Discuss issues associated with the classification and/or diagnosis of schizophrenia. (24 marks)
When diagnosing a mental disorder there's are no objective laboratory test, it’s a subjective interpretation of the psychiatrist using either DMS V and/or ICD 10. These classify the disorders into group and types making it useful to make sure the diagnosis is consistence – this increases the reliability and the improves the chances of patient receiving the right treatment. Also by sharing common diagnosis tool can reduce the professional bias and the misinterpretation.
However there are some limitations and issues regarding the diagnosing: such as labelling someone with schizophrenia causes discrimination in society leading to a negative self fulfilling prophecy, therefore schizophrenia only get worse if patient is treated badly. In order to over come this schizophrenia should be kept confidential and not disclosed on the forms or application.
DMS IV has been criticised for culturally biased- due to not considering the CBS (cultural bound syndrome). Cooper et al found that people are twice as likely to be diagnosed as schizophrenia in new NYC than in the UK due to using different diagnostic manuals. This shows that concept of abnormality varies between cultures and subcultures. This can lead to misdiagnosis and given the wrong treatments. To overcome this issue 1 manual could be developed or use ICD 10 (by WHO) to improve inter-rater reliability, this will also increase the validity of schizophrenia diagnosis.
Another main issue is the difficulty of being able to predict outcome or response to a treatment without trial and error and sometimes the patient can become addictive and face withdrawal symptoms. Some of the medications have a side effect such as Clozapine (antipsychotic) can lead to Parkinson's disease- which can increase the psychological harm and require further treatments to treat Parkinson's disease.
Another issue is the subjective diagnosis- symptoms cannot be always tested or measured e.g. hallucination cannot be seen by the doctor, they have to rely on the patients testimony. Rosenhan 1972 study showed that 8 sane people were admitted to hospital after faking schizophrenia symptoms. The solution could be to multiple diagnoses from range of different doctors to increase the inter-rater reliability. Also use a range of different measurements such as dopamine level or genetic history.
Symptoms are similar to the depression and bipolar disorder, Schneider argues that the content of the symptom is more important than the symptom itself e.g. type of hallucination. Also some individuals don’t fit into specific categories therefore does it mean they don't suffer from SZ? This raises the issue of validity and it ignores the individual difference.
According to some of the research such as Beck et al (1961) looked at the reliability of 2 psychiatrists considering the same 154 patients and found that there was only 54% agreement in diagnosis. This shows lack of reliability even with medical records and interviews which can be inaccurate retrospective data because the SZ patients won't be able to tell whether they are delusional or hallucinating as they have loss the contact with reality.
According to Szasz – there's a question of whether schizophrenia is a mental disorder at all or a form of political control leading to self fulfilling prophecy. In order to overcome this problem you could scrap the idea of SZ and focus on other illness more, which can solve the problem of overlapping symptoms.
As a result of these issues and research studies the diagnostic material have been re- evaluated such as in DSM V there are no more subtypes of Schizophrenia compared to old DSM IV. If the right diagnosis are done the patients with SZ are more likely to recover well due to the right treatments provided, or else they could further develop more harm to their health such as Clozapine (antipsychotic) can lead to Parkinson's disease.
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- Thread Starter
- 16-03-2016 20:15
- Official Rep
- 18-03-2016 21:40
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