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PSYA4 > Issues with the reliability and validity in classification/diagnosis of SZ > Flashcards

Issues with the reliability and validity in classification/diagnosis of SZ Flashcards

1
Q

What is reliability?

A

Consistency of research study or measure

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2
Q

What are the 3 AO1 points?

A

Inter Rater Reliability
Test Retest Reliability
Comorbidity

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3
Q

What are the 8 AO2 points?

A 
Inter Rater Reliability 
Rosenhans Study
Unreliable Symptoms
Test Retest Reliability 
Cultural Diffs
Comorbidity and Medical Comps
Prognosis
Ethnicity and Misdiagnosis
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4
Q

Why was the DSM 3 published?

A

Create a reliable system for classifying psychiatric disorders

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5
Q

What did the DSM claim to have solved?

A

The issue of inter-rater reliability

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6
Q

If the DSM has solved the issue of IRR, what should it therefore do?

A

Minimise conflict over diagnosis of patients

Lead to an increase in agreement

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7
Q

What is a problem with the reliability of the DSM?

A
  • 30 years later, little proof to show it is routinely used by mental health clinicians
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8
Q

What have recent studies shown the reliability of the DSM to be?

A

IRR as low as 0.11+

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9
Q

Overall, due to the little proof of DSM use and low IRR, what does this show?

A
  • Evidence against use of DSM
  • Suggests need for further improvement
  • We cannot be certain current edition offers dependable classification
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10
Q

What did Rosenhans classic study illustrate?

A

Further issues with c/d in terms of its reliability

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11
Q

What happened in Rosenhnans study?

A
  • Normal people recruited to present themselves to P hospital
  • All admitted and diagnosed with SZ
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12
Q

In Rosenhans study, how did the ‘normal people’ present themselves?

A

Claims of unfamiliar voice repeating the words empty, hollow and thud

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13
Q

In Rosenhans study, what did healthcare professionals fail to identify?

A

Patients were healthy

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14
Q

What happened in Rosenhans follow up study?

A
  • Hospitals warned of intent to send out pseudo patients

- 21% detection rate

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15
Q

Overall, what do the results of Rosenhans study illustrate?

A
  • Even central diagnostic requirement lacks sufficient reliability
  • Reinforces need for more reliable classification - more rigorous means of testing?
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16
Q

AO2 What is an issue with the SZ symptoms?

A

Unreliable

Condition diagnosable with presence of only one characteristic symptom

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17
Q

Sz has unreliable symptoms. What problems has this created for psychiatrists?

A

Diagnostic issues

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18
Q

Sz has unreliable symptoms. What study illustrated the difficulties this can cause?

A
  • IRR only 0.40+ when 50 US senior psychiatrists asked to differentiate between bizarre/non bizarre
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19
Q

Sz has unreliable symptoms. Overall, what is a problem with this?

A
  • Bizarre is subjective

- Means of diagnosis may be reductionist/over-simplified when we do not fully understand what bizarre is

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20
Q

What does test-retest reliability refer to?

A

Consistency of tests in delivering diagnoses

21
Q

Which tests are essential in the diagnosis of SZ?

A
  • Cog screening tests such as RBANs
22
Q

What do cog screening tests such as Rbans do?

A

Measure the degree of impairment

23
Q

What did Wilks do to test the test-retest reliability of cognitive screening tests?

A
  • Alternative forms to test Schizo patients over intervals of 1-134 days
24
Q

What did Wilks find in his test of alternative RBANs systems?

A

TRR was high with score of 0.84

25
Q

Who provided support for the Test-Retest Reliability of RBANs/cog screening classification/diagnosis of SZ?

A

Prescott

26
Q

What did Prescott do?

A

Analysed TRR of several measures of attention/info processing in 14 chronic SZ patients

27
Q

What did Prescott find?

A

Stable performance over 6 month period

28
Q

What do Prescotts findings show?

A

Results are in favour of test-retest reliability of SZ screening tests as they show consistency over time

29
Q

What is an issue regarding cultural differences in the reliability of SZ classifications/diagnosis?

A

Lack of agreement between countries in SZ diagnosis

30
Q

How has culture challenged the reliability of SZ diagnosis?

A

Variations between countries

31
Q

What did Copeland find regarding cultural variations?

A
  • 34 US and 194 British psychiatrists
  • Description of patient
  • 69% of US diagnosed compared to only 2% of British
32
Q

What do Copelands findings show?

A

Evident cultural bias in how SZ is classified and diagnosed

33
Q

Why might there be cultural diffs in c/d of SZ?

A

Behaviour in one country seen as normal but a SZ symptom in another

34
Q

What is validity?

A

Refers to the extent to which a diagnosis represents something real and distinct from other disorders

35
Q

What is comorbidity?

A
  • Common in SZs

- Two or more conditions co occur

36
Q

What conditions might co occur with schizo?

A

Substance abuse, anxiety, depression

37
Q

Comorbid depression occurs in how many SZ patients?

A

50% have depression

47% diagnosed with life-time substance abuse

38
Q

What can comorbidity create problems with?

A

Both diagnosis and treatment

39
Q

What medical complications can comorbidity create?

A

Poor functioning not due to SZ but other complications instead

40
Q

What was the study regarding comorbidity/medical complications?

A
  • Analysed 6 mil hospital discharge notes
  • Pschiatric/behaviour diagnoses accounted for 45% of cm
  • 55% of non-psychiatric diagnoses like diabetes
41
Q

What is a consequence of co-morbid diagnosis/medical complications?

A
  • Reduces quality of medical care

- Affects prognosis

42
Q

What do the findings of the comorbidity/medical complications study show?

A

Importance of differentiating between SZ and comorbid disorders to ensure adequate healthcare

43
Q

Validity. What is another factor affecting diagnosis?

A
  • Varied outcomes in terms of symptoms

- Patients rarely share the same

44
Q

What can prognosis vary between?

A
  • 20% recover to previous functioning levels

- Low as 10 or high as 30 though

45
Q

What does the varying outcomes in prognosis demonstrate?

A

Very little predictive validity, some recover to greater extent
Why does this happen? Further research

46
Q

What can affect the outcome in validity of SZ diagnosis?

A

Ethnicity

47
Q

What ethnic group shows highest SZ rate in Western countries?

A

Caribbean

48
Q

What could the higher prevalence of SZ in caribbean ethnic group be attributed to?

A 
Poor SOL
Poor QOL (social isolation)
Language barriers, diffs in relating between white patients/black doctors
49
Q

Why does ethnicity reduce valid diagnoses?

A
  • Diagnostic tools may only be effective to their full extent in some cultural groups
  • Developed to accommodate other groups

PSYA4 (13 decks)

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