Issues with Diagnosis of Schizophrenia
Discuss the issues with classification and diagnosis In order to diagnose the symptoms of mental health disorders , practitioners use classification systems like the DSM which classifies the symptoms of schizophrenia. The DSM has been criticised for issues including cultural problems and the overlap of disorders such as schizophrenia with depression. The DSM is used to diagnose patients with a disorder and indicates what treatment they will require.
Other problems involved with the classification includes inter-rater reliability and test-retest reliability.
Ronsenhan conducted a study which demonstrated the issue of reliability. Participants with no mental health administrated themselves into a practice by saying they could hear noises in their head saying ‘thud’. Once the participants were admitted they behaved normally however they were still interpreted as schizophrenic. This raises issues on the reliability of the classification as it suggests anyone can be admitted, and once labelled with a diagnosis every behaviour they may show is blamed on the disorder.
The publication of the DSM-III in 1980 was designed as offering a much more reliable classification system in order to diagnose disorders. Carson claimed it would fix all problems of reliability for once and for all allowing agreement between psychiatrists to who and who did not have schizophrenia. Despite these claims there is still little to no evidence proving its reliability and a study conducted by whaley found the inter-rater reliability was as low 0. 11. Whaleys research is into inter-rater reliability is supported by the findings of majtabi and Nicholson.
In this research 50 senior psychiatrists were asked to distinguish between ‘bizzare’ and ‘non bizzare’ behaviour, they produced inter-rater reliability as low as 40 percent proving the central diagnosis system lacks sufficient reliability for it to be a reliable method or differentiate schizophrenic sufferers and non-schizophrenics. Overall the low reliability is diagnosing and its individual systems show that the diagnosis of schizophrenia is affected by the interpretation of the psychiatrist.
As the reliability is low in then leads to the questioning of the validity of diagnosis. With scientists not agreeing on patients who have schizophrenia the question of what schizhrenia actually is becomes meaningless. People diagnosed rarely share the same symptoms and outcomes. The prognosis involves 20 percent recovery to the previous level of functioning, 10 percent achieve significant improvement and 20 percent demonstrate recovery with relapses.
As there is no common outcomes we can state it has low predictive validity. Bentall claims that schizophrenia is no longer a scientific category as it has too many issues involved in the classification and prognosis. As sufferers rarely demonstrate similar symptoms or outcomes assumptions have been made that it is not just one disorder but rather many disorders that have all been classed as one under the title of schizophrenia. Buckley found that schizophrenia is often comorbid with substance abuse, anxiety and depression.
With concordance rates as high as 50 percent between schizophrenia and depression and 47 percent between schizophrenia and substance abuse. This makes diagnosis and prescribing treatment even harder as the categories are too narrow to be used as a valid indicator at what treatment should be carried out. Kessler proves there is a link between suicidal rates and those suffering depression comorbid with schizophrenia, with statistics only one percent attempt it with schizophrenia with 40 percent attempting it when suffering schizophrenia and depression.
This supports Buckleys finding as it proves schizophrenia and depression sufferers need an entirely different treatment. There is no common universal prescription for schizophrenic patients. The frail reliability becomes even more evident when looking at the contrast of diagnosis in different cultures. Copeland found that when he gave a description of a patient to 134 us psychiatrists and 194 uk psychiatrists. While 69 percent of the us psychiatrists diagnosed the patient as schizophrenic only 2 percent of the uk did the same diagnosis.
Therefor suggesting schizophrenia is a disorder that is extremely subjective to diagnosis and varies greatly from culture to culture. In conclusion it is evident there is great issues surrounding both the classification and diagnosis of schizophrenia. Findings from Buckley and Kessler suggest that schizophrenia is in fact just a term to describe multiple disorders including depression and anxiety. It is therefore difficult to accurately treat each individual patient, making the diagnosis invalid.