Classification and Symptom

Question 1

Diagnosis

Answer 1

DSM-5 and ICD-10 are used to diagnose Sz
- ICD-11 features: (one or more)
¬ Delusions (false belief that are firmly held, despite being illogical)
¬ Hallucinatory voices
Criteria: (any two)
¬ Persistent Hallucinations
¬ catatonic behaviour i.e.posturing

Question 2

Statistics

Answer 2

-1% of pop develop sz during lifetime, therefore it’s statistically infrequent
- The economic cost of sz is very great, as treating a sz patient is about 6x the cost of treating a patient with heart disease

Question 3

Symptoms

Answer 3

positive > distortion of normal functioning i.e. delusions i.e. grandeur - belief they are an important individual ‘god’
- hallucinations (disturbances in perception, they have no basis in reality) > auditory
negative > loss of normal functioning i.e. speech poverty (lack of ability to produce fluent words) > Alogia
- Avolition (inability to start/continue with goal-directed behaviour) > social widthdrawal

Question 4

Reliability/ Validity

Answer 4

How is reliability IMPROVED?
- inter rater reliability where there’s an agreement of 0.8 correlation

How is validity IMPROVED?
- measured using N,O,I
- Using high levels of control to eliminate any extraneous variables that may impact data
WHY is it important?
- it provides the empirical evidence needed

WHAT is reliability of diganosis?
- consistency of diagnosis. Can be diff diagnoses made depending on which stats manual is used (DSM-5, ICD-10)
¬ WHY is this important?
- inconsistent diagnosis could mean, a type II error was made, where patients are diagnosed incorrectly
- diff psychiatrists should reach the SAME diagnosis again and again. (Rosenhan)

WHAT is validity of diagnosis?
- diagnosis needs to be accurate. Gender, culture and use of diff manuals can affect the accuracy of diagnosis
- overlap and morbidity can affcet accuracy
¬ WHY is this important?
- accurate diagnosis leads to accurate treatment
- inaccurate diagnosis could mean patients taking anti-psychotic medication when not needed. This can be dangerous and fatal

Question 5

RESEARCH: ROSENHAN: VAL/RELIABLE

Answer 5

• staff diagnosed 11 pseudo patients and one manic depression with sz.
  ¬ they never detected their sanity
• situational factors affect diagnosis i.e. institution (hospital) deemed sane behanviour as insane.
  *follow up studies: Hospital told to expect pseudo patients, they incorrectly identified genuine patients as pseudo patients
• It’s highly dangerous to make this error in a mental disorder as severe as sz
• Concluded that the DSM is flawed

Question 6

Co-morbidity

Answer 6

**Buckley et al: concluded that half of patients with diagnosis of sz, 50% had diagnosis of depression and 47% substance abuse
- Post traumatic stress (PTS) occured in 29% of cases and OCD in 23%, showing that sz commonly occurs alongside other mental illnesses and disorder are co-morbid.

Question 7

Symptom Overlap

Answer 7

**Ellason/Ross: those with DID (dissociative identity disorder) had more sz symptoms than those diagnosed with. Using the ICD a patient may be diagnosed as sz, however others may be diagnosed as having bipolar disorder when using the DSM

**Ketter: points out that misdiagnosis due to overlap, can lead to years of delay in receiving treatment, during which suffering and further degeneration can occur, as well as high levels of suicide, so overlap can have serious consequences.

Question 8

Gender Bias

Answer 8

**Loring/Powell: random selection of 290 male and female psychiatrists to read two cases of patients’ behaviour and then asked to offer their judgement on those people using standard diagnostic criteria.
- when patients described as ‘male’ or no info given about their gender, 56% were given a diagnosis of sz. However, when patients were described as ‘female’, only 20% were given diagnosis of sz.
- This gender bias, was only evident among male clinicians and not female. Therefore, suggesting that diagnosis is influenced by the gender of the patient as well as the clinician.

Question 9

Culture Bias

Answer 9

**Escobar: white psychiatrists tend to over interpret symptoms of blacks during diagnosis, as cultural diff in language and mannerisms, make it difficult for white psychiatrists to relate to black patients, and myth that blacks rarely suffer from affective disorders may be causing this issue.
¬ Therefore, clinicians and researchers must pay more attention to effects of cultural differences on diagnosis.