Schiz - Issues in diagnosis

Question 1

Two ways to measure reliability in diagnosis

Answer 1

Inter-rater reliability (observer reliability)
Test-retest reliability (external reliability)

Question 2

Evaluating reliability- Copeland

Answer 2

P - IN EVALUATION, a study to highlight problems with inter-rater reliability of the diagnosis of schizophrenia, was conducted by Copeland (1970) which illustrates how the culture of the clinician can damage INTER-RATER reliability.
E - Copeland
L - This suggests…the reliability of diagnosing schizophrenia is influenced by location and culture of the clinician

Question 3

What did Copeland do

Answer 3

Gave a description of a patient to 134 US and 194 British psychiatrists and found that 69% of the US psychiatrists diagnosed the patient with schizophrenia whereas only 2% of British psychiatrists gave the same diagnosis

Question 4

Copeland gave a description of a patient to ___ US and ____ British psychiatrists

Answer 4

134
194

Question 5

Copeland gave a description of a patient to 134 US and 194 British psychiatrists and found that ___ of the US psychiatrists diagnosed the patient with schizophrenia whereas only __ of British psychiatrists gave the same diagnosis

Answer 5

692

Question 6

Evaluating reliability- Read

Answer 6

P- In addition, worryingly Read (2004) reported that test- retest analysis is as low as 37% for schizophrenia which is extremely concerning,

E- Especially when we consider the potential false positives and false negatives this could create. This suggests that some patients may not be diagnosed when they should - and as such miss out on key medication

E- Alternatively, it also implies that some patients may receive a schiz diagnosis, not actually need the diagnosis or the medication that goes with it

L -This could imply that clinicians need to take extra care when diagnosing patients to avoid false positives and negatives

Question 7

What did Read find

Answer 7

Reported that test- retest analysis is as low as 37% for schizophrenia which is extremely concerning, especially when we consider the potential false positives and false negatives this could create.

Question 8

Read reported that the test re-test analysis for diagnosing schiz was what?

Answer 8

37%

Question 9

Evaluating reliability- improvement of the DSM

Answer 9

P- However, the DSM has also now improved the reliability of diagnosis through revising the criteria.

E- For example, DSM 5 has now stripped the criteria of trying to differentiate between bizarre and non-bizarre delusions from the diagnostic guide as it was difficult to complete and led to increased reliability problems in diagnosis

L- This supports the notion that the DSM has helped to increase the reliability of diagnosis by adapting and changing certain specific criteria to make diagnosis more consistent.

Question 10

What are the two issues of validity in diagnosing schiz

Answer 10

Over-lapping symptoms comorbidity issues

Question 11

Evaluating validity- Buckley

Answer 11

P - In evaluation, comorbidity reduces the validity of diagnosis as a clinician could make an inaccurate diagnosis due to the additional disorder.

E - Buckley et al (2009) identified the following comorbid conditions with schizophrenia and argues they could actually be subtypes of schizophrenia. The following was reported with schizophrenia: 50% with depression and 47% with substance abuse.

E - in addition - to complicate matters further, we are unsure as to which condition came first

L - This suggests that..the validity of diagnosing schiz is damaged by the presences of comorbid conditions

Question 12

What did Buckley find

Answer 12

Identified the following comorbid conditions with schizophrenia and argues they could actually be subtypes of schizophrenia. The following was reported with schizophrenia: 50% with depression and 47% with substance abuse.

Question 13

Buckley et al (2009) identified the following comorbid conditions with schizophrenia and argues they could actually be subtypes of schizophrenia. The following was reported with schizophrenia: __% with depression and __% with substance abuse.

Answer 13

50
47

Question 14

Evaluating validity- re-considering comorbid conditions

Answer 14

P - In further evaluation, we must really re-consider comorbid conditions and schizophrenia.

E - As patients actually suffer from 2 or more mental health states for example, having both schizophrenia and post traumatic stress disorder - both with very specific symptoms and huge amounts of emotional distress

E -Surely that is a UNIQUE CONDITION as opposed to 2 states that coexist and receive 2 separate diagnoses. This has been partly addressed in DSM V, but problems remain with comorbidity and schizophrenia.

L-Therefore….DSM and other manuals will continue to refine diagnostic criteria to tackle the reality of patients suffering from 2 disorders and improve the validity of diagnosing schiz

Question 15

Evaluating validity- Hewitt

Answer 15

P - An issue with overlapping symptoms is that they can decrease the validity of diagnosis as a clinician may identify symptoms which are common with other disorders.

E - Hewitt (2001) investigated the symptoms of autistic patients and patients of schizophrenia. They found that…

E - from 14 patients with schiz and 14 with autism- none of the schizophrenic patients had symptoms of autism, but 50% (7) of the autistic patients had symptoms of schizophrenia (particularly negative symptoms

L- This shows support for the fact that symptom overlap has the potential to damage the validity of diagnosing schiz

Question 16

What did Hewitt do/find

Answer 16

Investigated the symptoms of autistic patients and patients of schizophrenia. They found that…From 14 patients with schiz and 14 with autism- none of the schizophrenic patients had symptoms of autism, but 50% (7) of the autistic patients had symptoms of schizophrenia (particularly negative symptoms

Question 17

From __ patients with schiz and __ with autism- none of the schizophrenic patients had symptoms of autism, but __% (_) of the autistic patients had symptoms of schizophrenia (particularly negative symptoms

Answer 17

14
14
50
7

Question 18

Evaluating validity- How DSM can help improve validity

Answer 18

P - In conclusion, classification systems such as the DSM can help to improve the validity of diagnosis due to having to meet more than one criteria.

E - For example with schiz, patients do not just need to show 2 symptoms, but also nowadays there is exclusion criteria (e.g. no major depression or manic episodes)

E - AND due to symptoms needing to be present for a certain time frame e.g. symptoms present for a month and disturbance for 6 months

L - This could help to make the diagnosis of schiz more accurate and hopefully avoid misdiagnosis

Question 19

Four issues of cultural bias in diagnosing schiz

Answer 19

Cultural interpretations
Negative cultural attitudes to Schiz
The culture / nationality of the clinician
Race discrimination in diagnosing schiz

Question 20

Evaluating cultural bias- Malgady

Answer 20

In evaluation, there is research into cultural differencesMalgady’s (1987) research has demonstrated that different cultures interpret symptoms of schiz in very unique ways. This research showed that in traditional Costa Rican culture hearing voices is interpreted as spirits talking to the individual (a prized abnormality), whereas in the USA the same phenomenon is interpreted as a core symptom of schizophrenia. This research implies..the cultures we find ourselves in impact on the diagnosis of schizophrenia

Question 21

What did Malgady’s research show

Answer 21

Demonstrated that different cultures interpret symptoms of schiz in very unique ways. This research showed that in traditional Costa Rican culture hearing voices is interpreted as spirits talking to the individual (a prized abnormality), whereas in the USA the same phenomenon is interpreted as a core symptom of schizophrenia.

Question 22

Evaluating cultural bias- practical applications

Answer 22

However there are strong practical applications that have come from research into cultural biases of the diagnosis of schizophrenia. Finding cultural biases allows for training for psychologists into the differences in interpretation and expression of symptoms in cultures. E.g. in Nigeria many patients may claim they have ants running all over their body (tactile hallucination)This can improve diagnosis because it should make clinicians more sensitive to subtle cultural norms and ways of expressing symptoms This implies that..by attending to cultural differences we can improve the validity of diagnosis schizophrenia

Question 23

Evaluating cultural bias- culture impacts prognosis as well as diagnosis

Answer 23

In further evaluation not only does culture impact on diagnosis - it also affects prognosis of schizophrenia Recent research has actually implied that the recovery form Schiz is much more likely to occur in collectivist cultures compared to individualistic cultures This could be due to the greater interconnectedness of the these cultures and how when individuals suffer schiz and the accompanying emotional distress, others are more involved in their recovery This implies that exploring the significance of culture could have an influence on recovery from schiz as well its diagnosis

Question 24

Evaluating culture bias- Copeland

Answer 24

There has been further support in research, the culture or nationality of the psychologist or clinician has shown to affect the rate of diagnosis. Copeland (1971) gave a description of a patient to 134 US and 194 British psychiatrists and found that 69% of the US psychiatrists diagnosed the patient with schizophrenia whereas only 2% of British psychiatrists gave the same diagnosis. This shows that American clinicians are far more likely to diagnose schizophrenia than their UK counterparts, suggesting the culture of the clinician does impact on diagnosis

Question 25

Evaluating culture bias- Blake

Answer 25

Blake (1973) found that clinicians are six times more likely to diagnose a patient with schizophrenia if the case summary referred to them as African American than if they were referred to as white. This shows how the race and culture of the patient can inadvertently effect the reliability of diagnosis.

Question 26

What did Blake find

Answer 26

Found that clinicians are six times more likely to diagnose a patient with schizophrenia if the case summary referred to them as African American than if they were referred to as white.

Question 27

Blake found that clinicians are _ times more likely to diagnose a patient with schizophrenia if the case summary referred to them as _______ ______ than if they were referred to as ____.

Answer 27

6 African American White

Question 28

3 issues with gender bias in diagnosing schiz

Answer 28

Unreported facts in diagnosis of schiz
Biased, androcentric research
Underdiagnosis of female patients

Question 29

Evaluating gender bias- Cotton’s

Answer 29

In evaluation, Cotton’s (2009) research implies women also seem to recover more and suffer less relapse than their male counterparts. Ignoring these facts would result in gender bias (a BETA BIAS) in clinicians not considering important factors in the diagnosis and recovery from schizophrenia.This could mean that we miss key factors that are involved in women suffering less rleapse that in theory we could apply to all This implies that…underreporting of key facts relating to gender and the diagnosis of schiz, not only creates gender bias - but neglects considerations that could help all

Question 30

What did Cotton’s research show

Answer 30

Implies women also seem to recover more and suffer less relapse than their male counterparts.

Question 31

Evaluating gender bias- Nasser

Answer 31

There is also an issue with how research initially only focussed on men and schiz. Nasser (2002) found that that much of the early research into schizophrenia was conducted with men only. This means lots of research findings concerning treatments and explanations of the disorder may be inappropriate for women.When research focuses exclusively on men it can be accused of androcentrism and lacks generalisability to target populations.This suggests…that research into the diagnosis of schiz may suffer from beta bias

Question 32

What did Nasser find

Answer 32

Found that that much of the early research into schizophrenia was conducted with men only.

Question 33

Evaluating gender bias- Loring and Powell

Answer 33

In addition, there may be a gender bias in the diagnosis of schizophrenia due to clinician’s preconceptions as to which gender the disorder is more prevalent in.Loring and Powell (1988) randomly selected 290 male and female psychiatrists to read two cases. They were then asked to offer there judgments on these individuals using standard diagnostic criteria. When the patient were described as ‘males’ or no information was given about their gender, 56% gave a diagnosis of schizophrenia. However, when the patients were described as ‘females’ only 20% were given a diagnosis of schizophrenia. Interestingly, this gender bias was less prominent with female psychiatrists. Therefore, this study illustrates the gender biases with regards to schiz. are held by clinicians and how this needs to be addressed in their initial training

Question 34

What did Loring and Powell do/find

Answer 34

Loring and Powell (1988) randomly selected 290 male and female psychiatrists to read two cases. They were then asked to offer there judgments on these individuals using standard diagnostic criteria. When the patient were described as ‘males’ or no information was given about their gender, 56% gave a diagnosis of schizophrenia. However, when the patients were described as ‘females’ only 20% were given a diagnosis of schizophrenia. Interestingly, this gender bias was less prominent with female psychiatrists.

Question 35

Loring and Powell (1988) randomly selected ___ male and female psychiatrists to read two cases. They were then asked to offer there judgments on these individuals using standard diagnostic criteria. When the patient were described as ‘____’ or no information was given about their gender, __% gave a diagnosis of schizophrenia. However, when the patients were described as ‘_____’ only __% were given a diagnosis of schizophrenia. Interestingly, this gender bias was less prominent with female psychiatrists.

Answer 35

290
males
56
females
20

Question 36

Evaluating gender bias- practical applications

Answer 36

However research into gender biases does have good practical applications as it reduces the possibility of diagnoses being made according to gender. Research can be used to help train psychologists to not misdiagnose females who have schizophrenia symptoms with other disorders associated with females e.g. schizoaffective disorder. This should result in more women receiving the correct diagnosis of schizophrenia, (and subsequent treatment).It also means that male patients should not be overdiagnosed and should not receive a diagnosis of schizophrenia that is incorrect. The findings from studies such as Loring and Powell can help to show there are biases and improve the validity of the process.Hence, attending to gender issues in diagnosing schiz could be beneficial for all

Question 37

In addition, worryingly ____ reported that test- retest analysis is as low as __% for schizophrenia which is extremely concerning, especially when we consider the potential false positives and false negatives this could create.E - ____________E- Alternatively, it also implies that some patients may receive a schiz diagnosis, not actually need the diagnosis or the medication that goes with itL - ____________

Answer 37

Read37This suggests that some patients may not be diagnosed when they should - and as such miss out on key medicationThis could imply that clinicians need to take extra care when diagnosing patients to avoid false positives and negatives

Question 38

P - In evaluation, comorbidity reduces the validity of diagnosis as a clinician could make an inaccurate diagnosis due to the additional disorder. E - Buckley et al (2009) identified the following comorbid conditions with schizophrenia and argues they could actually be subtypes of schizophrenia. The following was reported with schizophrenia: 50% with depression and 47% with substance abuse. E - in addition - to complicate matters further, we are unsure as to which condition came first L - _____________

Answer 38

This suggests that..the validity of diagnosing schiz is damaged by the presences of comorbid conditions

Question 39

In further evaluation, we must really re-consider comorbid conditions and schizophrenia. E - As patients actually suffer from 2 or more mental health states for example, having both schizophrenia and post traumatic stress disorder - both with very specific symptoms and huge amounts of emotional distressE -Surely that is a UNIQUE CONDITION as opposed to 2 states that coexist and receive 2 separate diagnoses. This has been partly addressed in DSM V, but problems remain with comorbidity and schizophrenia.L- ____________

Answer 39

Therefore….DSM and other manuals will continue to refine diagnostic criteria to tackle the reality of patients suffering from 2 disorders and improve the validity of diagnosing schiz

Question 40

P - In conclusion, classification systems such as the DSM can help to improve the validity of diagnosis due to having to meet more than one criteria. E - For example with schiz, patients do not just need to show _ symptoms, but also nowadays there is exclusion criteria (e.g. no major depression or manic episodes)E - ___________L - ___________

Answer 40

2AND due to symptoms needing to be present for a certain time frame e.g. symptoms present for a month and disturbance for 6 monthsThis could help to make the diagnosis of schiz more accurate and hopefully avoid misdiagnosis