Zusammenfassung der Ressource
Issues Surrounding
Classification + Diagnosis
- RELIABILITY
- The Reliability of the Major Classification
Systems (ICD + DSM)
- Clinicians -
ICD/DSM - diagnose
SZ reliably. Agree on
diagnosis is follow
guidlines
- Evidence - low
diag/ reliability -
Copeland et al
(1971) -
Description
patient, 134 US,
194 UK
psychiatrists -
69% US = SZ, 2%
UK. Cross
Cultural variation
- Still little ev/ DSM high reliability. Whalley (2011) -
inter-rater reliability correlations in diagnosis - 0.11
- Treatment: wrong diagnosis...
Serious side effects drugs
- Labelling: neg/ labels hard
to remove. Carry stigma rest
of lives
- Improve
Manuals: Many
differences
early versions.
Current = more
sim/ still diff/s
(6/1 months)
- Variation in Symptoms
- Variability in symptoms required -
different beh/s = same diagnosis
- Klosterkotter et al (1994) - assessed 489
admissions, German psychiatric unit - pos/
neg/ symptoms = greater agreement bet/w/
clinicians (more reliable diag/). Pos/ = more
reliable. Incorrect diag/ = wrong treatment
- VALIDITY
- Differentiating SZ
- Probs/ - distinct from other MDs (Mood Ds, depression,
developmental Ds, autism, drug-induced psychosis). Additional
tests make distinction. (Drug induced/ - obs/ + toxicology tests)
- Further complicated -
depression =
COMORBID (occurs
w/ SZ)
- Early diagnosis + prompt
treatment = better long-term
(Jackson + Birchwood,
1966). Blurred boundaries +
comorbidity = early diag/
problematic - less likely
recover
- Treatment:
Multiple
disorders =
strict
consideration
compatibility
drugs.
Comorbidity,
diff/ predict
outcome +
response
- Cultural Relativism
- Newer versions - DSM+ICD - deal, cultural diff/s. Davison + Neale (1994) - Asian - emotional turmoil
praised if no expression. Arabic - full expression, emotion public encouraged. Interpret emotional beh/ as
symptoms.
- Higher rates SZ - African-Caribbean patients UK+USA. Keith et
al (1991) - 2.1% Afr/ SZs, 1% white. Doctors not Afr/
misinterpret symp/s. Unnecessary labelling + treatment