Discuss the validity of diagnosis of schizophrenia (16 marks)
A01
Validity: the extent to which we are measuring what we are intending to measure/ truthfulness.
Validity in schizophrenia: We have to consider the validity of the diagnostic tools; for example, do different
assessment systems arrive at the same diagnosis for the same patient?
Gender bias: The tendency for diagnostic criteria to be applied differently to males and females
- If women are under-diagnosed then this suggests that the validity of the diagnosis of schizophrenia
is poor, because the procedures for diagnosis work well only on patients of one gender.
Example of test of validity in terms of a gender bias: Broverman et al found that clinicians in the US equated
mentally healthy “adult” behaviour with mentally healthy “male” behaviour. As a result, there was a tendency
for women to be perceived as less mentally healthy.
Comorbidity: two or more conditions occur together.
- If conditions occur together it can call into question the validity of their diagnosis because they
might only have one condition. Schizophrenia is commonly diagnosed alongside other conditions.
Example test of validity in terms of comorbidity: Buckley found that 50% of people with schizophrenia also
have a diagnosis of depression, 47% all suffer with substance abuse, 29% have PTSD and 23% have OCD. In
terms of diagnosis, if half of schizophrenia patients are also diagnosed with depression, it could just be that
we struggle to tell the difference between the two conditions. As a result, this reduces the validity of a
schizophrenia diagnosis.
A03
One limitation of the diagnosis of Sz is the validity in relation to gender bias. There is further research
supporting the fact that there is gender bias when it comes to diagnosing schizophrenia. Longenecker et al
reviewed studies of the prevalence of schizophrenia and concluded that since the 1980s men have been
diagnosed with schizophrenia more often than women. While this could be because men have more genetic
vulnerability in developing schizophrenia than women, it could also be due to a gender bias in diagnosis.
A03
One limitation of the diagnosis of Sz is the validity in relation to comorbidity. There is further evidence by
Weber et al proving the consequence of comorbidity.
Weber looked at nearly 6 million hospital discharge records, finding evidence of many co-morbid
non-psychiatric diagnoses. Many patients with a primary diagnosis of Sz were also diagnosed with medical
problems including asthma, hypertension and type 2 diabetes. This suggests that the very nature of a
diagnosis of a psychiatric disorder is that patients tend to receive a lower standard of medical care, which in
turn adversely affects the prognosis for patients with Sz.
However…
A strength of those who are able to be correctly diagnosed is that they will be able to understand what is
happening to them which could reduce their anxiety and confusion and help them to deal with their
symptoms.
Extra validity issues in diagnosis of Sz (8 marks)
A01
Symptom overlap: where certain symptoms such as speech poverty are symptoms of many different
conditions and it makes it hard to decide which conditions the person actually has.
Eg. Bipolar disorder involves positive symptoms like delusions and negative symptoms like avolition (also
symptoms of Sz) meaning:
1) Hard to get the right diagnosis.
2) Could cause some people to develop symptoms they don’t already have because of a self-fulfilling
prophecy.
As a result, symptom overlap could lead to misdiagnosis which comes to show that the diagnostic tools could
be invalid when it comes to the diagnosis of Sz.
A03
One limitation of the diagnosis of Sz is the validity in relation to symptom overlap. There is further research
into symptom overlap. Ellason and Ross have pointed out that people with dissociative identity disorder
actually have more schizophrenic symptoms than people diagnosed as being schizophrenic. Read et al also
, suggested that most people who are diagnosed with Sz have sufficient symptoms of other disorders that they
could also receive at least one other diagnosis. As a result, it has been further reinforced above how symptom
overlap could lead to misdiagnosis which comes to show that the diagnostic tools could be invalid when it
comes to the diagnosis of Sz.
However…
One strength of being given the schizophrenia diagnosis, even if it’s initially invalid, is that the patients will
be able to have access to support groups and talk to other people who have similar experiences to them, for
example, Eleanor Longden who started a support group called ‘Talking with voices’. This interaction with
fellow sufferers could help the person get through the tougher moments as they can gain advice from people
who have actually experienced the symptoms.
A01
Cultural bias: the tools that are being used to diagnose patients with Sz are ethnocentric.
- Therefore when it comes to applying the criteria to non-whites, patients may be misdiagnosed.
A03
One limitation of the diagnosis of Sz is the validity in relation to cultural biases. There is evidence to suggest
that the tools that are being used to diagnose patients could be culturally biased. This is where different
cultures could affect the diagnosing of schizophrenia. Eg. African-Americans and English people of
Afro-Caribbean heritage are several times more likely to be diagnosed than white people. This could be
because hearing voices is more acceptable in Africa, so people are more willing to come forward, perhaps
due to cultural beliefs in the communication of ancestors.
Eg. Escobar found that typically, white psychiatrists may over interpret and distrust the honesty
of black people during diagnosis. Schizophrenia rates are not particularly high in Africa and the West is
suggesting that there are issues of cultural bias instead in the diagnosis of non-white patients. This comes to
show that cultural bias can have an effect on the diagnosis of Sz.
However…
A strength of this could be that it de-stigmatises the condition. In some cultures, hearing voices is definitely
frowned upon and people could be made to feel “crazy” or ill, whereas in these cultures they may feel like
they have a lot more support from those around them and they may not feel negative emotions from those
around them, which could negatively impact their mental health.
Discuss classification of schizophrenia (6 marks)
A01
Positive symptoms - reflect an excess of normal functioning.
1) Delusions : false beliefs that are firmly held despite being completely illogical
- Delusions of persecution: The belief that others want to harm, threaten or manipulate you.
- Delusions of grandeur: This is the idea that you are an important individual,god-like, and have powers.
- Delusions of control: Individuals may believe that they are under the control of an alien force.
2) Hallucinations: disturbances in perception
- The most common hallucinations are auditory ones (hearing voices) but can include smell, touch and
sight.
Negative symptoms - reflect a loss of normal function.
1) Speech poverty
-is the inability to speak properly, characterised by lack of ability to produce fluent words; this is thought to
reflect slowing or blocked thoughts. It can manifest itself as short and empty replies to questions.
2) Avolition
- inability to start and continue with goal directed behaviour. Examples of avolition include: no longer being
interested in going out and meeting with friends ect.
A01
Validity: the extent to which we are measuring what we are intending to measure/ truthfulness.
Validity in schizophrenia: We have to consider the validity of the diagnostic tools; for example, do different
assessment systems arrive at the same diagnosis for the same patient?
Gender bias: The tendency for diagnostic criteria to be applied differently to males and females
- If women are under-diagnosed then this suggests that the validity of the diagnosis of schizophrenia
is poor, because the procedures for diagnosis work well only on patients of one gender.
Example of test of validity in terms of a gender bias: Broverman et al found that clinicians in the US equated
mentally healthy “adult” behaviour with mentally healthy “male” behaviour. As a result, there was a tendency
for women to be perceived as less mentally healthy.
Comorbidity: two or more conditions occur together.
- If conditions occur together it can call into question the validity of their diagnosis because they
might only have one condition. Schizophrenia is commonly diagnosed alongside other conditions.
Example test of validity in terms of comorbidity: Buckley found that 50% of people with schizophrenia also
have a diagnosis of depression, 47% all suffer with substance abuse, 29% have PTSD and 23% have OCD. In
terms of diagnosis, if half of schizophrenia patients are also diagnosed with depression, it could just be that
we struggle to tell the difference between the two conditions. As a result, this reduces the validity of a
schizophrenia diagnosis.
A03
One limitation of the diagnosis of Sz is the validity in relation to gender bias. There is further research
supporting the fact that there is gender bias when it comes to diagnosing schizophrenia. Longenecker et al
reviewed studies of the prevalence of schizophrenia and concluded that since the 1980s men have been
diagnosed with schizophrenia more often than women. While this could be because men have more genetic
vulnerability in developing schizophrenia than women, it could also be due to a gender bias in diagnosis.
A03
One limitation of the diagnosis of Sz is the validity in relation to comorbidity. There is further evidence by
Weber et al proving the consequence of comorbidity.
Weber looked at nearly 6 million hospital discharge records, finding evidence of many co-morbid
non-psychiatric diagnoses. Many patients with a primary diagnosis of Sz were also diagnosed with medical
problems including asthma, hypertension and type 2 diabetes. This suggests that the very nature of a
diagnosis of a psychiatric disorder is that patients tend to receive a lower standard of medical care, which in
turn adversely affects the prognosis for patients with Sz.
However…
A strength of those who are able to be correctly diagnosed is that they will be able to understand what is
happening to them which could reduce their anxiety and confusion and help them to deal with their
symptoms.
Extra validity issues in diagnosis of Sz (8 marks)
A01
Symptom overlap: where certain symptoms such as speech poverty are symptoms of many different
conditions and it makes it hard to decide which conditions the person actually has.
Eg. Bipolar disorder involves positive symptoms like delusions and negative symptoms like avolition (also
symptoms of Sz) meaning:
1) Hard to get the right diagnosis.
2) Could cause some people to develop symptoms they don’t already have because of a self-fulfilling
prophecy.
As a result, symptom overlap could lead to misdiagnosis which comes to show that the diagnostic tools could
be invalid when it comes to the diagnosis of Sz.
A03
One limitation of the diagnosis of Sz is the validity in relation to symptom overlap. There is further research
into symptom overlap. Ellason and Ross have pointed out that people with dissociative identity disorder
actually have more schizophrenic symptoms than people diagnosed as being schizophrenic. Read et al also
, suggested that most people who are diagnosed with Sz have sufficient symptoms of other disorders that they
could also receive at least one other diagnosis. As a result, it has been further reinforced above how symptom
overlap could lead to misdiagnosis which comes to show that the diagnostic tools could be invalid when it
comes to the diagnosis of Sz.
However…
One strength of being given the schizophrenia diagnosis, even if it’s initially invalid, is that the patients will
be able to have access to support groups and talk to other people who have similar experiences to them, for
example, Eleanor Longden who started a support group called ‘Talking with voices’. This interaction with
fellow sufferers could help the person get through the tougher moments as they can gain advice from people
who have actually experienced the symptoms.
A01
Cultural bias: the tools that are being used to diagnose patients with Sz are ethnocentric.
- Therefore when it comes to applying the criteria to non-whites, patients may be misdiagnosed.
A03
One limitation of the diagnosis of Sz is the validity in relation to cultural biases. There is evidence to suggest
that the tools that are being used to diagnose patients could be culturally biased. This is where different
cultures could affect the diagnosing of schizophrenia. Eg. African-Americans and English people of
Afro-Caribbean heritage are several times more likely to be diagnosed than white people. This could be
because hearing voices is more acceptable in Africa, so people are more willing to come forward, perhaps
due to cultural beliefs in the communication of ancestors.
Eg. Escobar found that typically, white psychiatrists may over interpret and distrust the honesty
of black people during diagnosis. Schizophrenia rates are not particularly high in Africa and the West is
suggesting that there are issues of cultural bias instead in the diagnosis of non-white patients. This comes to
show that cultural bias can have an effect on the diagnosis of Sz.
However…
A strength of this could be that it de-stigmatises the condition. In some cultures, hearing voices is definitely
frowned upon and people could be made to feel “crazy” or ill, whereas in these cultures they may feel like
they have a lot more support from those around them and they may not feel negative emotions from those
around them, which could negatively impact their mental health.
Discuss classification of schizophrenia (6 marks)
A01
Positive symptoms - reflect an excess of normal functioning.
1) Delusions : false beliefs that are firmly held despite being completely illogical
- Delusions of persecution: The belief that others want to harm, threaten or manipulate you.
- Delusions of grandeur: This is the idea that you are an important individual,god-like, and have powers.
- Delusions of control: Individuals may believe that they are under the control of an alien force.
2) Hallucinations: disturbances in perception
- The most common hallucinations are auditory ones (hearing voices) but can include smell, touch and
sight.
Negative symptoms - reflect a loss of normal function.
1) Speech poverty
-is the inability to speak properly, characterised by lack of ability to produce fluent words; this is thought to
reflect slowing or blocked thoughts. It can manifest itself as short and empty replies to questions.
2) Avolition
- inability to start and continue with goal directed behaviour. Examples of avolition include: no longer being
interested in going out and meeting with friends ect.
