Download Issues in diagnosis Sz 2012 new

Description of Issue
Evidence/Evaluation
Further commentary
Ethnic bias
Different criteria
Sub-types
Predictive validity
Labelling
This could reduce reliability and validity in
diagnosis. It is the idea that certain ethnic
groups may be more likely to be
diagnosed with a mental illness such as
schizophrenia than other ethnic groups,
with essentially the same symptoms. i.e. a
bias in diagnosis.
Evidence supports the existence of this bias.
Keith et al. (1991) found that 2.1 % of African
Americans are diagnosed with sz, compared with
1.4 % of White Americans. McGovern & Cope
(1987) reviewed the ethnicity of patients in
Birmingham mental hospitals: 2/3 of psychotic
patients were African-Caribbean, compared with
only 1/3 who were white or Asian.
This suggests.......
However, it could be argued that the evidence by
Keith is due to the fact that African-Americans are
more likely to live in poverty and to suffer marital
separation, suffer discrimination etc. Therefore, it
could be that these stressful life events trigger the
sz and therefore there really is more sz in this
ethnic group and that the diagnosis is valid. (this is
known as the social causation hypothesis). This
issue has also been suggested in terms of social
class bias.
Due to disagreement in the diagnosis of
schizophrenia between US and UK
clinicians, the diagnostic systems of DSM
and ICD have been made similar to avoid
these diagnostic differences. Whilst this
has reduced reliability problems, there are
still differences between the most recent
versions E.g.
The consequence of having different criteria to
diagnose schizophrenia makes it difficult to
research studies. For example it is then very
difficult to compare data on treatment outcomes
since it is based on individuals diagnosed with
schizophrenia using different criteria.
Therefore, it is confusing to have alternative
diagnostic criteria. Since clinicians cannot agree on
precisely what the diagnosis of schizophrenia
entails this suggests that any definitions are
arbitrary and likely to be only temporary and
therefore inconsistent.
In support of this issue, the diversity of symptoms
associated with the different types poses
problems for the notion of “schizophrenia”. E.g.
catatonic and paranoid schizophrenia patients
often have absolutely no symptoms in common –
why should they be regarded as two forms of the
same disorder? Are they actually reflecting sz and
therefore valid?
Moreover, the subtype of undifferentiated
schizophrenia is basically a ‘rag bag’ category for
those patients that are hard to classify into the
other types. These patients therefore have a wide
range of symptoms, and no two such patients
might be the same. This therefore also shows
issues of reliability in diagnosis.
This is the idea that a diagnostic and
classification system can predict the
course of the disorder and the outcome of
any treatment. If someone is given a
diagnosis of sz, it is expected that they
should respond to a particular drug. If
they do not respond this casts doubt on
the validity of the original diagnosis.
The fact that there are such differences in the
course of schizophrenia suggests that the
classification of this illness is perhaps incorrect.
For example, in terms of sz there is the rule of
1/3s where approximately 1/3 may have an
episode and not have any more, 1/3 may have
increasingly worse episodes intermittently and a
1/3 may not recover at all. This variety suggests
that the diagnosis of sz may not have been
correct.
However, the categorization of sz is from a
biological approach. Consequently, if patients do
not correctly respond to drug treatment (e.g.
evidence shows between 15-30 %of patients) this
may not mean the diagnosis was invalid, but that
the assumption of it having a biological basis may
be flawed.
Diagnosis of a psychological disorder such
as sz can lead to the individual being
labelled. This can be helpful in terms of
providing appropriate treatment, however
it can be stigmatising and can lead to selffulfilling prophecy.
Scheff (1966) believed that people labelled with a
diagnosis will conform to the label and therefore
be a self-fulfilling prophecy.
However, the self-fulfilling prophecy idea could be
considered inadequate for such a serious disorder
as schizophrenia.
Similarly, there are still several other
diagnostic tools being used to diagnose
schizophrenia such as the Schneider first
rank criteria, or the standard interview
technique PSE (present state exam).
The marked variability among people with
schizophrenia in terms of symptoms,
course, treatment response and causal
factors has led to a development of
subtypes in the categorization of
schizophrenia. However, the validity of
these subtypes can be questioned.
In fact, most British psychiatrists prefer to use the
overarching diagnosis of sz and only use the subcategories in a minority of cases. This lack of
practical use also suggests.......
Nevertheless, it is true that mental illness labels
stick and can have drastic effects on their lives, as
other people are often suspicious of such labels.
In fact, Szasz (1974) suggested that mental illness
is a myth and society uses this stigmatising label in
order to exclude non-conformists from society.
Extension:
Why is it important to ensure there are no issues in the classification/diagnosis of schizophrenia? (Additional AO2)
It is important that the individual receives a correct diagnosis so that they receive the correct treatment for their illness.
Evidence shows early diagnosis and treatment are linked to a better long-term outcome for people with schizophrenia (Jackson & Birchwood, 1996).
Description of Issue
Ethnic bias
This could reduce reliability and validity in
diagnosis. It is the idea that certain ethnic
groups may be more likely to be
diagnosed with a mental illness such as
schizophrenia than other ethnic groups,
with essentially the same symptoms. i.e. a
bias in diagnosis.
Evidence/Evaluation
Evidence supports the existence of this bias.
Keith et al. (1991) found that 2.1 % of African
Americans are diagnosed with sz, compared with
1.4 % of White Americans. McGovern & Cope
(1987) reviewed the ethnicity of patients in
Birmingham mental hospitals: 2/3 of psychotic
patients were African-Caribbean, compared with
only 1/3 who were white or Asian.
This suggests.......
Further commentary
However, it could be argued that the evidence by
Keith is due to the fact that African-Americans are
more likely to live in poverty and to suffer marital
separation, suffer discrimination etc. Therefore, it
could be that these stressful life events trigger the
sz and therefore there really is more sz in this
ethnic group and that the diagnosis is valid. (this is
known as the social causation hypothesis). This
issue has also been suggested in terms of social
class bias.
Different criteria
Sub-types
Predictive validity
Labelling
Extension:
Why is it important to ensure there are no issues in the classification/diagnosis of schizophrenia? (Additional AO2)