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Classification of SZ - Coggle Diagram
Classification of SZ
Issues
Co-morbidity: where two conditions co-exist in the same individual at the same time, leading to confusion over which condition is being diagnosed
S: Evidence to support, Buckley found that 50% of ppl with SZ also have depression, 47% also have substance abuse and further 23% have OCD, this calls into question the validity of the diagnosis as it means SZ may not be a distinct disorder, the validity is questioned as they may be one single condition
L: Issue with Co-morbidity extends to the real world to, due to the high prevalence of different disorders being present at the same time had implications on the treatments for patients, when treating SZ ppl its important to recognise and understand that disorders may be present together and this can effect the effectiveness of the treatments given, the implication is a better awareness and more research info co-morbidity is that people with SZ will then have more effective treatment options for them
Culture bias: concerns the way in which members of other cultures are more likely to be diagnosed with SZ e.g Afro-Caribbean descent are more likely to be diagnosed with SZ and more likely to be kept in secure hospitals
S: Evidence to suggest culture bias in diagnosis, Escobar found that Afro Caribbeans ppt were 10x more likely to be diagnosed with SZ, ppl from African cultures believe and are praised for being able to communicate with spirits, this means they are more likely to report these experiences, which are misinterpreted as symptoms of SS this can lead to over-diagnosis of certain cultural groups
O: To account for this cultural bias in diagnosing there have been changes made to the DSM-V, there is now a section that account for cultural related diagnostic issues demonstrating differences in the symptoms for other cultures, this allows for the psychiatrists to have abetter understanding of the difference in culture presentations of the disorder, this has implications for accuracy as by having a better understanding of the differences it allows for a more accurate diagnosis
Gender bias:
S: Evidence to suggest gender bias in SZ, Longenecker found that men have been diagnosed with SZ more than women have, this may be because men may be more genetically vulnerable or other researchers have suggested that females function better so a diagnosis may be missed, the implication is that women may be less likely to receive the appropriate treatment for their condition
To account for this there have been some changes made to the DSM-V, there is now a section in it demonstrating differences in the symptoms as females often don't show negative symptoms, this allows for greater understanding of the differences, having implications for accuracy
Symptoms overlap: Considerable overlap between symptoms of SZ and other disorders, this means it is hard to define boundaries between SZ and other disorders
Implications of this:
- Labelling/stigmatisation occurs when a person is diagnosed with SZ and these negative labels are hard to remove, a wrong diagnosis means someone risks carrying the stigma for the rest of their lives
- Misdiagnosis/Treatment: the wrong diagnosis could lead to the wrong treatment and these can have huge side effects
S: Evidence to suggest symptom overlap, Ellason and Ross found that ppl with dissociative identity disorder DID have more symptoms of SZ than people diagnosed with SZ, further research from Rosenhan showed that there is a problem with symptom overlap with 1 of 11 patients being diagnosed with BPD not SZ, this wrong diagnosis means that there could be problems with treatment and not being able to recover from the disorder as quickly
The real world implication of there being symptom overlap is that it can lead to a delay in treatment, Ketter said that misdiagnosis due to symptom overlap can lead to years of delay with treatment, this is an issue with symptom overlap as this can result in high levels of suicide, by focusing on more research into SO will have a positive outcome on the lives of those suffering with SZ
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Reliability and Validity
Reliability: refers to both the level of agreement/consistency on the diagnosis by different psychiatrists across time and culture, clinicians should be able to agree on a diagnosis if they follow the guidelines given in the manuals
Cheniaux had two psychiatrists independently diagnose 100 patients using both the DSM and the ICD, using inter-rater reliability, they found that the number were different between the two psychiatrists demonstrating that there was poor reliability between the two psychiatrists
A03
S: Evidence to suggest that diagnosis and classification is reliable, classification systems provide a common language for clinicians, which enables them to communicate with each other about the disorder, Soderberg reported a concordance rate of 81% using the DSM, this suggests that there is a good level of agreement between doctors on the diagnosis of SZ
S: Due to the huge difference in number of diagnosis between 2 psychiatrists there has been improvements in the manuals, the DSM and ICD are now very similar in the wording about SZ, on top of this training is being offered to psychiatrists to allow them to have a better understanding of the manuals and how to use them, this allows for greater reliability in the diagnostics due to understanding of how to apply the manuals and means that the diagnosis of SZ is applied consistently
Validity: refers to the extent diagnosis represents something that is real and distinct from other disorders, the extent that a classification system such as the DSM measures what is claims to measure
A03
S: Evidence to suggest that there is an issue with validity in the diagnosis of SZ, Rosenhans study on sane in insane places demonstrated the issues with validity with diagnosing, 7 ppt who were his psychology students fakes SZ symptoms, they went to 12 different hospitals in American and ppt got admitted each time, 11 were diagnosed with SZ and one with BPD, this demonstrates the problems with validity as none of them had SZ but were in the hospital for an average of 19 days
L: Problems with generalisability in Rosenhan's research, he had a small sample and only 12 hospitals were used, this is a problem as the research is not representative of the general population, this lacks validity for diagnosis as whilst Rosenhans study does show that there are problems with validity, due to the methodological issues with the sample size this means that the results should be taken with care