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Schizophrenia Paper 3 > Issues in the diagnosis of Schizophrenia > Flashcards

Issues in the diagnosis of Schizophrenia Flashcards

1
Q

Prevalence of Schizophrenia?

A
  • affects 1% of population
  • symptoms appear between 15-45
  • Men more susceptible than women
  • Men tend to be diagnosed mid 20s
  • Women tend to be diagnosed early 30s
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2
Q

Prognosis of Schiz?

A
  • Symptoms most severe during first 5 years after onset
  • 40% recover from positive symptoms
  • 20% make full recovery, diagnosed early
  • 40% have it for life
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3
Q

What are positive symptoms?
Give two examples

A
  • Symptoms normal people don’t experience
  • Delusions & Hallucinations
  • referred to as Category A symptoms
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4
Q

What are negative symptoms?
Give two examples

A
  • Symptoms normal people experience that schiz patients do not
  • Avolition & Alogia (speech poverty)
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5
Q

How does the DSM classify a schiz patient mainly?

A
  • symptoms must persist for 6 months
  • this period must include 1 month of two symptoms
  • one of the two has to be positive
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6
Q

What is the relationship to Autism the DSM outlines?

A
  • If there is history of Autism in the patient, diagnosis of Schiz. is only made if there are delusions/hallucinations & other symptoms for at least 1 month (or less if successfully treated
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7
Q

Describe Hallucinations as a positive symptom?

A
  • Sensory experiences, seeing distortions, hearing critical voices
  • Can include olfactory (phantom odours) which are smells
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8
Q

Describe Delusions as a positive symptom?

A
  • Irrational beliefs
  • Feelings of persecution (from the government)
  • Feelings of grandeur (thinking they’re royalty)
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9
Q

Describe Avolition as a negative symptom?

A
  • lack of purposeful behaviour
  • No energy, lack of social activity, lack of personal hygiene
  • Generally apathetic towards people
  • won’t go outside
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10
Q

Describe speech poverty as a negative symptom?

A
  • lack of quantity & quality of verbal responses
  • Disorganised verbal communication can become positive symptom
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11
Q

What’s a positive implication of being diagnosed with a disorder?

A
  • appropriate treatment
  • placed on road to recovery
  • family at ease
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12
Q

What’s are 3 negative implications of being diagnosed with schizophrenia?

A
  • stigma of schizophrenia
  • labelling theory and self-fulfilled prophecy
  • employment/housing
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13
Q

In reliability of Schiz diagnosis what two types of reliability arise & what are they?

A
  • Inter-rater reliability
  • two+ clinicians make identical diagnosis of the SAME patient with SAME information
  • Test-retest reliability (external reliability)
  • clinicians make the same diagnosis of the patient on separate occasions with SAME information
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14
Q

What factors could influence a low rate of agreement between clinicians?

A
  • bias (gender, race)
  • subjective guidelines
  • vague symptoms
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15
Q

A03 Reliability of diagnosis
Beck et al 1963?
(153 patients)

A
  • Beck reviewed 153 patients diagnosed by 2 different psychiatrists
  • Diagnosis concordance rate only 54%
  • Suggests low inter-rater reliability in diagnosis
  • Suggests many misdiagnosed leading to incorrect treatments
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16
Q

A03 Reliability of diagnosis
Farmer 1988?
(PSE)

A
  • Found standardised interview known as Present State Examination (PSE) increases reliability
  • PSE focuses on frequency & severity of symptoms
  • therefore diagnosis can be made reliable as all patients are asked the same things
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17
Q

A03 Reliability of diagnosis
Copeland 1970?
(U.S. & British)
(can be used for cultural differences)

A
  • Copeland gave description of a patient to 134 U.S. psychiatrists & 94 British psychiatrists
  • 69% U.S. diagnosed patient with schiz
  • 2% British diagnosed patient with schiz
  • shows no consistency in diagnostic criteria
  • shows DSM may be flawed
  • shows differences in diagnosis dependent on country
18
Q

AO3 Reliability of diagnosis
Cheniaux 2009?
(DSM & ICD-10)

A
  • classification systems are unreliable in diagnosis
  • 2 psychiatrists evaluated 100 patients using DSM & ICD-10
  • Psych 1 found 26 patients had schiz (using DSM) & 44 (using ICD-10)
  • Psych 2 found 13 patients had schiz (using DSM) & 24 (using ICD-10)
  • suggests low inter-rater reliability & low reliability between both classification systems.
19
Q

What is validity in schiz?

A
  • are we measuring what we are intending to measure
  • validity of diagnostic tools
20
Q

What two areas of validity affect schiz & what are they?

A

Comorbidity
- refers to when more than one disorder exists alongside schiz e.g. BPD & Schiz
- calls into question validity of classification of both illnesses
- should be seen as one separate condition

Overlapping symptoms
- none of schiz symptoms are exclusive to the disorder (pathognomonic)
- this makes valid diagnosis harder to achieve
- estimated 13% of population hear voices yet only 1% are diagnosed schizophrenics (read et al 2011)

21
Q

Pathognomic?

A
  • where symptoms are not exclusive to one disorder e.g social avolition in Schiz.
22
Q

A03 Validity of diagnosis
Buckley 2009?
(comorbidity, other disorders)

A
  • Buckley found comorbidity rates with schiz
  • 50% depression, 47% drug abuse, PTSD 29%, OCD 23%
  • as well as complicated treatment plans, diagnosis is wrong if disorders share symptoms
  • e.g. BPD also has delusions as a symptom
  • So schiz should be redefined
23
Q

A03 Validity of diagnosis
Konstantareas & Hewitt?
(autism & schiz)

A
  • Compared 14 male sufferers of schiz & autism
  • found none of schiz group had symptoms of autism
  • But 50% (7) of autistics had negative symptoms of schiz
  • Shows Overlapping symptoms of schiz
24
Q

A03 Validity of diagnosis
Benefits of classification systems (DSM)

A
  • DSM helps with validity of diagnosis as it meets more than 1 criteria
  • e.g. 2 or more characteristic symptoms for at least 6 months relative to patients condition
  • So this helps to make accurate diagnoses for an area of medicine not physical
25
Q

AO3 Validity of diagnosis
Rosenhan 1973?
(8 pseudo-schizophrenics)

A
  • Criticises the validity of Schiz. diagnosis
  • 8 healthy volunteers presented themselves to 12 pscyh hospitals claiming schizophrenic symptoms
  • All 8 were diagnosed with Schiz. & discharged with Schiz. in remission
  • Results suggests Doctors did not have valid methods for diagnosing Schiz.
26
Q

What are the 4 aspects of cultural bias in Schiz?

I
A
N
D

A
  1. Cultural interpretations of symptoms affect diagnosis (insanity or gift)
  2. Negative cultural attitudes (stigma)
  3. Culture/nationality of clinician
  4. Race discrimination evident in diagnosing Schiz.
27
Q

Outline Cultural interpretations of Schiz symptoms affecting diagnosis of the disorder?

A
  • Some research shows that religious & cultural groups perceive Schiz. differently
  • e.g. ‘insane’ in one culture is a spiritual ‘gift’ in another
  • this can complicate a valid diagnosis of Schiz.
28
Q

Outline negative cultural attitudes to Schiz that affect the diagnosis of the disorder?

A
  • Psychological distress & mental health issues attract different levels of stigma in different cultures affecting diagnosis of Schiz.
  • implies without being diagnosed, people with schizophrenia will continue to suffer and fail to receive effective treatment
29
Q

Outline the culture/nationality of the clinician which affects the diagnosis of the disorder?

A
  • nationality/culture of the clinician creates reliability & validity issues when diagnosing Schiz.
  • Some nationalities diagnose Schiz. in different ways
  • US & UK diagnose in similar ways however the US is far more likely diagnose Schiz.
30
Q

Outline race discrimination which affects the diagnosis of the disorder?

A
  • research implies some nationalities have more Schiz. than others
  • It is suggested clinicians perceive diverse ethnic groups very differently and then discriminate
  • Implies to avoid misdiagnosis clinicians should be mindful of unconscious bias
31
Q

AO3 Cultural Bias
Copeland 1970?
(US & British)

A
  • Copeland gave description of a patient to 134 U.S. psychiatrists & 94 British psychiatrists
  • 69% U.S. diagnosed patient with schiz
  • 2% British diagnosed patient with schiz
  • shows no consistency in diagnostic criteria
  • shows DSM may be flawed
  • shows differences in diagnosis dependent on country
32
Q

AO3 Cultural Bias
Malgady 1987?
(VooDoo)

A
  • Research demonstrated different cultures interpret symptoms of Schiz. in different ways
  • In traditional Costa Rican culture, hearing voices is associated with spirits speaking to the individual
  • On the other hand this is a positive symptom of Hallucinations in the US through the DSM
  • Shows culture can disrupt schiz diagnosis & DSM is invalid as its not universally applicable
33
Q

AO3 Cultural Bias
Practical Applications?
(psych training)

A
  • Strong practical applications that have come from research (Malgady) into cultural biases.
  • Finding cultural biases allows for training of clinicians into the differences in interpretations of symptoms.
  • This can improve diagnosis of SZ because it will be standardised & applicable to everyone in society irrespective of culture.
34
Q

AO3 Cultural Bias
Escobar 2012?
(Cocaine - White)

A
  • Some White clinicians may over interpret symptoms of Black people during diagnosis.
  • Factors including mannerisms & language encompass difficulties in black patients relating to white clinicians.
  • The myth black people rarely suffer from affective disorders may be causing this problem.
  • So clinicians & researchers must pay more attention to their unconscious bias and focus on the objective facts.
35
Q

What are 3 aspects of Gender Bias which affects the diagnosis of schizophrenia?

U
B
U

A
  1. Unreported facts when diagnosing schizophrenia in men & women
  2. Biased research
  3. Underdiagnosing female patients suffering from schizophrenia
36
Q

Outline unreported facts in gender
when diagnosing schizophrenia?

A
  • Men suffer more severe negative symptoms & more substance related disorders than women
  • Men are more likely to be admitted to psychiatric wards (Goldstein 1993)
37
Q

Outline Biased research in gender when diagnosing schizophrenia?

A
  • Some psychologists claim research into schiz. has disregarded females patients
  • questions usefulness & representation
38
Q

Outline underdiagnosing of female patients when diagnosing schizophrenia?

A
  • Research has suggested women go under-diagnosed compared to males
  • clinicians ignore differences between predisposing risk factors between genders
  • this gives them different vulnerability factors in life
  • Implies women are denied access to treatment & have to continue suffering from schiz. symptoms
39
Q

AO3 Gender bias
Cotton 2009?
(Females are nice so I doubt they have schiz.)

A
  • Suggests better interpersonal functioning of women causes doctors to dismiss their symptoms
  • women seem to recover more & suffer less relapse than males
  • Beta bias will transpire if clinicians disregard female sufferers
  • Shows existence of gender bias if gender differences are ignored if its the case male patients are more likely to relapse than females
40
Q

AO3 Gender bias
Nasser 2002?
(Androcentrism)

A
  • Incorporating gender in research analysis is essential
  • Gender influences onset, illness, & treatment
  • Early research into schiz. was mainly on men
  • Research findings will not be appropriate for women
  • If research exclusively focuses on men it can be deemed androcentric and lacks generalisability to target populations
41
Q

AO3 Gender bias
Lorring & Powell 1988?
(290 m&f psychiatrists)

A
  • Randomly selected 290 male & female psychiatrists to read 2 cases
  • using DSM they were asked to offer their judgements
  • when patient was male/no gender: 56% said schiz.
  • gender bias was less prominent with female psychiatrists (20%)
  • Further support for lack of validity in the DSM in relation to gender
42
Q

AO3 Gender bias
Practical application?
(psych training)

A
  • Research can help to train psychologists to not misdiagnose females
  • especially if they have symptoms associated with other disorders (overlapping symptoms)
  • This should result in females receiving correct diagnosis
    Male sufferers, in turn, should also not be over diagnosed
  • Findings from Lorring & Powell can show biases when diagnoses are made
  • this improves the validity of the process

Schizophrenia Paper 3 (5 decks)

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