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Schizophrenia RAG - Coggle Diagram
Schizophrenia RAG
Reliability an validity in the diagnosis of schizophrenia
Assessment tools
DSM-5
In order to be diagnosed with SZ there must be positive symptom present.
Recognises speech disorganisation as a positive symptom and speech poverty as a negative symptom.
ICD-10
Two or more negative symptoms must be present to diagnose SZ.
Recognises subtypes of SZ: paranoid, hebephrenic and catatonic.
Test-retest reliability - occurs when clinicians make different diagnoses on separate occasion based on the same information.
Inter-rate reliability - occurs when different clinicians make the same independent diagnoses of the same patient.
Osorio et al - Reliability
Reported excellent reliability of diagnosis for 180 individuals using the DSM-5.
Pairs of interviewers achieved an inter-rater reliability of +0.97 and test-retest reliability of +0.92.
From these results, we can be confident that the diagnosis of SZ is consistently applied, there is good reliability.
Ellie Cheniaux et al - Validity
Had psychiatrists independently assess the same 100 patients using either the DSM-5 or the ICD-10.
68 were found to be diagnosed with SZ when the ICD system was used and 39 under the DSM-5.
Suggests that SZ is either over or under diagnosed and diagnosis is dependent on which diagnosis tool is used.
Buckley et al - Co-morbidity
Found that 50% of individuals diagnosed with SZ also had depression, 47% had substance abuse and 23% had OCD.
Gender bias
There is a tendency for diagnostic criteria to be applied to males and females differently and for there to be differences in the classification.
Loring and Powell
Patients described as "male" or with no gender information were described with SZ 56% of the time.
Female patients were only given diagnoses 20% of the time.
However this gender bias did not appear to be evident amongst female psychiatrsts.
Cotton
Found female patients typically have closer relationships and function better than men, this social support could explain why female individuals with SZ can cope better with the condition, possibly leading to under-diagnosis.
Longenecker
Males tend to suffer more negative symptoms and have higher levels of substance abuse whereas a s women have better recovery rates and lower relapse rates.
Onset for males is between 18-25 years old, but 25-30 years old for females.
This could lead to an under-diagnosis of women of SZ, leading to many women being denied services and treatment that could benefit them.
Psychological explanations
Family dysfunction
The schizophrenogenic mother
Schizophrenogenic = schizophrenia causing
Refers to a mother who is cold, rejecting and controling and tends to create a family climate charceterised by tension and secrecy.
This leads to distrust that later develops into paranoid delusions (beliefs that you are being persecuted by another person,) and ultimately SZ.
Double-bind theory
A communication style in families where it is unclear what the intention behind communication is. For example a parent saying they love their child, but ignoring them for the rest of the day.
This communication style leaves individuals with an understanding that the world is confusing and dangerous - this can contribute to symptoms such as disorganised thinking and paranoid delusions.
Expressed emotion
The level of emotion, in particular negative emotion, expressed towards a person with SZ by their carers/family members.
Examples - verbal criticism of a person (occasionally accompanied by violence,) hostility towards the person (including anger and rejection,) emotional over-involvement n the life of the person (needless self-sacrifice.)
Cognitive explanations
Dysfunctional thinking
Metarepresentation dysfunction
Central control dysfunction