Issues surrounding the classification and diagnosis of SZ

Question 1

What are the issues surrounding the classification and diagnosis of schizophrenia

Answer 1

Reliability and validity

Question 2

Define reliability (of a diagnosis)

Answer 2

The level of agreement and consistency of the diagnosis by different psychiatrists across time and cultures.

Question 3

Define inter-rater reliability

Answer 3

The level of agreement and consistency of the diagnosis by different psychiatrists

Question 4

Define test-retest reliability

Answer 4

The level of agreement and consistency of a diagnosis over time given no change in symptoms

Question 5

Define Validity (of a diagnosis)

Answer 5

The extent to which SZ is a unique syndrom with characteristics, symptoms, and signs. To be valid, patients with SZ should have different symptoms from patients with other disorders

Question 6

What are the issues affecting validity

Answer 6

• co-morbidity
• gender bias
• culture bias
• symptom overlap
• range of symptoms

Question 7

define co-morbidity

Answer 7

When 2 or more conditions occur together in the same individual at the same time

Question 8

define culture bias

Answer 8

A tendecy to interpret all phenomena through the ‘lens’ of one’s own culture, ignoring the effects that cultural differences might have on behaviour

Question 9

Define symptom overlap

Answer 9

Shared symptoms that could lead to an incorrect diagnosis. Often calls into question teh validity of classification.

Question 10

Define range of symptoms

Answer 10

The are a range of symptoms that could be present for a diagnosis of SZ. e.g. positive and negative symptoms.

Question 11

Give evidence for co-mobitity affecting validity

Answer 11

Buckley et al 2009:
found that 50% of patients with SZ have depression or substance abuse, 29% had PTSD and 23% had OCD.

Question 12

Give evidence for gender bias affecting validity

Answer 12

Longnecker et al 2010:
found that since the 1980s men have been diagnosed more than women
Cotten et al 2009:
suggests this underdiagnosis is due to women having more closer relationship so get more support which leads to women with SZ functioning better than men with SZ.

Question 13

Give evidence for culture bias affecting validity

Answer 13

Keith et al 1991:
found that 2.1% of African Americans are diagnosed with SZ compared to 1% of the white population. Many people from african cultures believe and praised for being able to communicate with ancestral spirits. This means they are more likely to report these experiences which are often misinterpreted as symptoms of SZ.

Question 14

Give evidence of symptom overlap affecting validity

Answer 14

There is considerable overlap between symptoms of SZ and other disorders. e.g. bipolar disorder. This means that it is hard to define the boundries between SZ and other disorders.

Question 15

give evidence of range of symptoms affecting validity

Answer 15

2 individual could display very different behaviour but still be diagnosed with SZ.
for example the DSM-5 requires one positive symptoms whereas the ICD-10 requires 2 negative symptoms.

Question 16

Give evidence for the reliablity of diagnosis of SZ

Answer 16

Osório et al 2019:
reports excellent reliability for SZ diagnosis (DSM-5) with an inter-rater agreement of +9.7 and a test-retest reliability of +9.2. This means that the diagnosis of SZ is consistently applied.

Question 17

Give evidence against the reliability of diagnosis of SZ

Answer 17

Cheniaux et al 2009:
had 2 psychiatrists independantly diagnose 100 people using both the DSM and ICD criteria. Inter-rater reliability was poor, with one psychiatrist diagnosing 26 with SZ using DSM and 44 using ICD. The other diagnosed 13 with SZ using the DSM and 24 using the ICD. This poor reliability is a weakness of diagnosis of SZ.

Question 18

What are the implications for a lack of reliability and validity when diagnosis SZ

Answer 18

A lack of reliability and validity in diagnosising SZ may result in misdiagnoses leading to providing incorrect or unnecessary treatment.

Question 19

What are the advantages of classification and diagnosis of SZ

not in essay plan

Answer 19

• Communication (between mental health professionals)
• treatment (appropriate)
• prognosis (provides info)
• cause (can aid research)

Question 20

What are the issues when classifiying and diagnosing SZ

Answer 20

• misdiagnosis
• labelling
• historical/ cultural context

Question 21

Explain what is meant by misdiagnosis

Answer 21

individuals may be given the wrong treatment

Question 22

explain what is meant by labelling as a issue of classifying and diagnosis SZ

Answer 22

Diagnosis leads to labelling. This can be helpful in providing the appropriate treatment, but can be stigmatised and lead to a self-fufilling prophesy

Question 23

explain what is meant by historical/ cultural context as a issue of classifying and diagnosis SZ

Answer 23

Disorders in the diagnostic manuals may reflect social/political attitudes at the time e.g. homosexuality was included in the early manuals as a mental disorder. Not understanding an individual’s cultural frame of reference also leads to problems with diagnosis.

Question 24

Breifly outline Rosenhan

Answer 24

Rosenhan had himself and 8 of his collegues who had no symptoms or history if mental disorders set up appointments at metal hospitals under fake names, occupations and employment. At the appointment they complained of hearing a voice saying “empty”, “hollow” and “thud”. Once they were admitted the psudopatients stopped simulating any psychiatric symptoms.

Question 25

Evaluate Rosenhan

Answer 25

S – field study – higher in ecological validity than a lab
S - participant observation – got a lot of detailed data without the problem of demand characteristics
S – ethical - debrief to staff
W – ethical – staff being deceived