Discuss issues surrounding the classification and diagnosis of schizophrenia
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Discuss issues surrounding the classification and diagnosis of schizophrenia. The term reliability means that each time the classification systems are used (International Classification System for Diseases (ICD) and the Diagnostic and Statistical Manual of Mental disorders (DSM)) they should produce and provide the same outcome. The reliability of the early editions of these two classifications were marked as inconsistent and the vagueness of the DSM led to very low reliability in diagnosis. Schizophrenia was more commonly diagnosed in the USA (80% of patients during the 1950s) than compared to England (at the same period - 20%). However, ICD-10 and DSM-IV-TR have now become very similar, although there are two important differences between the classifications: the DSM requires symptoms to have been in evidence for a period of six months whilst ICD requires only one month. Secondly, the DSM is multi-axial, which means that various factors are taken into account before a diagnosis is made. Although most researchers agree that DSM-IV-TR has improved reliability; Eysenks argues that the approaches to diagnosing schizophrenia have proved to be reasonably reliable.
About one-third of patients have one episode or a few brief episodes of schizophrenia then fully recovering. Another one-third, throughout their lives have occasional episodes and function reasonably effectively between episodes. The remaining patients deteriorate over a series of increasingly incapacitating episodes. Between 10-15% of people with schizophrenia commit suicide. Co-morbidity is described as a patient who suffers from two or more mental disorders at the same time. Sim et al. (2006) studied 142 hospitalised schizophrenic patients in which 32% of that had an additional mental disorder. Co-morbidity occurs in part because the symptoms of different mental disorders often overlap with each other. An example of this might be, schizophrenia and major depressive disorder both involve very low levels of motivation. This creates a problem of reliability, whether the low motivation reflects the existence of depression or schizophrenia, or both. There is a growing trend to diagnose patients as suffering from 'co-morbidity disorder". This may be because many individuals do not neatly fit into a category that has been created.
Patients being diagnosed with schizophrenia can have many negative effects on them. A person diagnosed with schizophrenia might become fearful of another episode, or unable to deal with new challenges as they have lost confidence to use this ability. Critics argue that placing a person in a diagnostic category distracts from understand the person as a unique human being, but that instead the label can be used to describe the person instead of the disorder. This can lead to prejudice towards the individual with schizophrenia - e.g. dangerous, unpredictable or unemployable. Once labelled with schizophrenia, it is extremely difficult to remove - whether they suffered one episode of schizophrenia or lots and recovered, they may still always be labelled 'schizophrenic'. Although there are serious issues to do with classification, there are arguments for why classification is used in psychopathology - to make communication between professionals easier; to predict the outcome of the disorder and to choose appropriate treatment and to understand more about the possible causes of mental disorder, are only a few to name. ?? ?? ?? ?? A2 Psychology Sam Wong
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