Introduction to schizophrenia Flashcards
Positive symptoms meaning
Additional experiences beyond those of ordinary existence
Two positive symptoms of schizophrenia
Hallucinations and delusions
Two negative symptoms of schizophrenia
Speech poverty and avolition
What are the two main classification systems for schizophrenia and how are they different?
DSM 5 - one positive symptom must be present
ICD 11 - two or more negative symptoms are sufficient for diagnosis
Explain one issue of the classification of schizophrenia
Symptoms plus others can be present in a number of different disorders as well as schizophrenia. This overlap between disorders can make it very hard to see if they are different or just different forms of the same thing e.g Asperger’s syndrome.
Furthermore, it is common for people with schizophrenia to also show signs of secondary mental illnesses without being able to distinguish between them, known as comorbidity.
This therefore makes it more challenging to determine the exact classification for schizophrenia, in turn misdiagnosing and giving inappropriate treatments is an actual possibility
State the 5 issues with the diagnosis of schizophrenia
Reliability
Validity
Comorbidity
Gender bias
Culture bias
EVALUATION: Why is reliability an issue in diagnosing schizophrenia
One issue of the diagnosis of schizophrenia is reliability, due to the classification systems being quite vague. The extent to which various psychiatrists from different times and cultures agree on a diagnosis is known as reliability.
Different clinicians using the same system should get the same diagnosis for the same patient in order for the system of classification to be considered reliable.
For example, according to Cheniaux et al. (2009), there was little inter-rater reliability between the two psychiatrists. Using the DSM, one identified 26 out of 100 patients as having schizophrenia, and the ICD, 44 out of 100 patients. The other made 24 ICD diagnoses and 13 DSM diagnoses.
This demonstrates the validity and reliability issues with the disorder’s classification and diagnosis.
EVALUATION: Why is validity an issue in diagnosing schizophrenia
The diagnosis’s poor criteria validity is another problem. The extent to which we are measuring what we want to assess is referred to as validity. Assessing whether multiple methods used to assess the same people lead to the same diagnosis is known as criterion validity.
Cheniaux also discovered differences in the proportion of individuals with schizophrenia identified by the DSM and ICD. As a result, we cannot be certain that any classification system is valid for diagnosing schizophrenia.
This is an issue since diagnosing a patient and choosing a course of treatment are frequently trial and error processes, psychiatrists cannot predict how a patient will respond to treatment and which is best for an individual.
COUNTERPOINT to validity
However, in the Osorio study, clinicians using various approaches that were both derived from the DSM system showed great agreement. So criteria validity for schizophrenia is good as long as it occurs within a single diagnostic framework.
EVALUATION: Why is comorbidity an issue in diagnosing schizophrenia
Comorbidity refers to the fact that two or more conditions occur together. If conditions occur together a lot of the time then this calls into question the validity of the diagnosis and classification because they might actually be a single condition.
Schizophrenia is commonly diagnosed with other conditions, for example in one review Buckley et al concluded that around half of patients with schizophrenia also have a diagnosis of depression (50%) or substance abuse (47%) or OCD (43%).
This is an issue for classification because it means schizophrenia may not exist as a distinct condition, and is a problem for diagnosis as it suggests that at least some people diagnosed with schizophrenia may instead have unusual cases of conditions like depression
EVALUATION: Why is gender bias an issue in diagnosing schizophrenia
A further issue of schizophrenia diagnosis is the existence of gender bias. Since the 1980s men have been diagnosed with schizophrenia more commonly than women.
For example, Cotton et al suggest this is due to the fact that women have closer social and familial relationships than men and hence get more support.
This leads to women with schizophrenia functioning better than men, which may explain why some women have not been diagnosed with schizophrenia where men with similar symptoms might have been; the better interpersonal functioning (social skills/communication)may bias practitioners to underdiagnose schizophrenia, either because symptoms are masked altogether or because of the quality of interpersonal function makes the case seem too mild to warrant a diagnosis
EVALUATION: Why is culture bias an issue in diagnosing schizophrenia
Some symptoms e.g hearing voices, are accepted in some cultures e.g Afro-Caribbean societies ‘hear voices’ from ancestors
Afro-Caribbean British men are up to ten times more likely to receive a diagnosis as white British men, probably due to overinterpretation of symptoms by UK psychiatrists
This means that Afro-Caribbean men living in the UK appear to be discriminated against by culturally biased diagnostic system.
