Schizophrenia - Classification and Diagnosis Flashcards

(39 cards)

1
Q

Implications of classification and diagnosis?

A

Misdiagnosis, Stigma, Advantages

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Misdiagnosis could lead to…

A

incorrect or no treatment, which will affect progress (recovery) and general outcomes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Stigma could…

A

affect career (e.g. health questionnaires when applying, promotions), personal and social life

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Advantages of classification and diagnosis?

A

Determines treatment, information on implications/course of SZ, gives professionals a shared language

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Kendell and Jablensky?

A

Diagnostic categories are justifiable concepts and a useful framework for organising and explaining

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Reliability?

A

Refers to the consistency of a measuring instrument, such as the DSM

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

How can reliability be measured?

A

Through inter-rater reliability or test-retest reliability

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Issues of reliability?

A

Low inter-rater reliability, unreliable symptoms, differences between the DSM and ICD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Relationships between reliability and validity?

A

If it’s not reliable it can’t be valid - if psychologists can’t agree who has SZ (reliability) then what is it? (validity)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Low inter-rater reliability?

A

There have been improvements but it remains an issue

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Researchers on low inter-rater reliability?

A

Beck BUT Carson BUT Whaley

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Beck?

A

Early versions of manuals weren’t very reliable as key terms weren’t clearly deigned and clinicians used different interview techniques

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Carson?

A

DSM-III has overcome problems described by Beck and has inter-rater reliability

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Whaley?

A

Found inter-rater reliability correlations as low as +0.11

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Implications of low inter-rater reliability?

A

Misdiagnosis and therefore stigma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Issue with unreliable symptoms?

A

Some symptoms aren’t consistently identified by clinicians - they must be able to decide whether a symptom is present or not to make a diagnosis, but SZ is difficult to diagnose as there are no physical signs or definitive tests

17
Q

Researchers on unreliable symptoms?

A

Mojtabi and Nicholson

18
Q

Mojtabi and Nicholson?

A

Asked 50 senior psychiatrists in the US to differentiate between bizarre and non-bizarre symptoms and found IRR of +0.4

19
Q

DSMs and unreliable symptoms?

A

DSM-IV only requires 1 symptom if delusions are bizarre (the key symptom) BUT DSM V required 2 symptoms so no longer a problem

20
Q

Implications of unreliable symptoms?

A

While it’s no longer an issue it may’ve led to misdiagnosis in the past so may still be affecting individuals

21
Q

Issue with differences between the DSM and ICD?

A

Individuals should receive the same diagnosis from each if reliable

22
Q

What are the differences between the DSM and ICD?

A

More likely to be diagnosed with the ICD (requires 1 month of symptoms) than the DSM (1 month of symptoms + 6 months of disturbance/social occupational dysfunction)

23
Q

Researcher on differences between the DSM and ICD?

24
Q

Copeland?

A

69% of 134 US psychologists (DSM) and 2% of 184 British ones (ICD) diagnosed SZ

25
Implications of differences between the DSM and ICD?
Misdiagnosis or no diagnosis at all
26
How are differences between the DSM and ICD being fixed?
Organisations such as WHO and APA have recognised the issue and have worked to produce the DSM V to improve reliability
27
Issues of validity in classification and diagnosis?
Predictive validity, comorbidity
28
What is validity?
The extent that a diagnosis represents something that's real and distinct from other disorders, and the DSM and ICD measure what they claim to
29
Issues with predictive validity?
If SZ is a valid disorder then patients should share the same outcomes and on that basis clinicians should be able to predict outcomes, but there are a lot of individual differences in response to treatment and outcomes
30
Research on predictive validity?
Bentall et al
31
Bentall et al?
20% of SZs responded to treatment and recovered previous levels of functioning, 10% achieved significant and lasting improvements, 30% some improvement with intermittent relapses
32
What does Bentall's research show?
SZ may not be a single unitary disorder so classification as a distinct disorder may not be valid
33
Implications of predictive validity?
Brings into question one of the main aims of classification and diagnosis: deciding treatment - how clinically useful is C&D really?
34
What is comorbidity?
The extent to which 2 conditions co-occur, e.g. SZ and substance abuse, anxiety etc.
35
Research on comorbidity?
Buckley et al and Kessler et al
36
Buckley et al?
Estimated comorbid depression in 50% of SZs and that 47% have a lifetime diagnosis of substance abuse
37
Kessler et al?
National Comorbidity Survey - attempted suicide rate 1% for those with SZ alone, 40% of those with at least 1 lifetime comorbid disorder
38
Issue with comorbidity?
It's difficult to determine cause - is it SZ or a 2nd condition? If classification is valid the causes should be clear and the same for everyone
39
Implications of comorbidity?
Which disorder should be focussed on? Therefore what treatment?