Discuss issues surrounding the classification and diagnosis of schizophrenia (8+16) A01: One issues related to the classification

and diagnosis of schizophrenia is reliability. This refers to the consistency of a measuring instrument, such as the DSM or ICD that is used when classifying and diagnosing schizophrenia. Reliability can either be measured in terms of inter-rater reliability, which is the extent to which two or more independent assessors give a similar diagnosis, or in terms of test-retest reliability which is the extent to which the tests used to deliver these diagnoses are consistent over time. Although it has been claimed that the DSM (version three) onwards is reliable, evidence shows that the reliability of the DSM is low when assessed by interrater reliability. For example Whaley (2001) found only a small positive correlation of +.11 between different raters. This is evidence for low reliability when using the DSM to diagnose schizophrenia. However, test-retest reliability studies have shown positive results. Prescott et al (1986) analysed the test-retest reliability of several measures of attention and information processing in 14 chronic schizophrenics. Performance on these measures was stable over a 6-month period. This shows that there is high test-retest reliability when using these measures of attention and information processing to diagnose schizophrenia. Differences in cultural interpretations also pose a threat to the reliability of the diagnosis of schizophrenia. A research study by Copeland et al (1971) compared 134 US psychiatrists and 194 British psychiatrists in their diagnosis of a patient, and found that 69% of the US psychiatrists diagnosed schizophrenia compared with only 2% of the British psychiatrists. This suggests that there is massive variation between countries and it affects the reliability of diagnosis in schizophrenia. Reliability is also an issue for diagnosis alone. This was raised by Rosenhan (1973) who claimed that situational factors were more important in determining the diagnosis of schizophrenia rather than any specific characteristics of the illness. This shows clearly that the diagnostic procedure used at the time was flawed.

Discuss issues surrounding the classification and diagnosis of schizophrenia (8+16) Rosenhan demonstrated his lack of faith in the classification and diagnostic system in a well-known study where he arranged for pseudo patients to present themselves to psychiatric hospitals claiming to be hearing voices in their heads a classic symptom of schizophrenia. All were diagnosed with schizophrenia despite the fact that they displayed no further symptoms during their hospitalisation, with none of the stuff recognising them to be normal. This points to a lack of reliability in the classification and diagnostic system of schizophrenia. Rosenhan further demonstrated the unreliability of diagnosis in a follow- up study where he warned hospitals of his intention to send out more pseudo patients. This resulted in a 21% detection rate, even though there werent any pseudo patients sent. This means that real patients missed out on being treated and it provides further evidence that there are issues with the reliability of the classification and diagnostic system of schizophrenia. Another issue concerning both classification and diagnosis of schizophrenia is validity. For example, under this heading is the issue of co morbidity, which is the extent to which two or more conditions, such as schizophrenia and depression, occur in the same patient at the same time. This makes it difficult to diagnose schizophrenia as a valid, real and distinct mental illness, and thus decide on appropriate treatment. Therefore, the poor levels of functioning found in many schizophrenics may be les the result of their psychiatric disorder and more to do with their untreated co morbid physical disorders. A US study (Weber et al) examined nearly 6 million hospital discharge records to calculate co morbidity rates. They found that psychiatric and behaviour related diagnosis accounted for 45% of comorbidity. However, the study also found evidence of many co morbid non-psychiatric diagnoses. Weber concluded that a consequence of being diagnosed with a psychiatric disorder such as schizophrenia is that patients tend to receive a lower standard prognosis of medical care which in turn affects their prognosis.

Discuss issues surrounding the classification and diagnosis of schizophrenia (8+16) Another aspect of validity is the issue of prognosis. Diagnosis of schizophrenia has low predictive validity as it is unable to predict the outcome of how the disorder develops and how people respond to treatment. People diagnosed with schizophrenia do not usually share the same symptoms and neither do they share the same outcomes. This compromises the validity of the diagnosis of schizophrenia. Despite the belief that identification of the symptoms of schizophrenia would make for more valid diagnoses of the disorder, many of these symptoms are also found in many other disorders, such as depression and bipolar disorder. Ellason and Ross point out that people with dissociative identity disorder (DID) actually have more schizophrenic symptoms than people diagnosed as being schizophrenic.