Discuss some of the issues surrounding the classification and diagnosis of schizophrenia free essay sample

Classification systems are needed for the purpose of treatment and research. It can also be comforting to and individual and their family to be able to identify what their problem is and give it a name. Any classification system relies on the symptoms an individual display. However, symptoms tend to cluster together, so most classification systems of mental disorder focus on syndromes (i. e. clusters of symptoms that tend to occur together). However there isn’t always a perfect fit between the symptoms an individual displays those identified for a particular diagnostic category, such as schizophrenia. The two systems currently used to classify psychological abnormality are the International Classification of Diseases (ICD) and the Diagnostic and Statistical Manual of Mental Disorders (DSM). For a classification system to be meaningful and useful, it needs to be valid and reliable. Reliability refers to the consistency of a measuring instrument, such as a questionnaire or scale to assess, for example, the severity of their schizophrenic symptoms. Reliability of such questionnaires or scales can be measured in terms of whether two independent clinicians give similar diagnoses (this is known as inter-rate reliability) or whether the diagnoses are consistent over time (this is known as test-retest reliability). Validity refers to the extent that diagnosis represents something that is real and distinct from other disorders and the extent that a classification system such as ICD or DSM measures what it claims to measure. One problem is that of differential diagnosis where clinicians find it difficult to distinguish schizophrenia from those of other psychiatric illnesses presenting similar symptoms. Co-morbidity refers to the extent to which two or more conditions co-occur and psychiatric co-morbidities are common among schizophrenia patients- these including substance abuse, anxiety and symptoms of depression. Dual diagnosis is specifically used to describe people with mental illness who have coexisting problems with drugs and/or alcohol. For example, recreational drugs such as amphetamines and cannabis can give rise to schizophrenia like symptoms-making diagnosis very difficult. Studies show that ? of people with severe mental illness (including bipolar disorder and schizophrenia) also experience substance abuse. Such co-morbidity creates difficulties in the diagnosis of a disorder and also in deciding what appropriate treatment to give the patient. This is a problem because the patient may be misdiagnosed and given the wrong type of treatment which will not cure the symptoms they have and may cause another type of illness e. g. Clozapine drug can lead to Parkinson’s disease. People diagnosed with schizophrenia rarely share the same symptoms, nor is there evidence that they share the same outcomes. The prognosis for patients varies with about 20% recovering their previous level of functioning, 10% achieving significant and lasting improvement and 30% showing some improvement with intermittent relapses. From this we can conclude that that a diagnosis of schizophrenia, therefore, has little predictive validity- some people never appear to recover from the disorder, but many do. Another issue regarding the validity in the diagnosis of schizophrenia is that factors such as ethnicity or social class may lead to misdiagnosis. Research suggests that in the UK and elsewhere, rates of schizophrenia among African-Caribbean are much higher than any other group. One study showed that in a survey on hospital detained psychotic patients in Birmingham, 2/3 were African-Caribbean (both migrants and British born), whilst the remaining 1/3 were White and Asian. This may suggest that the diagnosis is subjective (purely based on the opinion of the clinician) but it’s difficult to determine whether this is due to psychosocial factors (being part of an ethnic minority) or if there is in fact a greater genetic vulnerability to schizophrenia. Another complication in the diagnosis and classification of schizophrenia is the fact that schizophrenia does not seem to be a single disorder (each of the symptoms of schizophrenia could be a disorder in its own right, with its own cause and treatment). This suggests there is no single underlying causal factor. Individuals don’t respond in the same way to treatments suggesting that there is a lack of validity in the diagnosis of schizophrenia. There are several subtypes of schizophrenia, differing between the DSM and ICD and there is a very fine distinction between each subtype however, people diagnosed with one subtype can often go on to develop another. This questions the validity of the categories in schizophrenia thus weakening its reliability. A further issue that raises question towards the diagnosis is treatment aetiology fallacy- where diagnosis may change depending on treatment success- because causes of schizophrenia are unknown , suggesting that diagnosis is only really a trial and error judgement which truly lacks validity and reliability. Further issues concerning the reliability in the diagnosis of schizophrenia is the differences between the classification systems (DSM IV and ICD-10). When dealing with schizophrenia, the manuals differ in terms of duration and symptoms. Another problem of the diagnosis of schizophrenia is that when someone is labelled as schizophrenic they can be discriminated as everyone can view they’re health record e. g. a person may not be given a job because they are labelled as schizophrenic. This is an issue because this will not cure schizophrenia and can lead to the self-fulfilling prophecy. This issue can be solved if the information is kept confidential and not disclosed to everyone.