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
Access this essay

Psychological Explanations of Schizophrenia

Discuss research in biological explanations of schizophrenia In order for schizophrenia to be diagnosed the person needs to have two or more of the following symptoms for over 6 months. These are; thought disturbances (positive= bizarre additions to normal behaviour) such as thought insertion, hallucinations and delusions. (negative= absence of normal behaviour) Disturbances of affect/volition such as withdrawal, reduced motivation and difficulty carrying out actions. Thirdly; Psychomotor disturbances such catatatonia, stereotypy and frenetic activity. Research into psychological explanations of schizophrenia had come up with the idea that expressed emotions in families can have considerable affect. This states that families who had high expressed emotion had higher levels of concern or hostility to the sufferer of schizophrenia. This argues that high expressed emotion families can cause schizophrenia. This gives the assumption that schizophrenia can be partly caused by the onset of stress caused by families. This could result from conflicting demands and breakdown in communication with family. This can explain how a child can become confused and doubtful from parents giving conflicting demands. For example a child could be criticised for not giving hugs, when the child tries to give a hug it will be rejected. In this situation the child can not win and can not avoid

  • Word count: 851
  • Level: University Degree
  • Subject: Medicine and Dentistry
Access this essay

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
Access this essay

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
Access this essay

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

  • Ranking:
  • Word count: 448
  • Level: AS and A Level
  • Subject: Psychology
Access this essay

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
Access this essay

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
Access this essay

Psychological Explanations for Schizophrenia

Psychological explanations Biological factors alone cannot account for the origin and maintenance of schizophrenia and therefore psychological explanations look at other important contributory factors shown through psychodynamic views, family models and cognitive models. According to one psychodynamic view, schizophrenia arises from the inability to test reality for instance, draw up logical conclusions and to be able to distinguish between the internal and external world. It is also said that childhood experiences can then lead to the unconscious conflict within the ego, id and super-ego which can contribute to schizophrenia. Although this approach provides us with an alternative explanation to schizophrenia, it is very weak. This is a retrospective approach to studying schizophrenia which means overtime memory fades and therefore reports back to childhood cannot be completely reliable. Also by being a retrospective approach it overemphasises childhood. Childhood may have a large impact on schizophrenia but what it fails to consider is recent events. For instance, the Diathesis-Stress Model suggests that schizophrenia can occur due to stressful life events that could trigger psychotic symptoms. Perhaps recent events that cause stress are a more important factor rather than childhood. Lastly, the approach focuses on the unconscious which is difficult to falsify

  • Word count: 1002
  • Level: AS and A Level
  • Subject: Psychology
Access this essay

Discuss Psychological Explanations of Schizophrenia

Psychological explanations of schizophrenia Schizophrenia is a psychotic disorder as it often involves a loss of contact with reality and a lack of self insight. Schizophrenia has a large number of clinical characteristics. Some of these are Thought control, delusions of passivity, control and influence, and hallucinatory voices. Other symptoms may include catatonic behaviour, incoherent speech and general negativity about the self. Research states, according to family theories, that schizophrenia is a consequence of maladaptive behaviour and poor communication within the family. Bateson suggested the "double-bind" hypothesis, where children are given conflicting messages from parents who express care, yet at the same time appear critical, which was thought to lead to confusion, self-doubt and withdrawal. Litz et al (1965) also coined the term "marital schism", to explain an abnormal family pattern where conflict between parents was associated with schizophrenia in offspring. However, these theories were based on methodologically flawed studies. One major problem was that families were studied retrospectively, long after the persons mental disorders may have affected the family. Also, these studies did not include control groups and used poorly operationalized definitions of schizophrenia. Also, ethical implications are possible using such explanations of schizophrenia.

  • Word count: 848
  • Level: AS and A Level
  • Subject: Psychology
Access this essay

Psychological explanations of schizophrenia

Psychological explanations of Schizophrenia (SZ) There are many suggestions that Schizophrenia can be caused by certain psychological factors and stressors. E.g. the more stressful an event the more likely that someone will develop schizophrenic symptoms. Other reasons can be social or cognitive. It is thought that SZ occurs more in people of lower socio-economic stature and this can be explained in 2 ways: low economic status itself has been said to cause high levels of stress due to the poor living conditions and struggle to survive, making those who have the potential to get schizophrenia more likely to show symptoms. It is said that this view is reductionist as it doesn’t take into account the biological factors also even though there is evidence supporting the claims that acute stress can inhibit SZ it is unlikely that Social class and economic stature is the sole cause and it is more likely to be just a contributing factor. It can also be defined with the social drift hypothesis which is where people with SZ can no longer cope with jobs and relationships so drift down the socioeconomic hierarchy. However in 1990 Fox produced a meta-analysis from studies by him and other professionals and found no conclusive evidence for the drift theory. Family relationships are also thought to help develop SZ. Fromm Reichmann (1948) created the term ‘Schizophrenogenic

  • Word count: 584
  • Level: AS and A Level
  • Subject: Psychology
Access this essay