Schizophrenia- Diagnosis and classification ISSUES

Question 1

Double whopper, limitation, reliability

CHENIAUX ET AL- DIAGNOSIS

Answer 1

The reliability of schizophrenia diagnosis is poor.
Cheniaux et al (2009) had two psychiatrists independently diagnose 100 patients using both DSM and ICD criteria. One psychiatrist diagnosed 26 patients with schizophrenia using the DSM and 44 with the ICD.
The other psychiatrist diagnosed 13 patients with schizophrenia using the DSM and 24 with the ICD. This shows that clinicians are not consistent in using the classification systems to diagnose people, meaning that it is unreliable.
This can harm the faith patients have in doctors if different clinicians are giving different diagnoses and thus treatment.

Question 2

Hamburger, limitation,validity

INACCURATE USE OF CLASSIFICATION SYSTEMS

Answer 2

The validity of the classification systems used to diagnosis schizophrenia appears to be inaccurate. Cheniaux et al (2009) had two psychiatrists independently diagnose 100 patients using both DSM and ICD criteria.
One psychiatrist diagnosed 26 patients with schizophrenia using the DSM and 44 with the ICD. The other psychiatrist diagnosed 13 patients with schizophrenia using the DSM and 24 with the ICD. If both classification systems were accurate, there would be criterion validity; the same number of patients should have been diagnosed with schizophrenia using the DSM and ICD.
This suggests that clinicians using the ICD are likely to over diagnose patients with schizophrenia, while those using the DSM are likely to under diagnose patients with schizophrenia, suggesting that neither classification may be accurate.

Question 3

Hamburger,limitation, validity,

BUCKLEY ET AL

Answer 3

There is more evidence to suggest that there are difficulties with the validity of schizophrenia classification and diagnosis.
Buckley at al. (2009) completed a review of patients with schizophrenia finding that 50% also had depression, 47% also had substance abuse, 29% also had PTSD and 23% also had OCD. Regarding diagnosis, if 50% of those with schizophrenia are also diagnosed with depression clinicians may be quite bad at telling the difference between the two.
Furthermore, regarding classification, if very severe depression looks like schizophrenia and vice versa then they may actually be a single condition. This suggests that comorbidity creates a large issue in the classification and diagnosis of schizophrenia.

Question 4

Double whopper, limitation, validity

SYMPTOM OVERLAP- OPHOFF ET AL

Answer 4

Symptom overlap creates issues for the validity of the classification systems for schizophrenia. Ophoff et al (2011) assessed genetic material from 50000 participants.
Of 7 gene locations on the gene associated with schizophrenia, 3 of them were associated with bipolar disorder. This suggests a genetic overlap between the two disorders and might mean that they are actually one condition.
This may mean people are being labelled with the wrong mental health illness and may not be getting appropriate treatment.

Question 5

combo whopper, limitation, validity?

GENDER BIAS SO NOT ALL THE SAME

Answer 5

The issue of gender bias means that some genders may not be getting a diagnosis of schizophrenia and therefore are not getting treatment to help with their disorder.
Longenecker et al (2010) reviewed studies of the prevalence of schizophrenia and concluded that since the 1980s more men have been diagnosed with schizophrenia than women. There had been no differences prior to this.
It could be that males are more genetically vulnerable. However, it is more likely that female patients tend to function better than men. They are more likely to work and have better interpersonal skills.
The high functioning may have prevented a schizophrenia diagnosis as clinicians could have misapplied the diagnostic criteria.

Question 6

Double whopper, limitation,

CULTURE BIAS

Answer 6

Culture bias creates one of the largest issues in the classification and diagnosis of schizophrenia.
In Britain, Afro-Caribbean’s are more likely than white people to be diagnosed with schizophrenia. They are also more likely to be in a secure unit.
This cannot be due to differences in genetic vulnerability as rates of schizophrenia are not higher in Africa and the West Indies.
Explanations for this pattern include the fact that hearing voices is more acceptable in African culture because of cultural beliefs in communication with ancestors and thus people are more ready to acknowledge such experiences. If reported to a clinician with a different cultural background this can be seen as bizarre and irrational, which may lead to a diagnosis of schizophrenia showing that a lack of cultural understanding can affect the diagnosis given.