Issues Surrounding Classification + Diagnosis

Issues Surrounding Classification + Diagnosis

1. RELIABILITY

   • The Reliability of the Major Classification Systems (ICD + DSM)
     • Clinicians - ICD/DSM - diagnose SZ reliably. Agree on diagnosis is follow guidlines
     • Evidence - low diag/ reliability - Copeland et al (1971) - Description patient, 134 US, 194 UK psychiatrists - 69% US = SZ, 2% UK. Cross Cultural variation
       • Still little ev/ DSM high reliability. Whalley (2011) - inter-rater reliability correlations in diagnosis - 0.11
     • Treatment: wrong diagnosis... Serious side effects drugs
     • Labelling: neg/ labels hard to remove. Carry stigma rest of lives
     • Improve Manuals: Many differences early versions. Current = more sim/ still diff/s (6/1 months)
   • Variation in Symptoms
     • Variability in symptoms required - different beh/s = same diagnosis
       • Klosterkotter et al (1994) - assessed 489 admissions, German psychiatric unit - pos/ neg/ symptoms = greater agreement bet/w/ clinicians (more reliable diag/). Pos/ = more reliable. Incorrect diag/ = wrong treatment

2. VALIDITY

   • Differentiating SZ
     • Probs/ - distinct from other MDs (Mood Ds, depression, developmental Ds, autism, drug-induced psychosis). Additional tests make distinction. (Drug induced/ - obs/ + toxicology tests)
     • Further complicated - depression = COMORBID (occurs w/ SZ)
     • Early diagnosis + prompt treatment = better long-term (Jackson + Birchwood, 1966). Blurred boundaries + comorbidity = early diag/ problematic - less likely recover
     • Treatment: Multiple disorders = strict consideration compatibility drugs. Comorbidity, diff/ predict outcome + response
   • Cultural Relativism
     • Newer versions - DSM+ICD - deal, cultural diff/s. Davison + Neale (1994) - Asian - emotional turmoil praised if no expression. Arabic - full expression, emotion public encouraged. Interpret emotional beh/ as symptoms.
     • Higher rates SZ - African-Caribbean patients UK+USA. Keith et al (1991) - 2.1% Afr/ SZs, 1% white. Doctors not Afr/ misinterpret symp/s. Unnecessary labelling + treatment

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