Prevalence of Schizophrenia?
- affects 1% of population
- symptoms appear between 15-45
- Men more susceptible than women
- Men tend to be diagnosed mid 20s
- Women tend to be diagnosed early 30s
Prognosis of Schiz?
- Symptoms most severe during first 5 years after onset
- 40% recover from positive symptoms
- 20% make full recovery, diagnosed early
- 40% have it for life
What are positive symptoms?
Give two examples
- Symptoms normal people don’t experience
- Delusions & Hallucinations
- referred to as Category A symptoms
What are negative symptoms?
Give two examples
- Symptoms normal people experience that schiz patients do not
- Avolition & Alogia (speech poverty)
How does the DSM classify a schiz patient mainly?
- symptoms must persist for 6 months
- this period must include 1 month of two symptoms
- one of the two has to be positive
What is the relationship to Autism the DSM outlines?
- If there is history of Autism in the patient, diagnosis of Schiz. is only made if there are delusions/hallucinations & other symptoms for at least 1 month (or less if successfully treated
Describe Hallucinations as a positive symptom?
- Sensory experiences, seeing distortions, hearing critical voices
- Can include olfactory (phantom odours) which are smells
Describe Delusions as a positive symptom?
- Irrational beliefs
- Feelings of persecution (from the government)
- Feelings of grandeur (thinking they’re royalty)
Describe Avolition as a negative symptom?
- lack of purposeful behaviour
- No energy, lack of social activity, lack of personal hygiene
- Generally apathetic towards people
- won’t go outside
Describe speech poverty as a negative symptom?
- lack of quantity & quality of verbal responses
- Disorganised verbal communication can become positive symptom
What’s a positive implication of being diagnosed with a disorder?
- appropriate treatment
- placed on road to recovery
- family at ease
What’s are 3 negative implications of being diagnosed with schizophrenia?
- stigma of schizophrenia
- labelling theory and self-fulfilled prophecy
- employment/housing
In reliability of Schiz diagnosis what two types of reliability arise & what are they?
- Inter-rater reliability
- two+ clinicians make identical diagnosis of the SAME patient with SAME information
- Test-retest reliability (external reliability)
- clinicians make the same diagnosis of the patient on separate occasions with SAME information
What factors could influence a low rate of agreement between clinicians?
- bias (gender, race)
- subjective guidelines
- vague symptoms
A03 Reliability of diagnosis
Beck et al 1963?
(153 patients)
- Beck reviewed 153 patients diagnosed by 2 different psychiatrists
- Diagnosis concordance rate only 54%
- Suggests low inter-rater reliability in diagnosis
- Suggests many misdiagnosed leading to incorrect treatments
A03 Reliability of diagnosis
Farmer 1988?
(PSE)
- Found standardised interview known as Present State Examination (PSE) increases reliability
- PSE focuses on frequency & severity of symptoms
- therefore diagnosis can be made reliable as all patients are asked the same things
A03 Reliability of diagnosis
Copeland 1970?
(U.S. & British)
(can be used for cultural differences)
- Copeland gave description of a patient to 134 U.S. psychiatrists & 94 British psychiatrists
- 69% U.S. diagnosed patient with schiz
- 2% British diagnosed patient with schiz
- shows no consistency in diagnostic criteria
- shows DSM may be flawed
- shows differences in diagnosis dependent on country
AO3 Reliability of diagnosis
Cheniaux 2009?
(DSM & ICD-10)
- classification systems are unreliable in diagnosis
- 2 psychiatrists evaluated 100 patients using DSM & ICD-10
- Psych 1 found 26 patients had schiz (using DSM) & 44 (using ICD-10)
- Psych 2 found 13 patients had schiz (using DSM) & 24 (using ICD-10)
- suggests low inter-rater reliability & low reliability between both classification systems.
What is validity in schiz?
- are we measuring what we are intending to measure
- validity of diagnostic tools
What two areas of validity affect schiz & what are they?
Comorbidity
- refers to when more than one disorder exists alongside schiz e.g. BPD & Schiz
- calls into question validity of classification of both illnesses
- should be seen as one separate condition
Overlapping symptoms
- none of schiz symptoms are exclusive to the disorder (pathognomonic)
- this makes valid diagnosis harder to achieve
- estimated 13% of population hear voices yet only 1% are diagnosed schizophrenics (read et al 2011)
Pathognomic?
- where symptoms are not exclusive to one disorder e.g social avolition in Schiz.
A03 Validity of diagnosis
Buckley 2009?
(comorbidity, other disorders)
- Buckley found comorbidity rates with schiz
- 50% depression, 47% drug abuse, PTSD 29%, OCD 23%
- as well as complicated treatment plans, diagnosis is wrong if disorders share symptoms
- e.g. BPD also has delusions as a symptom
- So schiz should be redefined
A03 Validity of diagnosis
Konstantareas & Hewitt?
(autism & schiz)
- Compared 14 male sufferers of schiz & autism
- found none of schiz group had symptoms of autism
- But 50% (7) of autistics had negative symptoms of schiz
- Shows Overlapping symptoms of schiz
A03 Validity of diagnosis
Benefits of classification systems (DSM)
- DSM helps with validity of diagnosis as it meets more than 1 criteria
- e.g. 2 or more characteristic symptoms for at least 6 months relative to patients condition
- So this helps to make accurate diagnoses for an area of medicine not physical
AO3 Validity of diagnosis
Rosenhan 1973?
(8 pseudo-schizophrenics)
- Criticises the validity of Schiz. diagnosis
- 8 healthy volunteers presented themselves to 12 pscyh hospitals claiming schizophrenic symptoms
- All 8 were diagnosed with Schiz. & discharged with Schiz. in remission
- Results suggests Doctors did not have valid methods for diagnosing Schiz.
What are the 4 aspects of cultural bias in Schiz?
I
A
N
D
- Cultural interpretations of symptoms affect diagnosis (insanity or gift)
- Negative cultural attitudes (stigma)
- Culture/nationality of clinician
- Race discrimination evident in diagnosing Schiz.
Outline Cultural interpretations of Schiz symptoms affecting diagnosis of the disorder?
- Some research shows that religious & cultural groups perceive Schiz. differently
- e.g. ‘insane’ in one culture is a spiritual ‘gift’ in another
- this can complicate a valid diagnosis of Schiz.
Outline negative cultural attitudes to Schiz that affect the diagnosis of the disorder?
- Psychological distress & mental health issues attract different levels of stigma in different cultures affecting diagnosis of Schiz.
- implies without being diagnosed, people with schizophrenia will continue to suffer and fail to receive effective treatment
Outline the culture/nationality of the clinician which affects the diagnosis of the disorder?
- nationality/culture of the clinician creates reliability & validity issues when diagnosing Schiz.
- Some nationalities diagnose Schiz. in different ways
- US & UK diagnose in similar ways however the US is far more likely diagnose Schiz.
Outline race discrimination which affects the diagnosis of the disorder?
- research implies some nationalities have more Schiz. than others
- It is suggested clinicians perceive diverse ethnic groups very differently and then discriminate
- Implies to avoid misdiagnosis clinicians should be mindful of unconscious bias
AO3 Cultural Bias
Copeland 1970?
(US & British)
- Copeland gave description of a patient to 134 U.S. psychiatrists & 94 British psychiatrists
- 69% U.S. diagnosed patient with schiz
- 2% British diagnosed patient with schiz
- shows no consistency in diagnostic criteria
- shows DSM may be flawed
- shows differences in diagnosis dependent on country
AO3 Cultural Bias
Malgady 1987?
(VooDoo)
- Research demonstrated different cultures interpret symptoms of Schiz. in different ways
- In traditional Costa Rican culture, hearing voices is associated with spirits speaking to the individual
- On the other hand this is a positive symptom of Hallucinations in the US through the DSM
- Shows culture can disrupt schiz diagnosis & DSM is invalid as its not universally applicable
AO3 Cultural Bias
Practical Applications?
(psych training)
- Strong practical applications that have come from research (Malgady) into cultural biases.
- Finding cultural biases allows for training of clinicians into the differences in interpretations of symptoms.
- This can improve diagnosis of SZ because it will be standardised & applicable to everyone in society irrespective of culture.
AO3 Cultural Bias
Escobar 2012?
(Cocaine - White)
- Some White clinicians may over interpret symptoms of Black people during diagnosis.
- Factors including mannerisms & language encompass difficulties in black patients relating to white clinicians.
- The myth black people rarely suffer from affective disorders may be causing this problem.
- So clinicians & researchers must pay more attention to their unconscious bias and focus on the objective facts.
What are 3 aspects of Gender Bias which affects the diagnosis of schizophrenia?
U
B
U
- Unreported facts when diagnosing schizophrenia in men & women
- Biased research
- Underdiagnosing female patients suffering from schizophrenia
Outline unreported facts in gender
when diagnosing schizophrenia?
- Men suffer more severe negative symptoms & more substance related disorders than women
- Men are more likely to be admitted to psychiatric wards (Goldstein 1993)
Outline Biased research in gender when diagnosing schizophrenia?
- Some psychologists claim research into schiz. has disregarded females patients
- questions usefulness & representation
Outline underdiagnosing of female patients when diagnosing schizophrenia?
- Research has suggested women go under-diagnosed compared to males
- clinicians ignore differences between predisposing risk factors between genders
- this gives them different vulnerability factors in life
- Implies women are denied access to treatment & have to continue suffering from schiz. symptoms
AO3 Gender bias
Cotton 2009?
(Females are nice so I doubt they have schiz.)
- Suggests better interpersonal functioning of women causes doctors to dismiss their symptoms
- women seem to recover more & suffer less relapse than males
- Beta bias will transpire if clinicians disregard female sufferers
- Shows existence of gender bias if gender differences are ignored if its the case male patients are more likely to relapse than females
AO3 Gender bias
Nasser 2002?
(Androcentrism)
- Incorporating gender in research analysis is essential
- Gender influences onset, illness, & treatment
- Early research into schiz. was mainly on men
- Research findings will not be appropriate for women
- If research exclusively focuses on men it can be deemed androcentric and lacks generalisability to target populations
AO3 Gender bias
Lorring & Powell 1988?
(290 m&f psychiatrists)
- Randomly selected 290 male & female psychiatrists to read 2 cases
- using DSM they were asked to offer their judgements
- when patient was male/no gender: 56% said schiz.
- gender bias was less prominent with female psychiatrists (20%)
- Further support for lack of validity in the DSM in relation to gender
AO3 Gender bias
Practical application?
(psych training)
- Research can help to train psychologists to not misdiagnose females
- especially if they have symptoms associated with other disorders (overlapping symptoms)
- This should result in females receiving correct diagnosis
Male sufferers, in turn, should also not be over diagnosed - Findings from Lorring & Powell can show biases when diagnoses are made
- this improves the validity of the process
