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Schizophrenia (Reliability (Culture (:silhouette: Luhrmann (2015)…

- - - - 134 US and 194 British psychiatrists a description of a patient
      - 69% of the US psychiatrists diagnosed schizophrenia
      - Only 2% of British psychiatrists diagnosed schizophrenia
    - - Found that black Afro-Caribbean immigrants in the UK are up to seven times more likely to be diagnosed with Sz than white people
    - - Found that lower-class patients were more likely to spend longer in hospital, be prescribed physical rather than psychological treatments and have poorer prognosis
    - - Interviewed 60 adults with diagnosis of Sz and asked about voices they heard
      - 20 from Ghana, 20 from India, 20 from US
      - Pps from Ghana and India reported positive experiences with their voices (playful)
      - US pps reported only negative experiences (hateful)
    - - Explain that Asian cultures, a person experiencing some emotional turmoil is praised and rewarded if they show no expression of their emotions
  - - - Sex-role stereotype questionnaire of 122 bipolar items to 79 actively functioning clinicians
      - 1 of 3 sets of instructions: to describe a healthy, mature, socially competent
        
        Adult sex unspecified, a man and a woman
      - Women perceived as being less mentally healthy (validity)
    - - That DSM system emphasises problems in women, making them appear more prone to mental illness and instability
    - - Investigated sexism in assessment and diagnosis
      - Suggested male and female clients present same symptoms, different diagnosis are make indicating a differential diagnosis based on gender
      - They believed that this could be in part due to theoretical orientation gender bias of clinicians
  - - - May result in invalid conclusions about the cause of the 'illness' and/or treatment
    - - Agreement on diagnosis for 153 patients was only 54%. This was often due to vague criteria for diagnosis and inconsistencies in techniques to gather data
    - - Found inter-rater reliability correlations in the diagnosis of Sz as low as 0.11
  - - - Tried to make the diagnosis of Sz more reliable
      - Identified a group of symptoms characteristics of Sz but rarely found
  - - - Despite improvements over the years in the revisions of the DSM, there is little evidence for a high reliability of use by clinicians.
    - - One of the characteristics symptoms is 'Bizarre delusions' :silhouette: Mojtabi and Nicholson (1995) assessed inter-rater reliability for this and found only -.4- correlation
    - - 'Ethnic Culture Hypothesis' suggests that ethnic minority groups experience less distress from mental disorders due to the social structures that exist in minority cultures
- - - - Co-morbidity of depression is approx.50%
      - 47% co-morbidity of substance abuse
    - - Meta-analysis
        
        12% of Sz patients also fulfilled the diagnostic criteria for OCD
        
        Approx. 12% displayed significant OCD symptoms
        
        Clinicians make dual diagnosis - appropriate treatment for both disorders
        
        DSM - multi-axial classification system encourages multiple diagnosis
  - - - Does the test measure what it sets out to measure?
    - - Secondary measures used in diagnosis relevant to primary disorders
    - - Does the measure/rating system contain correct and relevant predictors that can be supported and measured through self-report and clinical observations