Dual Diagnosis: Schizophrenia and Substance Misuse

Dual Diagnosis: Schizophrenia and Substance Misuse Schizophrenia is a serious mental health disorder affecting 1% of the population, but incurs a considerable cost for the health care system due to its chronic nature. It represents a significant issue to the community as the illness not only affect the patients themselves, but also their families and friends in terms of care and social support. Schizophrenia involves many non-medical problems to the patient and his/her carers, such as prejudice and stigma by a public who is poorly educated in regards to mental illness. Some patients find themselves rejected by employers who're either fearful, or unwilling to hire a worker who they see as a burden to them. Thus, many chronically ill patients are caught in a deteriorating social cycle, falling into homelessness, or into crime and end up in the prison system. Patients who develop depression in association with schizophrenia also risk self-harm and suicide. All these problems are compounded in patients with a dual diagnosis, who have a second disorder, most often substance abuse. Dual diagnosis is, unfortunately, all too common among schizophrenic patients, who have a four-fold risk of drug use [1], and approximately 50% become involved in substance abuse at some point during their illness [2]. Dual diagnosis shows a male predominance, especially in 18 to 25 year olds.

  • Word count: 2073
  • Level: University Degree
  • Subject: Subjects allied to Medicine
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Issues associated with the classification and diagnosis of schizophrenia

Discuss issues associated with the classification and/or diagnosis of schizophrenia. An important aspect of any classification system is its reliability, high inter-rater reliability is important as it means that each time the system is used it has the same outcome. There has been little consistency in the diagnosis of schizophrenia in the past due to vagueness of the classification systems and inconsistencies between them, it is difficult to achieve reliable diagnosis when there is no universally agreed definition of schizophrenia. In order to improve reliability of diagnosis a group of symptoms characteristic of schizophrenia but rarely found in other mental disorders were identified as first rank symptoms, these form the basis of the current DSM and ICD and have helped reduce misdiagnosis. However DSM and ICD systems do still differ in a few key ways, for example in the length of time symptoms have to be present for diagnosis, ICD is one month while DSM is six months, this is a significant difference given how quickly severe symptoms can present in acute onset schizophrenia. Another important issue in classification is the validity of the classification system, this is the degree to which the system measures what it set out to measure, in this case it refers to the appropriateness of the categories in diagnosing schizophrenia. Reliability can still be high if the

  • Word count: 513
  • Level: AS and A Level
  • Subject: Psychology
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Discuss issues surrounding the classification and diagnosis of schizophrenia

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. However his argument is that the reliability of the DSM in everyday usage may be lower than seen in research studies - meaning that only research studies are recorded with high reliability and non-research studies

  • Word count: 936
  • Level: AS and A Level
  • Subject: Psychology
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Discuss issues surrounding the classification and diagnosis of schizophrenia.

Discuss issues surrounding the classification and diagnosis of schizophrenia. There are many issues when it comes to the classification and diagnosis of schizophrenia, one of them being the reliability of the major classification systems, the DSM and ICD. Early versions of the DSM were deemed unreliable, even now when the newer versions are now said to have increased reliability there is little evidence to prove that the DSM is used with high reliability by mental health clinicians. This unreliable source of diagnosis may cause some patients to be misdiagnosed and due to this misdiagnosis many terrible situations may occur, they will be mistreated and therefore will be given drugs and exercises which are completely irrelevant to what they need to do, this could cause great harm to both their physical and mental well being, the misdiagnosis can also affect how they are in real life for example they will be labelled schizophrenic and therefore will struggle with everything in life, such as getting a job or even being themselves for they believe what they have been told to be true. There is also an issue with the treatment of schizophrenia due to the significant difficulty in predicting the outcome or the response, because every case of schizophrenia is different in their own way then there is no telling what the same treatment will do to one patient in comparison with another

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  • Level: AS and A Level
  • Subject: Psychology
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Discuss issues relating to the classification and diagnosis of schizophrenia

Discuss issues relating to the classification and diagnosis of schizophrenia Schizophrenia is a serious mental disorder characterised by a profound disruption of cognition and emotion, which affects a person’s language, thought, perception, affect and even sense of self. In most countries across the world, the lifetime risk of being diagnosed with schizophrenia is 1 per cent. There is a distinction between acute and chronic onset schizophrenia. In chronic onset, there is often an insidious change in an apparently normal young person who gradually loses drive and motivation and starts to drift away from friends. After months, or even years of this deterioration, more obvious signs of disturbance such as delusional ideas or hallucinations, appear. In acute onset, obvious signs such as hallucinations can appear quite suddenly, usually after a stressful event, and the individual shows very disturbed behaviour within a few days. In terms of symptoms that are used in diagnosis and classification, there are positive symptoms, which reflect an excess or distortion of normal functions, hallucinations, delusions, experiences of control and disorganised thinking. There are also negative symptoms which in fact reflect a loss or reduction in normal functions e.g. alogia (the loss of fluent speech) avolition (the loss of motivation) and accecore flattening (a reduction in the range of

  • Word count: 860
  • Level: AS and A Level
  • Subject: Psychology
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Discuss issues associated with the classification and/or diagnosis of schizophrenia

Discuss issues associated with the classification and/or diagnosis of schizophrenia One of the issue associated with the diagnosis and classification of schizophrenia is reliability.Reliability is how consistant a measurement is e.g the ICD and the DSM when diagnosis or classifiying schizophrenic patients.Reliability can be measured by inter rater reliability where they see if two independant sources come to the same diagnosis or classification or retest reliability where they see if the test used are consistant over time .Although psychologists say that DSM 3 is reliable , there is strong evidence that shows that reliability of the DSM is low when using inter-rater reliability.Whaley(2001) only found a small positive correlation between the different assesors.This is evidence of low reliability when using the DSM to diagnose schizophrenia ,however the test-retest reliability studies have shown more positive results which means that there is some sort of reliability with the DSM. Another issue surronding the diagnosis and classfication of schizophrenia is the cultral differences in diagnosis e.g A research study by Copeland et al (1971) compared 134 US psychiatrists and 194 British psychiatrists in their diagnosis of a patient, and found that 69% of the US psychiatrists diagnosed schizophrenia compared with only 2% of the British psychiatrists. This suggests that there is

  • Word count: 523
  • Level: AS and A Level
  • Subject: Psychology
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Classification and Diagnosis of Depression

Outline the clinical characteristics of depression (5) The clinical characteristics of depression are sad depressed mood, most of the day, nearly every day for two weeks, or loss of interest and pleasure in usual activities. There is also difficulties in sleeping (insomnia); not falling asleep initially; not returning to sleep after awakening in the middle of the night, and early morning awakenings; or, in some patients, a desire to sleep a great deal of the time. A shift in activity level and feeling lethargic or agitated is also a common symptom. Poor appetite and weight loss or increased appetite and weight gain is a physical symptom of depression. You may also experience loss of energy and great fatigue. A negative self concept, self blame and feelings of worthlessness and guilt with further evidence being difficulty in concentrating, such as slowed thinking and indecisiveness. Recurrent thoughts of death or suicide is the main symptom and finally apathy (no interest or pleasure in activities). There are two types of unipolar depression according to the classification systems. The first is major depressive disorder and the other is dysthymic disorder. Patients with MDD require five symptoms, suicidal thoughts. The symptoms are severe but can be short lived. On the other hand DD requires three or more symptoms, including depressed mood but not suicidal thoughts. Patients

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  • Level: AS and A Level
  • Subject: Psychology
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Issues with the Classification of Schizophrenia

Issues with classification of schizophrenia (8+16marks) There are many issues with the current classification system which in turn undermines the reliability and validity of the diagnosis of schizophrenia. This then consequently affects the validity and reliability of treatment options and limits the ability to validly compare schizophrenic research due to the ambiguity in recognising it. In order for the classification to both be reliable and valid characteristics should be adhere to many assumptions. Deviations from this ideal diagnostic system weaken the classification. Ideally characteristics should be mutually exclusive and jointly exhaustible categories. The advantage of valid and reliable diagnosis means aetiologies, treatment and prognosis are accurate. However, if the diagnosis lacks reliability, misdiagnosis, assumptions of categories and labelling effect may occur. One of the main issues is that there is no object test that can measure schizophrenia and a great deal of emphasis is placed on patient’s ability to report the symptoms which may not always be accurately described hindering reliability of the diagnosis. Despite no object tests there are diagnostic manuals that highlight the clinical characteristics of the disorder that clinicians can use to inform their diagnosis in attempt to objectify schizophrenia. However, discrepancies exist between the two

  • Word count: 779
  • Level: AS and A Level
  • Subject: Psychology
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Surviving Schizophrenia.

The DSM IV is a revised system of diagnosis and nomenclature and can also be referred to as the Diagnostic and Statistical Manual of Mental disorders. It can be used to diagnose people with serious mental illnesses, such as people who have mood disorders and schizophrenia. The DSM IV was designed to help doctors, professionals and even society as a whole recognize these disorders and the people who have them. The only way to treat someone is to recognize the problem first. The DSM IV is made up of five axes: clinical disorders, personality disorders/mental retardation, general medical conditions, psychosocial and environmental problems, and global assessment of functioning. Schizophrenia was once used in a more "broad" term and researchers felt that a more specific, strict definition was needed. The DSM IV definition was developed because of this and contains specific criteria that is needed to diagnose someone with schizophrenia. In the DSM IV, to be diagnosed as having schizophrenia, one must have two or more of the following conditions that are present for a significant time over a one-month time span. The conditions are: delusions, hallucinations, disordered speech, grossly disorganized or catatonic behavior, and negative symptoms, such as alogia and avolition. Other factors such as social/occupational dysfunction and duration also play a part in the diagnosis. Of

  • Word count: 1781
  • Level: AS and A Level
  • Subject: Healthcare
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Family Models of Schizophrenia

Family models Early theories: based on observations- not supported well by research Double bind theory (Bateso '56): child has repeated experiences with family members in which receives contradictory messages e.g. 'looks sleepy, go to bed now"-shows concern for welfare of child but hostility and desire to get child out of the way suggested by body language/tone Repeated exposure to contradictory messages ›child resorts to self deceptions communication problems etc. These interactions prevent the development of internally coherent construction of reality, and in the long run, this manifests itself as schizophrenic symptoms (e.g. flattened affect and withdrawal). R.D. Laing schizophrenia reasonable response to an insane world. Research before 1970's = view that dysfunctional families = most common schizophrenia HOWEVER = family interaction only studied after diagnosis of schizophrenia rarely involved proper control groups Hence Recent research = based on expressed emotion; originally by Brown ('72) then lower showed patients with schizophrenia relapse higher than in homes with high expressed emotions. Characteristics of high expressed emotions include: hostility, criticism and over concern. Patients' recall maybe affected by their schizophrenia. Other studies are less supportive. Hall and Levin ('80) analysed data various previous studies no difference families with

  • Word count: 662
  • Level: AS and A Level
  • Subject: Psychology
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