Is the Diagnosis of Schizophrenia Valid?

The media has often misrepresented schizophrenia, or confused it other mental disorders such a split personality disorder. But what exactly is schizophrenia?  How do psychiatrists make a valid diagnostician?

‘Schizophrenia is a severe form of mental illness affecting about 7 per thousand of the adult population, mostly in the age group 15-35 years. Though the incidence is low (3-10,000), the prevalence is high due to chronicity.’ According to World Health Organization.

However, according to about dot com ‘Schizophrenia is a severe mental disorder characterized by delusions, hallucinations, incoherence and physical agitation; it is classified as a “thought” disorder while Bipolar Disorder is a “mood” disorder’.

Both these websites have very different definitions; you could arguably say, “ That’s just because they are websites so probably not as valid as the medical journals used to diagnose mental illnesses by psychiatrists”.

However, when it comes to diagnosing schizophrenia in the two main journals, Diagnostic and Statistical Manual of Mental Disorders (DSM) and the International Classification of Diseases (ICD), which psychiatrists use to diagnose patients problems occur. Both journals suggest different methods for diagnosis. Firstly the DSM, which was produced in America, requires symptoms to have been evident for 6 months, and only identifies 5 subtypes. Whilst the ICD, which was developed in Europe requires that symptoms must be evident for one month and identifies 7 subtypes.

Both Journals put forward two types of symptoms, positive symptoms that reflect an excess or distortion of normal functions and negative symptoms, which reflect a diminution or loss of normal functions.

Firstly, positive symptoms such a delusions (beliefs that are real to the person with schizophrenia, but are actually not real.), experiences of control (the sufferer may believe that they are under the control of aliens or spirits that are taking over their mind/body), hallucinations (usually auditory such as hearing God) and disordered feelings (in some cases the person may feel their thoughts are being broadcast). Secondly, negative symptoms such as affective flattening (a reduction of emotional expression), alogia (poverty of speech) and avolition (inability to follow goal directed behavior).

Furthermore, schizophrenia is often dual diagnosed this means it comes with another disorder such a depression or bipolar and seen above negative symptoms of schizophrenia are very similar to both these mental disorders. So could negative symptoms just be a depression or bipolar that got diagnosed wrong?

A further issue comes from, Ellason and Ross (1995) who noticed that people suffering from dissociative identity disorder (DID) had more ‘schizophrenic’ symptoms than people diagnosed with actual schizophrenia.

So it seems that nobody is quite sure what schizophrenia is. So how can psychologist investigate ways to help sufferers if they don’t actually know what they are looking for because there is no valid definition.

 

http://www.who.int/mental_health/management/schizophrenia/en/

http://bipolar.about.com/od/glossary/g/gl_schizophreni.htm

Ellason,. J.W. and Ross, C.A. (1995). Positive and negative symptoms in dissociative identity disorder and schizophrenia : a comparative analysis. Journal of Nervous and Mental Disease, 183 (4), 234-41.

 

 

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2 Responses to Is the Diagnosis of Schizophrenia Valid?

  1. psychmja1 says:

    You make several good points in your blog, however have you considered that the differences in the two systems are only trivial. One study comparing the differences in the levels of diagnosis by the ICD-10 and the DSM-IV in 105 inpatients in a hopsital found that, in fact, there is a high concordance between the two systems of diagnosis (approximately 83% concordance)*. Basically 102 patients were diagnosed by the ICD-10 and 90 by the DSM-IV, which if you consider in the scale of things is not actually that big a difference. Similarly a comparison of symptoms of schizophrenia diagnosed by the two criteria’s did not show any significant differences between the two different methods of diagnosis. Whilst in the past there have been large differences between the ICD and DSM, each revision of the systems brings the two closer together.
    You also say that schizophrenia is often diagnosed with another disorder, and therefore the diagnosis of schizophrenia may not be as reliable. However, many disorders are often diagnosed alongside another, especially depression as people are generally upset and struggle to cope with their diagnosis, so is depression a cause of effect of schizophrenia? Schizophrenia is a difficult disease to diagnose reliably as there are so many different types, with varying degrees of the disorder. Many studies have aimed to discover the origins of schizophrenia. One theory is that schizophrenia may be caused by lesions in the brain. However, it’s very rare that an individual with schizophrenia has had a brain scan prior to diagnosis therefore it can be difficult to determine whether the lesions have caused the disease or whether they are a result of it.

    *http://ajp.psychiatryonline.org/article.aspx?Volume=157&page=1041&journalID=13

  2. Pingback: Comments for my TA « psychmja1

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