‘Discuss issues in the diagnosis of Schizophrenia’

Comorbidity within the diagnosis of schizophrenia refers to two or more conditions occurring together. For schizophrenia, comorbid disorders include depression, substance abuse, post-traumatic stress disorder and OCD. For example, Buckley et al found that 50% of patients with Sz had depression and 47% had substance abuse issues. This is an issue in the diagnosis of Sz as it can make it difficult to know which disorder to treat first. It may be that one disorder is the primary condition, and the other is a secondary condition as a result of the first. For instance, Sz could lead to depression or vice versa. There are also socially sensitive implications. For example, Buckley et al found that the suicide rate for patients with Sz but no co-morbid conditions is 1%. This increases to 47% for patients with comorbid depression. This means that comorbidity is a huge issue in regard to the diagnosis of schizophrenia, as a misdiagnosis due to comorbidity may lead to fatal consequences. Another issue regarding the diagnosis of Sz is system overlap. There is considerable system overlap between the symptoms of Sz and bipolar disorder, and Sz and dissociative identity disorder. For example, both bipolar and Sz involve delusions and avolition. Evidence for system overlap with DID comes from Ellason and Ross who found that patients with DID had more of the so called ‘first rank’ systems for Sz than patients with Sz did. This calls into question the validity of a diagnosis as Sz may be diagnosed when the patient really has bipolar/DID (Type 1 error), or bipolar/DID diagnosed when the patient really has Sz (Type 2 error). Further, there could be a case of comorbidity where the patient has both bipolar and Sz, yet the Sz is masked with the psychiatrist classifying the negative symptom of avolition as a symptom of depression. Again, this has implications for the treatment and suicide risk. Cultural bias is also an issue within the diagnosis of Sz. According to prevalence rates, people of Afro-Caribbean origin are several times more likely than white people to be diagnosed with Sz. This indicates issues of cultural bias. One reason for this may be that hearing voice is more acceptable in African cultures because of cultural beliefs in communication with ancestors, thus people are more likely to acknowledge such experiences. Evidence for this is presented by Luhrman et al (2015) who interviewed 60 adults with Sz in Africa, India and USA. African and Indian patients were more likely to report positive experiences of hearing voices, whereas those from the USA were more likely to report the voices as violent and hateful.Further, if the psychiatrist is from a different culture, these experiences may be misunderstood and judged as characteristics of Sz. For example, Escobar (2012) found that white psychiatrists tend to over interpret symptoms of black people during diagnosis. This is an issue because it may lead to a Type 1 error and a diagnosis that lacks validity. Type 1 errors can lead to labelling and hus a self-fulfilling prophecy. For instance, a patient who is diagnosed with Sz may start to live up to this label alter their perceptions and develop more symptoms as a result. It is thus important that training of psychiatrists for the assessment process includes the need to consider the cultural background of the patient before making a diagnosis.