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Issues with the Classification and Diagnosis of Schizophrenia
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- 1What is schizophrenia?a severe mental disorder characterised by a profound disruption of cognition and emotion
- 2What is SZ diagnosed with?DSM-V and ICD-10
- 3What is reliability?refers to the consistency of a measuring instrument, such as a questionnaire or scale, to assess, for example the severity of their schizophrenic symptoms
- 4What is inter-rater reliability?whether two independent assessors give similar diagnoses
- 5What was the publication of the DSM-III in 1980 specifically designed for?provide a much more reliable system for classifying psychiatric disorders
- 6What did Carson (1991) claim?the DSM-III had fixed the problem of inter-rater reliability
- 7What does this mean?psychiatrists now had a reliable classification system, leading to greater agreement over who did or did not have SZ
- 8Who provided contradictory evidence?Whaley (2001)
- 9What did they find?inter-rater reliability correlations in the diagnosis of SZ were as low as +.11
- 10What is one issue with the diagnosis of SZ?unreliable symptoms
- 11Give an example of an issue with symptomsfor a diagnosis of SZ, only one of the characteristic symptoms is required 'if delusions are bizarre'
- 12What did Mojtabi and Nicholson (1995) do?got 50 senior psychiatrists in the US to differentiate between 'bizarre' and 'non bizarre' delusions
- 13What were the results?they produced inter-rater reliability correlations of only around +.40
- 14What did this force the researchers to conclude?that even this central diagnostic requirement lacks sufficient reliability for it to be a reliable method of distinguishing between schizophrenic and non-schizophrenic patients
- 15What is test-retest reliability?whether tests used to deliver diagnoses are consistent over time
- 16What is important in the diagnosis of SZ?cognitive screening tests such as RBANS (repeatable battery for the assessment of neuropsychological status)
- 17What do these measure?the degree of neuropsychological impairment
- 18What did Wilks et al (2003) do?administered two alternate forms of the test to schizophrenic patients over intervals varying from 1-134 days
- 19What did they find?the test-retest reliability was high at .84
- 20What is vital in the diagnosis of SZ?measures of cognitive functioning
- 21What does this mean?there must be test-retest reliability in order for it to be useful
- 22What did Prescott et al (1986) do?analysed the test-retest reliability of several measures of attention and information processing in 14 chronic schizophrenics
- 23What did they find?performance on these measures was stable over a 6 month period
- 24What did Cheniaux et al (2009) investigaate?the inter-rater reliability of the diagnosis of SZ according to the DSM-IV and ICD-10
- 25What did they find?although the inter-rater reliability was above +.50 for both classificatory systems, SZ was more frequently diagnosed according to ICD-10 than DSM-IV criteria
- 26What does this indicate?possibly the ICD-10 is more reliable or perhaps the opposite, questions the reliability of it
- 27What happened in Rosenhan's (1973) study?'normal' people presented themselves to psychiatric hospitals in the US claiming they heard an unfamiliar voice saying 'empty', 'hollow' and 'thud'
- 28What happened?they were all admitted to the hospital and diagnosed with SZ
- 29What happened throughout their stay?none of the staff recognised that they were normal
- 30What happened in a follow up study?Rosenhan warned hospitals of his intention to send out more 'pseudopatients'
- 31What did this result in?a 21% detection rate
- 32What was weird about this?Rosenhan never actually sent anyone
- 33Who provided research for cultural differences?Copeland (1971)
- 34What did they do?gave 134 US and 194 British psychiatrists a description of a patient
- 35What were the results?69% of the US psychiatrists diagnosed SZ but only 2% of the British gave the same diagnosis
- 36What does this show?massive variation between cultures and different interpretations of the criteria, questioning its reliability
- 37What is validity?refers to the extent that a diagnosis represents something that is real and distinct from other disorders and the extent that a classification system such as ICD or DSM measure what it claims to measure
- 38What is comorbidity?refers to the extent that 2 (or more) conditions co-occur
- 39What is common among patients with SZ?psychiatric comorbidities
- 40What do these include?substance abuse, anxiety and symptoms of depression
- 41What did Buckley et al (2009) estimate?that comorbid depression occurs in 50% of patients and 47% of patients also have a lifetime diagnosis of comorbid substance abuse
- 42Why is comorbidity an issue?issues with diagnosing a disorder and also in deciding what treatment to advise
- 43What may the poor levels of functioning in many schizophrenics be more to do with?less the result of their psychiatric disorder and more to do with their untreated comorbid physical disorders
- 44What did Weber et al (2009) do?examined nearly 6 million hospital discharge records to calculate comorbidity rates
- 45What did they find?psychiatric and behaviour related diagnoses accounted for 45% of comorbidity
- 46What did the study also find?evidence of many comorbid non-psychiatric diagnoses
- 47What were many patients with a primary diagnosis of SZ also diagnosed with?medical problems including hyperthyroidism, asthma, hypertension and type 2 diabetes
- 48What did they conclude?a consequence of being diagnosed with a psychiatric disorder such as SZ is that patients tend to receive a lower standard of medical care, which in turn adversely affects their prognosis
- 49What do people with SZ pose a high risk for?suicide
- 50What role does comorbid depression have in this risk?the major cause for suicidal behaviour
- 51What did Kessler et al (1994) find to support this?among patients in the National Comorbidity Survey (NCS) the rate for attempted suicide rose from 1% for those with SZ alone to 40% for those with at least one lifetime comorbid mood disorder
- 52What did Klosterkotter et al (1994) was to detemine?whether positive or negative symptoms were more valid for a diagnosis
- 53Give examples of positive symptomshallucinations, disordered thinking, experiences of control and delusions
- 54Give examples of negative symptomsaffective flattening, alogia and avolition
- 55What did they do?assessed 489 admissions to a psychiatric unit in Germany
- 56What did they find?positive symptoms were more useful for diagnosis than negative symptoms
- 57What does research suggest about the effects of ethnicity on diagnosis?rates of SZ among African-Caribbeans are much higher compared to white populations
- 58What did Harrison et al (1997) report?the incidence rate for SZ was 8x higher for African-Caribbean groups (46.7 per 100,000) than for white groups (5.7 per 100,000)
- 59What can some of this increase be explained as?poor housing, higher rates of unemployment and social isolation
- 60What may cause a misdiagnosis?cultural differences in language and mannerisms and difficulties in relating between black patients and white clinicians
- 61What's a popular belief about symptoms?identification of the symptoms of SZ would make for a more valid diagnosis
- 62What is an issue with these symptoms?they are also found in other disorders such as depression and bipolar disorder
- 63What did Ellason and Ross (1995) point out?people with dissociative identity disorder (DID) actually have more schizophrenia symptoms than people being diagnosed as schizophrenic
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