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Discuss issues associated with the classification and/or diagnosis of schizophrenia (8marks + 16 marks) AO1 1.

Outline DSM-IV & ICD-10 2. Inter-reliability 3. Subjectivity 4. Labelling 5. Comorbidity 6. Stigmatisation AO2 Rosenhans study MUST link to each of above Becks study Implications Evaluation of research (MUST LINK!) Could mention DSM V vs NIMH (National Institute of Mental Health refusing to fund DSM V and are proposing a fairer alternative that addresses issues raised above. This has major implications for Psychology as practitioners will need retraining etc however, a fairer system will be of more benefit to patients and prevent misdiagnosis etc).

The main tools used for the diagnosis of schizophrenia are the DSM-IV criteria, which are in its fourth edition, and the ICD-10, which is produced by the world health organisation and is in its 10th edition. The two methods are often used alongside each other.

However there are several issues associated with the classification and diagnosis of schizophrenia. Firstly the reliability of the ICD and the DSM can be questioned because even though they provide a fast and easy way to break down the symptoms, treatments and prognoses of disorders, their interrater reliability is low. This concerns the extent to which two or more diagnosticians would at the same conclusions when faced with exactly the same individual and in many studies inter-rater reliability has been shown to be quite low.

This issue is backed up by research for example, Beck et al found that out of 154 patients, only 2 psychiatrists only agreed on the diagnosis of 54% of the individuals. These findings are staggering and show that a lack of reliability is a huge issue in diagnosis which means that there is danger that patients will be misdiagnosed and may consequently be prescribed drugs that are not suited to their condition and result in irreversible side effects.

Furthermore the behaviour of the individual is open to interpretation, the process is subjective. This could lead to the miss-diagnosis of millions of people, causing them to be labelled for the rest of their life even if they do not suffer form the disorder they have been diagnosed with. This therefore means that the process raises some ethical concerns. In addition, misdiagnosis may result in a self-fulfilling prophecy may then also take place which is where the sufferer who has been diagnosed believes that they do have the disorder.

Secondly many disorders described in the diagnostic manuals overlap, leading to a lot of patients being diagnosed with a co-morbid disorder, this may be because many individuals dont fit neatly into one single category so they are diagnosed with two different disorders. All of these issues were highlighted in Rosenhans study on sane in insane places,. Procedures, findings, conclusions implications.

Thirdly cultural relativism is another problem associated with the diagnosis of schizophrenia; every culture will see the symptoms of a mental disorder in a different way. For example in Asian cultures, a person experiencing some emotional turmoil is praised and rewarded if they show no expression of their emotions, whereas, in Western cultures this would be seen as abnormal behaviour. As a result the newer versions of the DSM and ICD attempt to highlight and deal with the issue of cultural differences between both subcultures within our society and cultures around the world.

Co-morbidity is another problem associated with the diagnosis of schizophrenia; this is where two mental health disorders seem to occur together, for example schizophrenia and depression. This can lead to the wrong diagnosis being made as the boundary between schizophrenia and depression is blurred with many of the symptoms being the same. Again there is the problem of subjectivity as it is down the mental health professional to diagnose the individual, and this diagnosis may be wrong. Furthermore the DSM and ICD have very similar approaches to the classification and diagnosis of schizophrenia, agreeing on the symptoms and characteristics.

However Schneider proposed a different approach to the diagnosis of schizophrenia. He argued that it was the nature of the symptom that would determine whether a person was schizophrenic, not just the fact that they had the symptom. For example he studied the types of hallucinations that schizophrenia sufferers would be afflicted with and made a group of first rank symptoms that were used to distinguish schizophrenia from other psychotic disorders. Finally to diagnose a mental disorder, interaction between a health care professional and the potential patient must take place. This raises another issue in terms of culture; the clinician may not speak the same language as the patient therefore making it impossible for the patient to describe the symptoms and for the clinician to diagnose the patient. This may lead to a miss-diagnosis, and therefore a translator would be needed.

Conclusion reductionism, beta bias, standardisation trained professionals)



Also must include detailed account of Rosenhans study and explain which issues are highlighted within this.