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Discuss the issues of classification and diagnosis- Jan Mock Essay
Classification systems are used in order to diagnose schizophrenia as it
allows categories to be put in place that group symptoms into a syndrome,
allowing diagnosis of a complex disorder. The two classification systems
widely used are the DSM-IV and the ICD-10. Therefore the first issue that
arises, when classifying and diagnosing schizophrenia, is the fact that
different classification systems may be used and that people may be
diagnosed from one system and not the other. For example, the DSM-IV
involves the use of 5 diagnostic criteria compared to the ICD-10 that outlines
7. As well as this, within the DSM-IV, two symptoms such as delusions,
hallucinations and affective flattening have to be present for a one month
period, which differs from the criteria of the ICD-10. This therefore creates a
cultural bias due to the difference in the use of classification systems
depending on culture which thus reduces the reliability of diagnosis.
Read et al. for example, found only a 37% concordance rate when diagnosing
schizophrenia and noted a 1970 study, which found that when assessing the
same patients, US clinicians diagnosed 69% of these patients with
schizophrenia whereas only 5% were diagnosed by clinicians from the UK.
This therefore exemplifies the issue of a achieving a completely reliable
diagnosis for schizophrenia, suggesting that schizophrenia is still a
condition so unknown in terms of what causes it and symptoms of it that
there is difficulty in reliably diagnosing it, especially using more than one
criteria.
Another issue produced by schizophrenia, which reduces reliability of
diagnosis, is the issue of co-morbidity, especially when symptoms similar to
those of depression are presented. As well as this, schizophrenia, as with other
mental disorders, is something that has no physical symptoms and can only
be diagnosed in terms of anecdotal evidence of symptoms, which thus
increases the difficulty in coming to a reliable diagnosis when treating
schizophrenia.
In terms of reliability of classification systems, although Read’s evidence
suggests it may be unreliable, Beck et al. found only a concordance rate of
54% when diagnosing 153 patients, however Soderberg, using up-to-date
classification systems (DSM-IV-TR) found an 81% concordance rate in
diagnosing schizophrenia, suggesting that reliability of diagnosis has
become better over time. Research by Jackobsen et al (2004) also supports this
because when assessing 100 Danish patients, they found a concordance rate of
98% suggesting high level of reliability in diagnosis. It could therefore be
argued that some of the issues of classification and diagnosis have been dealt
with.
In terms of classifying schizophrenia, multiple classification systems have
been used other than the DSM and ICD such as the Schneider criteria, which
can be used to help in reliably diagnosing schizophrenia. Farmer at al. also
found high reliability using the PSE technique (Present State Examination),
showing that more than two classification systems can be implemented when
diagnosis schizophrenia. This implies that perhaps diagnosis of schizophrenia
is more reliable than first assumed.
As a whole, the classification systems are important in allowing a
communication of findings and ideas between practitioners and they allow a
‘common language’ for the ideas to be communicated.
Other issues of classification and diagnosis involve issues of validity.
Heather et al. argued that few causes of mental disorders are known and
found that there is only a 50% chance in predicting the treatment a patient
will receive based on their symptoms and diagnosis. This suggests that
classification and diagnosis has low predictive validity, which is an issue in
accurately diagnosing patients. Cochrane et al also found that there may
again be an issue of cultural bias. Within the West Indies and the UK there is
a 1% prevalence of schizophrenia yet in the UK Caribbean’s are diagnosed
seven times more than British people. This either suggests that Caribbean’s
have more stressors once they have moved to the UK, or suggests that there is a
clear cultural bias within the medical profession when diagnosing people with
possible schizophrenia, perhaps because people of other cultures have more
untraditional and unusual lifestyles and cultures (as seen from the
perspective of someone from a western culture, for example). This evidence of
cultural bias is supported by Whaley el al. who found that black Americans
were more likely to be diagnosed as being schizophrenic compared to white
Americans, again suggesting that there is low validity within classification
and diagnosis of schizophrenia.
Kendel and Jablensky, however, argued that although the validity of
diagnosing schizophrenia may not be entirely accurate, schizophrenia as a
concept allows practitioners to have a using framework for diagnosing mental
disorder and allows a treatment for such mental disorders to be found.
Scheff raised the issue that there is a problem with diagnosing disorders like
schizophrenia for it creates ‘sticky labels’ that are hard to get rid of in terms
of being categorised as a schizophrenic, where people may actually see you as
your condition and may eventually lead to a ‘self-fulfilling prophecy’ in
which a person behaves in a way as to fulfil the criteria of their condition. It
may also allow them to behave in a negative way and blame their condition
for their actions. This consequently creates ethical issues, for diagnosing
people has schizophrenic would reduce their job prospects as well as reduce their
ability to create positive and meaningful relationships as they may deem
themselves unworthy if they are schizophrenic or their diagnosis may drive
other people away from them for fear of the schizophrenic’s unknown and
unpredictable behaviour.
Overall, there are a variety of issues in terms of validity and reliability of
classifications and diagnosis of schizophrenia such as cultural bias and the
issue of different classification systems, therefore these issues need to be
taken into consideration when diagnosing someone as schizophrenic.