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Outline and Evaluate at Least Two Issues in Classifying or Diagnosing Schizophrenia (24 Marks)

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Outline and evaluate at least two issues in classifying or diagnosing schizophrenia (24 marks)

One issue relating to the diagnosis and classification of sz is reliability. Inter-rater reliability is the extent to which psychiatrists can agree on the same diagnoses when independently assessing patients, and Test-retest reliability is the extent to which the tests used to deliver these diagnoses are consistent over time. DSM-III was designed to provide a more reliable system for classifying psychiatric disorders. Carson claimed that DSM-III had fixed the problem of reliability once and for all. However, 30 years later there is still little evidence that DSM is routinely used with high reliability by mental health clinicians.
However, test-retest studies have shown positive results. Prescott et al analysed the test-retest reliability of several measures of attention and information processing in 14 chronic schizophrenics. Performance on these measures was stable over a 6 month period, showing that there is high test-retest reliability when using these measures to diagnose sz.
Rosenhan proposed that reliability was a major issue for diagnosis alone and situational factors were more salient in determining sz diagnosis rather than any specific illness characteristics. This shows that the diagnostic procedure used at the time was inconsistent. Rosenhan demonstrated a lack of faith in the system where he arranged pseudo patients to present themselves to psychiatric hospitals claiming to be hearing voices in their heads – a typical symptom of sz. All patients were diagnosed with sz despite a lack of further symptom display during hospitalisation, with no staff recognising them to be “normal”. This denotes a lack of reliability in classification and diagnosis of sz.
Rosenhan further demonstrated unreliability in diagnosis in a follow-up study, warning hospitals of his

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