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    Hey can anyone mark my essay on schizophrenia which I am finding really hard.



    Discuss issues associated with the classification and/or diagnosis of schizophrenia.
    (8 marks + 16 marks)

    Schizophrenia is a mental disorder characterized by a breakdown of thought processes and by a deficit of typical emotional responses. Schizophrenia is classed in two different ways they are through the DSM and IV. The DSM is a device used in the USA to class schizophrenia while the IV is used in most of Europe. It is important to note that the DSM is more expensive. The time span for both systems differs. The IV is 6 month treatment while the DSM is one month treatment. The association for schizophrenia may also be put into question as there may be cultural/language barriers involved. For example, the DSM is only available in English therefore other speakers of different languages cannot use it therefore they may not get better treatment as the DSM is more in depth considering physical disorders and social stressors. DSM focuses too much on type 1 illnesses (positive symptoms) 4/5 sub classes are on positive symptoms. Therefore this ignores negative symptoms and someone who may actually show signs of schizophrenia may be given a wrong diagnosis and therefore a wrong classification will not treat the illness but instead make it worse. Also due to countries using different diagnosis results cannot be applicable. For example Cooper et al found that people are twice as likely to be diagnoses with SZ in New York City as the UK. Therefore wrong diagnosis can lead to extra harm and the wrong treatment may lead to other diseases such as Parkinson’s if drugs like Clozapine are administered.

    In addition to this, some signs of schizophrenia are also associated with illnesses such as depression for example, hallucinations and delusions. Therefore this also proves problems for the diagnosis of schizophrenia as someone with schizophrenia may be seen as having depression and vice versa therefore the wrong medicine administered will not improve the diagnosis. This can be dealt with by having multiple doctors making a diagnosis e.g. from across different countries specialists this improves the inter rater reliability and the validity of the diagnosis is also improved providing one system can be used for every country e.g. the DSM. In addition to this, some of the subtypes of schizophrenia is very vague for example, “undifferentiated schizophrenia” a classification for those symptoms which are not classifiable under any of the other subtypes. Therefore surely it can be argued that if they are not classifiable under any subtypes it cannot be schizophrenia it has to be something else e.g. depression. Therefore the sub types of DSM need to be more clearly laid out and concise to patients.

    Also symptoms cannot always be tested and measured e.g. hallucinations cannot be seen by a doctor. Therefore doctors have to rely on the testimony of the patients which may not be completely ideal. This is supported by the study of Rosenthal were 8 sane people were admitted to hospital after faking SZ. Therefore this leads to the idea that there should be a more objective measure compared to a subjective measure. The inter rater reliability may be improved if various different doctors look at the patient. However it is important to note that in order for this to occur we first need to have one manual for schizophrenia e.g. DSM. If we have the IV also then there will be dispute on to what is schizophrenia and what else it could be e.g. depression. Therefore to make the classification more reliable we first need to adopt one manual for the world which can be more generalizable and valid. Other objective measures also need to be considered such as dopamine scans, FMRI scans and looking at the brain structure. But it can be argued that this may not be a good idea as we do not have retrospective data e.g. an event may have triggered the event which was not biological therefore it would be futile to see FMRI scans and the brain structure if they are not the cause of schizophrenia.

    Another problem with the diagnosis is that it can lead to the self-fulfilling prophecy. This is when you label someone as schizophrenic therefore they may think their behaviour is reversible especially if you point out biological features. Therefore a consequence of this is that SZ won’t be cured and will only get worse if the patient gets demotivated. A solution which may be done to combat this is SZ should be confidential between the patient and the doctor and should not be disclosed on forms or applications. Also increases media campaigns should motivate people that schizophrenia can be reversible to reduce prejudice in society. But it can also be argued that this is very expensive as it would require the government to spend more of their money on this area especially during these hard times e.g. recession it may not be advisable and likely for government to spend on advertisements. However by saying this, if this leads to less people in schizophrenia in society it leads to more money being saved in the NHS therefore reducing costs for the government also.

    Finally the last problem with the classification is that it does not take into account culture. In some cultures hallucinations are normal. For example outpouring of public emotion is encouraged in Arabian cultures. Therefore according to the DSM and IV this may wrongly diagnose people with schizophrenia when in fact the actions follow the norm of the culture. Also some people believed that homosexuality was a disorder but now it has been proven wrong and removed from the DSM. Therefore the consequence of this is that you are diagnosing the normal people in society with illnesses which they do not have therefore it’s a waste of time and money and it causes the self-fulfilling prophecy therefore in the future this person may have schizophrenia. Therefore to overcome cultural barriers the DSM should be published in all languages and one manual should be used which understands the implications of culture, religion etc. . . This will ensure that the reliability is further improved and the diagnosis will increase the validity.

    In conclusion, the DSM and IV have many flaws. It appears that the main problem with this is being replicable to all countries. Also it can be argued that negative symptoms should be focuses on as well as systems such as the DSM focus heavily on positive symptoms. Therefore if schizophrenia is seen as a worldwide treatment the same quality of treatment should be given worldwide which may not be the case as the DSM is seen as more expensive and more intensive than the IV. However perhaps countries should provide the treatment of schizophrenia free as many pharmaceutical companies are said to care too heavily on profits than the treatment of patients.
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    a more up to date version of your essay. not finished yet I havn't talked about validity enough yet or research on it but i think this may help you

    Schizophrenia is a mental disorder characterized by a breakdown of thought processes and by a deficit of typical emotional responses. Schizophrenia is classed in two different ways they are through the DSM and ICD 10. The DSM is a device used in the USA to class schizophrenia while the ICD10 is used in most of Europe. It is important to note that the DSM has 5 subtypes that the patients must display for 6 months in order to be given their diagnosis however, the IDC10 used to have seven subtypes, which patients must display for 1 month in order to be diagnosed but now has none (it was modified). The purpose of this classification is to make communication between professionals clearer and to ensure the correct treatment is chosen, allowing a better understanding in the mental disorder. The validity of schizophrenia may also be put into question, as there may be cultural/language barriers involved. In addition to this, some signs of schizophrenia are also associated with illnesses such as depression for example, hallucinations and delusions. Therefore this also proves problems for the diagnosis of schizophrenia as someone with schizophrenia may be seen as having depression and vice versa therefore the wrong medicine administered will not improve the diagnosis. This can be dealt with by having multiple doctors making a diagnosis e.g. from across different countries specialists this improves the inter-rater reliability. The validity of the diagnosis is also improved providing one system can be used for every country e.g. the DSM. In addition to this, some of the subtypes of schizophrenia are very vague for example, “undifferentiated schizophrenia” a classification for those symptoms, which are not classifiable under any of the other subtypes.

    Rosenhan et al, conducted a study on the classification and diagnosis systems and how discovered how accurate the psychiatrists diagnosis was. Rosenhan asked 8 participants to go to a psychiatric unit and claim they had schizophrenia and to back this up by saying they heard noises such as ‘thud’ or ‘empty’ but to act normal other than that. All of these participants were diagnosed with a mental illness and were submitted to the unit and could only get out again if they continued to act insane and pretend to be getting better. This study was very controversial and raised issues with the classification and diagnosis systems.

    The lack of consensus within the two diagnoses and classification systems shows that the definitions are arbitrary and likely to change with various influences. The reliability of these systems is affected as it is difficult to diagnose patients with schizophrenia due to, the difficulty in distinguishing between character traits and symptoms. This can be supported through research carried out by Copeland et al who found that 69% of patients where diagnosed with SZ in the US through the DSM classification system whereas only 2% of these patients were diagnosed with SZ using the ICD 10 system in the UK. Furthermore, the lack of consistency across cultures with the different classification systems make it very hard to distinguish the time period at which individuals should display SZ symptoms before they are diagnosed. It is also difficult to classify and diagnose with the blurring of subtypes, as people do not fit neatly into one category. Having said that, although there are clear issues with reliability, research by Jacobsen et al on the OPCRIT symptom checklist showed clear and explicit description of symptoms. There was a high agreement level on the diagnosis of OPCRIT when compared against the ICD10, which shows high levels of reliability.

    The validity of the classification and diagnosis is an on going debate which refers to the extent at which psychologists agree on what Schizophrenia (SZ) actually is/if it actually exists as just one disorder. There are three prominent issues facing the..

    and then so on..
 
 
 
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