Validity of Diagnosis of Schizophrenia
Comorbidity
Culture Bias
Gender Bias
Symptom Overlap
Definition
Research
Evaluation
One or more additional disorders/diseases occur simultaneously
Can create problems w/ reliability of diagnosis b/c confusion over which disorder is being diagnosed
Schizophrenics often suffer from depression as well
issues of descriptive validity
having simultaneous disorders suggests that schizophrenia is not separate disorder
Sim et al.
32% of 142 hospitalised schizophrenics had additional mental disorder
Co-morbidity creates problems in achieving valid diagnosis of schizophrenia
Goldman
50% of schizophrenics had a co-morbid medical condition (substance abuse/polydipasia)
Reliable + valid diagnosis of schizophrenia problematic
Buckley et al.
50% o schizophrenics had co-morbid depression
15% co-morbid panic disorder
29% PTSD
23% OCD
Jeste et al.
schizophrenics w/ co-morbid conditions excluded from research but form majority of patients
suggest research into causes cannot be generalised to most sufferers
knock on effect to what treatment such patients should receive
High levels of certain co-morbid disorders --> some argue such co-morbidities = separate sub-types of disorder
problem = differing schizophrenia from bipolar disorders
Schizophrenia related changes in mood often include mania + depression
sometimes don't meet criteria to be diagnosed as separate disorders
schizophrenics often substance abuse (alcohol, cannabis)
Definition
Tendency to over-diagnose members of other cultures w/ schizophrenia
People of Afro-Caribbean descent in Britain are much more likely than white people to be diagnosed as schizophrenic
More likely to be confined in hospitals
Psychologists are racist b/c see black schizophrenics as more dangerous?
Heightened stress levels people from ethnic minorities experience contribute to higher levels of schizophrenia
Research
Cochrane
Incidence of schizophrenia in the West Indies + Britain similar = 1%
BUT people of Afro-Caribbean origin are 7x more likely to b diagnosed w/ schizophrenia when living in Britain
either suggests that AC ppl in Britain have more stressors or that invalid diagnoses made b/c cultural bias
McGovern & Cope
2/3 of patients detained in Birmingham hospitals were first/second generation Afro-Caribbeans
1/3 = white/asian
cultural bias to over-diagnose schizophrenia in black population
Ineichen
32/89 confinements in "closed" wards in Bristol hospitals were of non-white patients
Bigger proportion of non-whites in society
tendency to see non-white schizophrenics as more dangerous
Whaley
main reason for incidence of schizophrenia among black Americans (2.1%) greater than white (1.4%) cultural bias
Differences in symptom expression overlooked by practitioners
Lack of validity in diagnosing schizophrenia cross culturally
Evaluation
Fernando says higher levels of schizophrenia in minorities b/c triggered by greater levels of poverty and racism
Cochrane pointed out that only ethnic minority to experiences this is Afro Caribbean
may be because afro-caribbeans have little immunity to flu and child born to mother who had flu while pregnant are 88% more likely to get schizophrenia
Rack
In many cultures normal to see and hear deceased loved ones as part of grieving process
People exhibiting this behaviour in Western culture are liable to be diagnosed as schizophrenic
Cochrane and Shashidharan
racism and social deprivation immigrants suffer negatively affect mental health
Clinicians wrongly attribute their behaviour to their ethnicity.
Definition
Disagreement between psychologists over the gender prevalence rate of schizophrenia
Accepted belief was males and female equally vulnerable to the disorder
BUT some argue that clinicians, majority men, misapply diagnostic criteria to women
Recent studies have shown there are more than 50% more male sufferers
When making diagnosis, clinicians often fail to consider males tend to suffer more negative symptoms than females
also higher levels of substance abuse in men
Women have better recovery rates and lower relapse rates
Clinicians tend to ignore fact that there are different predisposing factors between males and females
Giver them different vulnerability levels at different points of life
Difference sin classification of schizophrenia
first onset occurring earlier in males (18-25 years)
Females generally 4-10 years later
two peaks for male schizophrenia (21 and 39)
three peaks for females (22, 37, 67 years)
Research
Lewin et al.
Reichler-Rossler + Hafner
if clearer diagnostic criteria applied, number of female sufferers became lower
gender bias in original diagnosis
Supported by Castle et al.
Found using more restrictive diagnostic criteria that the male incidence was more than twice of that of females
males have more severe negative symptoms
Reinforced by Galderisi et al.
found that males scored higher for negative symptoms
Hambrecht and Hafner
Male sufferers had higher levels of substance abuse
Haro et al.
Relapse rates higher in males but recovery higher in females
ALL suggest gender bias in clinicians not considering such important factors when making diagnosis
Kulkarni et al.
female sex hormone estradiol effective in treating schizophrenia when added to antipsychotic therapy
suggests may be different protective and predisposing factors in male and female vulnerability to schizophrenia
Clinicians do not consider this
Evaluation
Females tend to first develop schizophrenia between four and ten years later than men
Women can develop much later form of post-menopausal schizophrenia
Difference between types of schizophrenia between males and females
ALL question validity of diagnosis
Research findings indicate there is a case to be made for different diagnostic considerations for males and females
cast doubts on validity of schizophrenia as separate disorder
Difference in age where males and females experience schizophrenia may be related to different types of stressors both sexes experiences at different ages
AND age-related variations in female menstrual cycles
Definition
In diagnosing schizophrenia, symptoms of disorder are also found in other disorders
Makes deciding which particular disorder someone is suffering from difficult for clinicians
Occurs especially with bipolar disorder
Depression + hallucinations is a common symptom
can also occur w/ autism and cocaine intoxication
Research
Serper et al.
assessed patients w/ comorbid schizophrenia + cocaine abuse (schizophrenics + abusers on their own as well)
Although overlap, possible to make accurate diagnoses
Konstantareas and Hewitt
compared 14 autistic patients w/ 14 schizophrenics
none of schizophrenics had symptoms of autism but 7 autistics had symptoms of schizophrenia
some support for idea of symptom overlap
Ophoff et al.
assessed genetic material in 50,000 pps
foundof seven gene locations of the genome associated w/ schizophrenia, 3 also associated w/ bipolar
genetic overlap between the two disorders
Evaluation
genetic overlap between mental disorders suggests gene therapies might be developed that simultaneously treat both disorders
recently developed method of ascertaining which particular disorder someone is suffering w/ is to examine grey matter content of brain
schizophrenics experiences decrease of grey matter but bipolar sufferers cannot
Ketter reports that misdiagnosis due to symptom overlap can lead to years of delay in receiving relevant treatment
In that time suffering and further degeneration occur as well as high levels of suicide
Makes valid diagnosis difficult to achieve
Less compliant w/ medication
treating disorder more difficult