Issues surrounding the diagnosis of schizophrenia

One of the big issues with diagnosing schizophrenia is that there are different diagnostic systems. What are the two different diagnostic systems used by America and England

True or False: The DSM (used by America) has much broader diagnostic definitions which leads to a lot more people being diagnosed with Sz in America

Research by [blank_start]Cooper[blank_end] showed that sz diagnosis was [blank_start]twice[blank_end] as likely in America using the [blank_start]DSM[blank_end] compared to England where they used the [blank_start]ICD[blank_end]. Cooper said it was [blank_start]highly unlikely[blank_end] that this difference was due to [blank_start]cultural factors[blank_end] but rather that it was due to the [blank_start]unreliability[blank_end] of having two [blank_start]different diagnostic systems[blank_end]. However this research was conducted in the [blank_start]70's[blank_end] and since then efforts have been made to [blank_start]bring[blank_end] the two different systems [blank_start]closer together[blank_end], making this [blank_start]less[blank_end] of an issue.

What is low inter-rater reliability?

True or False: Inter-rater reliability is not always high in the diagnosis of schizophrenia.

Doctors who are working from the same diagnostic system, when presented with the same individual and the same symptoms, should all reach the same diagnosis.

Inter-rater Reliability Research Research by [blank_start]Beck[blank_end] showed that there is a [blank_start]low[blank_end] level of inter-rater reliability surrounding the diagnosis of schizophrenia. Two psychiatrists, working from the [blank_start]DSM[blank_end], were both presented with [blank_start]153[blank_end] patients and asked to diagnose them. [blank_start]Beck[blank_end] found their agreement rate on sz diagnosis was [blank_start]54[blank_end]%, and this percentage was even [blank_start]lower[blank_end] for the [blank_start]subcategories[blank_end]. This proves that inter-rater reliability for sz diagnosis is [blank_start]low[blank_end] considering, since they were working from the [blank_start]same[blank_end] diagnostic system, it should have been [blank_start]100[blank_end]%. Beck found that this [blank_start]lack[blank_end] of agreement came from [blank_start]broad[blank_end] and [blank_start]inadequate[blank_end] diagnostic [blank_start]descriptions[blank_end] in the [blank_start]DSM[blank_end] which left the diagnosis up to the psychiatrists [blank_start]interpretation[blank_end]. However this study was conducted in the [blank_start]70[blank_end]'s and since then the [blank_start]DSM[blank_end] has greatly [blank_start]improved[blank_end] its diagnostic [blank_start]definitions[blank_end] and a more recent study by [blank_start]Miller[blank_end] found a [blank_start]93[blank_end]% agreement rate, therefore this is now [blank_start]less[blank_end] of an issue.

There is an issue surrounding the [blank_start]validity[blank_end] of the [blank_start]classification[blank_end] and [blank_start]diagnosis[blank_end] of schizophrenia due to the [blank_start]large[blank_end] amount of [blank_start]issues[blank_end] surrounding it, from [blank_start]lack[blank_end] of [blank_start]objective[blank_end] testing to potential [blank_start]bias[blank_end].

What did Rosenhan claim the psychiatrist at the hospitals could not do?

What is the issue called surrounding the fact that there is not a single way to scientifically test for psychological disorders such as sz?

A problem with the diagnosis of Sz, as it is a [blank_start]psychological[blank_end] disorder, is that the [blank_start]lack of objective[blank_end] testing means the diagnosis is left up to the psychiatrists [blank_start]interpretation[blank_end] of the patients description of their symptoms, which is a form of [blank_start]self report[blank_end]. This causes many issues as self report is notoriously [blank_start]unreliable[blank_end], the patient may [blank_start]lie[blank_end], [blank_start]forget[blank_end] or other wise [blank_start]inadequately describe[blank_end] their symptoms which can lead to a misdiagnosis. An example of this can be found in [blank_start]Rosenhan[blank_end]'s study where the doctors wrongly diagnosed 7 out of 8 of the non-psychotic pseudo patients as schizophrenic, this was because the pseudo patients lied about their symptoms to the doctors which lead to the misdiagnosis. Another piece of research supporting this was done by [blank_start]Falek[blank_end] and [blank_start]Moser[blank_end], they showed that the [blank_start]agreement rate[blank_end] between doctors diagnosing [blank_start]tonsillitis[blank_end] without use of laboratory and objective testing was just as [blank_start]low[blank_end] as the agreement rate for schizophrenia diagnosis. This further proves that lack of objective testing causes a large issue for the diagnosis of schizophrenia.

What are the issues of Comorbity in the diagnosis of Sz?

Which of these is an issue with Comorbidity in the diagnosis of Sz?

What can happen once an individual is labeled as schizophrenic?

True or False: Rosenhan supported labelling

Labelling Studies A study by [blank_start]Scheff[blank_end] showed that once people were given a [blank_start]label[blank_end], such as 'schizophrenic', they began to act [blank_start]according[blank_end] to their label and their [blank_start]perception[blank_end] of the disorder. He said that labelling was a [blank_start]self- fulfilling prophecy[blank_end], they become their label. In his study [blank_start]Rosenhan[blank_end] found after the [blank_start]pseudo[blank_end] patients were assigned the [blank_start]label[blank_end] of 'schizophrenic and admitted to the hospital the hospital staff saw and interpreted pseudo patients [blank_start]behaviour[blank_end] as a [blank_start]characteristic[blank_end] of sz, even though they were behaving [blank_start]normally[blank_end] would. For example, one of the pseudo patients kept a diary and a nurse described the act of keeping a diary as '[blank_start]writing behaviour[blank_end]' which is a completely made up term that would not be recognised [blank_start]outside[blank_end] of the [blank_start]hospital[blank_end] environment. This proves that labelling someone as 'schizophrenic' creates an issue because all of their behaviour is then viewed and interpreted in relation to that label which can lead to ordinary behaviour being [blank_start]wrongly[blank_end] interpreted, as in [blank_start]Rosenhan[blank_end]'s study.

The psychiatrists _______ could reduce the reliability and validity of their sz diagnosis.

A study by [blank_start]Keith[blank_end] found that there was a social economical [blank_start]bias[blank_end] in the diagnosis of Sz as a [blank_start]larger[blank_end] amount of people from a [blank_start]lower[blank_end] social economical background are diagnosed with Sz. He found [blank_start]1.9[blank_end]% of woking class individuals were diagnosed with sz, compared to the [blank_start]0.9[blank_end]% of middle and [blank_start]0.4[blank_end]% of upper class people. Keith claims it is unlikely that this difference is caused by [blank_start]environmental[blank_end] factors and is due to the [blank_start]social bias[blank_end] of the doctor or psychiatrist. Furthermore [blank_start]2.1[blank_end]% of African Americans are diagnosed with sz compared to [blank_start]1.4[blank_end]% of white Americans, which suggests an ethical bias.