L1 - Classification Of Schizophrenia Flashcards

Question

Validity

Answer 1

- extent to which we are measuring what we intend to measure, so are we diagnosing schizophrenia correctly based on the symptoms used in the manuals. - can be assessed using criterion validity which is when different assessment systems arrive at the same diagnosis for the same patient (e.g. both using ICD and DSM – the patient is seen as schizophrenic). - According to Cheniaux’s study we can see the SZ is much more likely to be diagnosed using ICD than DSM suggesting that SZ is either over diagnosed in ICD and under diagnosed in DSM, this problem is a sign of poor validity.

Answer 2

- low validity can be explained through a classic piece of research carried out by Rosenhan (1973) – his research is known as ‘on being sane in insane places’. - Rosenhan aimed to test the validity of SZ diagnosis using DSM (at that time it was in its second version) classification. -Eight volunteers who did not suffer with mental illness presented themselves to different mental hospitals, claiming that they could hear voices such as, ‘hollow, empty, thud’. - All were admitted and acted normally. Time taken to be released and reactions to them were recorded. - The eight volunteers took between 7 and 52 days to be released, diagnosed as schizophrenics in remission. - Normal behaviours were interpreted as symptoms of SZ. However, 35 out of 118 actual patients suspected that the volunteers were sane! - Later a hospital was informed that an unspecified number of pseudo-patients would attempt entry over a three month period. - The number of suspected imposters were recorded. 193 patients were admitted, of whom 83 aroused suspicions of being false patients. No actual pseudo-patient attempted admission. - Rosenhan’s study highlights the reason for why the diagnosis of SZ lacks validity, psychiatrists are unable to distinguish between real and pseudo-patients. - unethical study, deception, no right to withdraw also un generalisable as only went to 1 state

Answer 3

- Birchwood and Jackson (2001) found about 20% of patients of schizophrenia show complete recovery and never have another schizophrenia episode, 10% show significant improvement, 30% show some improvement. - 40% never really recover. Of the 40% that never recover, 10% are so affected that they commit suicide. - This great variation in prognosis suggests very poor predictive validity.

Answer 4

recent Osario (2019) study suggests that because the reliability is so high using the DSM, the validity would also be high using this single diagnostic system suggesting that the ICD perhaps need more revision.

Answer 5

- idea that two or more mental disorders (or conditions) occur together at the same time with the same person. - If so, then we can question the validity of diagnosis for schizophrenia, it is commonly diagnosed with other conditions. - In one review Buckley et al. (2009) concluded that around half of the patients with SZ also have a diagnosis of depression (50%) or substance abuse (47%). - Post- traumatic stress disorder also occurred in 29% of cases and OCD in 23% of cases. - poses a challenge for both classification and diagnosis of SZ. - In terms of diagnosis, if half the patients are diagnosed with both SZ and depression, this suggests that we are not able to distinguish between both disorders very well. - In terms of classification, it may be that very severe depression looks like SZ or visa versa, that they may seen as a single condition.

Answer 6

- this means that there is considerable overlap between the symptoms of SZ and other conditions such as depression and bipolar disorders. E.g a person can show a symptom of SZ and this symptom will also be in another disorder. E.g. Ellason and Ross (1995) point out that people with DID (Dissociative Identity Disorder) actually having more schizophrenic symptoms than people diagnosed with SZ. - most people diagnosed with SZ have sufficient symptoms of other disorders that they could also receive at least one other diagnosis (Read, 2004) - overlap would question the validity of the classification and diagnosis of SZ. E.g under the ICD, a patient may be diagnosed with SZ but under the DSM the same person will be diagnosed with bipolar disorder – because of this overlap, this suggests that SZ and bipolar may not be two disorders but one

Answer 7

- Since the 1980s men have been diagnosed with SZ more commonly than women (a ratio of 1.4:1 – Fischer and Buchanan (2017). - One possible explanation for this is that women seem to function better than men having good family relationships & more likely to work (Cotton 2009). - Therefore it is less likely to be diagnosed with SZ because women showing better interpersonal function than men. - Thus, there seems to be a gender bias in diagnosis of SZ with more males getting diagnosed than females

Answer 8

- African American and English people of Afro Caribbean origin are nine times more likely to be diagnosed with SZ. (Pinto and Jones, 2008) - It may be because positive symptoms of SZ such as auditory hallucinations may be acceptable in Africa because of cultural beliefs in communication with ancestors (e.g. hearing their dead ancestors talking to them) which are acceptable and not warranted to a diagnosis in Africa (as SZ rates low in Africa). - However in the UK, this is more likely to be seen as a positive symptom of SZ. Or, could it be that in Western cultures, we doubt the honesty of black people (Escobar, 2012).

Answer 9

- Communication shorthand: a patient with a mental disorder often has numerous symptoms. It is simpler to incorporate these symptoms into a single diagnosis and this makes communication between mental health professionals much easier - Treatment: treatments are often specific to certain disorders e.g. symptoms of schizophrenia respond well to certain anti-psychotic drugs but not anti-anxiety. A reliable diagnosis can point to a therapy that will alleviate symptoms. - Although there is variation, there are many underlying biological abnormalities seen in people with schizophrenia. It is hoped that a greater understanding of these abnormalities will lead to even more effective treatment.