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Issues Surrounding the Classification and Diagnosis of Schizophrenia.

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One issue related to classification and diagnosis is reliability. Reliability is the consistency of a measuring instrument such as DSM (diagnostic and statistical manual) that is used when diagnosing schizophrenia. Reliability can be measured in terms of whether two independent assessors give similar scores (inter-rater reliability). High reliability indicated by high positive correlation. Inter-rater reliability has been assessed for diagnoses of schizophrenia and found to be relatively low. This was especially true for early versions of DSM but it was hoped later versions of DSM would prove more reliable. However more recent versions continued to produce low inter rater reliability scores. Whaley (2001) found small +.11 correlation between different raters. Differences in cultural interpretations also pose a threat to the reliability of the diagnosis of schizophrenia. Research study by Copeland et al (1971) gave a description of a patient showing clinical characteristics of schizophrenia to US and UK psychiatrists. Of the US psychiatrists, 69% diagnosed schizophrenia. Whereas only 2% of UK psychiatrists gave same diagnosis. Suggests that the diagnostic criteria had quite a different meaning in different cultures and therefore not reliable when used in different cultural settings.

Reliability is also an issue for diagnosis. This was raised by Rosenhan (1973) who claimed that situational factors were more important in determining the ultimate diagnosis of schizophrenia, rather than any specific characteristics of the person. Rosenhan demonstrated this is ‘Sane in insane places’ study. ‘Pseudo patients’ presented themselves to psychiatric hospitals claiming to be hearing voices (symptom of schizophrenia). All were diagnosed with schizophrenia and admitted, despite the fact that they displayed no further symptoms during hospitalisation. None of staff recognised

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