Classification and diagnosis of schizophrenia

Reliability
1. Inter-rater reliability
  1. AO1
    1. the consistency of the measuring instrument
    2. CARSON
      1. the DSM-III had fixed the problem of inter-rater validity once and for all
  2. AO2
    1. WHALEY
      1. inter-rater reliability correlations in the diagnosis of Sz, as low as 0.11
      2. REJECT-there is a lack of inter-rater reliability, contradicting CARSON
    2. COPELAND
      1. 69% of US psychiatrists diagnosed Sz with only 2% of British psychiatrists diagnosed Sz
      2. differences in DSM and ICD affect diagnosis.
        AO3-DSM is culturally biased
2. the degree to which different raters give consistent estimates of the same behaviour
3. Test-retest reliability
  1. AO1
    1. assesses the external consistency of the test
    2. WILKS ET AL
      1. the test-retest reliability was high when looking at screening tests for Sz
  2. AO2
    1. ROSENHAN
      1. there is difficulty in distinguishing between normality and and abnormality, once admitted patients became their illness
    2. PRESCOTT ET AL
      1. analysed test-retest of several measures of attention and information in 14 chronic Sz patients found that performances on these measures were stable over 6 months
      2. this shows high reliability
      3. AO3-longitudinal
Validity
1. does the diagnosis represent something real and distinct and measure what it claims to
2. comorbidity
  1. AO1
    1. presence of one or more additional disorders co-occuring with a primary disorder
    2. BUCKLEY
      1. comorbid depression occurs in 50% of patients, 47% also have a lifelong diagnosis of comorbid substance abuse, creating difficulties in the diagnosis/treatment
  2. AO2
    1. WEBER ET AL
      1. morbidity and mortality from general medical conditions are elevated among patients with Sz compared with general US population. >50% of those with Sz have one or more comorbid psychiatric or general medical conditions
      2. Supports-more than half Sz go on to have another disorder
    2. KESSLER ET AL
      1. only a minority of those with mental disorders were found to have received professional treatment during the proceeding 12 months. Those with comorbid disorders - more likely to receive treatment however comorbidiity can affect treatment
      2. shows that difficulties can occur
3. Predictive validity
  1. AO1
    1. the degree to which a test accurately predicts a critereon that will occur in the future
  2. AO2
    1. BENTALL ET AL
      1. Sz is not a useful scientific category as symptoms are also found in other mental disorders
      2. People with Sz don't always share the same prognosis therefore there is little predictive validity
    2. HARRISON
      1. social skills, academic achievement and family tolerance may influence prognosis
      2. All cases can be different and therefore lacks predictive validity and test-retest reliability is difficult to achieve

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Classification and diagnosis of schizophrenia

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