Classification and Diagnosis of Schizophrenia

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Key ideas for an 24 marks essay on the classification and diagnosis of schizophrenia
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Inter-Rater Reliability Whether two different therapists can agree or not on their diagnosis of the same patient. If the diagnosis is consistent between clinicians or not.
Motjabi and Nicholson 20 senior psychiatrists had low inter-rater reliability when distinguishing between 'bizarre' and 'non-bizarre delusions' At the time this was the only factor needed for a full diagnosis of SZ.
Copeland 194 British and 134 American psychiatrists when asked to make a diagnosis using a case description. 69% Americans, 2% British diagnosed SZ Caused by the use of different manuals.
Test-Retest Reliability A measure of reliability obtained by administering the same test twice over a period of time to a group of individuals. The scores from Time 1 and Time 2 can then be correlated in order to evaluate the test for stability over time.
Manuals are revised and updates regularly - Affects Test-Retest Reliability - a SZ person could have been diagnosed in the past using from one symptom (i.e- bizarre delusions) but now the DSM5 requires 2 symptoms so the person wouldn't be considered SZ.
Low Construct Validity Some clinicians criticize the construct of SZ itself - is it a genuine disorder or not?
Davidson (use for low construct validity) The categories we use to determine SZ are 'constructs' because they were constructed from different combinations of symptoms appearing at once. Diagnosis is subjective; opinion of clinician.
Cultural Bias Diagnosed more frequently in US and UK in African Caribbean and African Americans. (Harrison) 'seeing visions' is seen positively in some cultures and SZ in others. - Classification systems are culturally bias.
Consequences of cultural differences - clinicians over or underestimate psychological problems in other cultures (Lopez) - African-Caribbean are more likely to be admitted to psychiatric hospital, given major tranquillizing drugs or ECT. (Fernando) - Clinicians predominantly white, middle class, males - not sensitive enough to cultural and social features of patients. (Winter)
Social Stigma The social stigma of SZ is considerable and can have a long lasting impact on those diagnosed. - ethical implications - diagnosis must be accurate
DSM5 - Published in America (English Only) - Used in UK - After 6 months of symptoms - Classifies 5 sub types of SZ - multi-axial approach - looks at many different factors
ICD - Published by WHO - international (multi languages) - classifies 7 sub types of SZ - classifies after one month - mainly positive symptoms - does not look at social factors
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