Reliability and validity in schizophrenia

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20 Terms

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Reliability and validity

What is reliability in schizophrenia?

Means the consistency of diagnosis

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Reliability and validity

What is diagnostic reliability?

  • Test-retest: same clinician, same conclusion, two different points in time (eg: original diagnosis, and when watching a recording)

  • Inter-rater reliability: different clinicians, same conclusions

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Reliability and validity

What is a kappa score?

  • measures inter-rater reliability

  • 1 perfect agreement, 0 zero agreement

  • 0.7 or above is considered good

  • Regier et a (2013): DSM-V’s 0.46 kappa score for schizophrenia (moderate)

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Reliability and validity

Reliability: what is cultural difference in diagnosis, and what does this indicate?

Cultural differences:

  • Significant variation between countries in diagnosing schizophrenia,

Indicates that:

  • Culture influences the diagnostic process

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Reliability and validity

(Can be Evaluation): Reliability: examples of cultural differences in diagnosis → inter-rater reliability

Copeland et al (1971):

  • 69% of the US psychiatrists diagnosed with schizophrenia vs 2% of British based on same description + same classification system (DSM-V) (low cross cultural inter-rater reliability)

  • Suggests reliability can be consistent within, but inconsistent between cultures (so cultural variations impact reliability

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Reliability and validity

(Can be Evaluation): Reliability: examples of cultural differences in diagnosis → symptom variance

Luhrmann et al (2015):

  • Interviewed adults (20 Ghanian, 20 Indian, 20 American)

  • Many African + Indian Ps reported positive experiences w/ voices BUT US patients violent/distressing voices

  • This suggests manifestation of symptoms vary culturally, + using one universal classification tool (imposed etic) would result in inconsistent, and so less reliable, diagnoses due to the variance in symptoms.

  • Can be overcome by using an emic approach (eg: indigenous classification systems)

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Reliability and validity

Rosenhan (1973) (part 1):

  • 8 pseudo patients, w/ fake name/job/one symptom (unfamiliar voice that said ‘hollow’, ‘empty’, ‘thud’) everything else said was real)

  • Recorded treatment + operation of ward

  • After admission - told staff they felt ‘fine’ and symptom was gone

  • NO Ps detected as not having schizophrenia by staff

  • Normal behaviour seen as symptoms → similar to real patients (eg: waiting outside of cafeteria = 'oral-accusative syndrome', NOT boredom)

  • Were in hospital b/ 1-7 weeks - discharged w/ 'schizophrenia in remission), BUT some other patients suspected they were sane (35/118 patients voiced this)

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Reliability and validity

Rosenhan (1973) (part 2):

  • Told institutions pseudo-patients were being admitted (none were) and people were falsely accused of being one

  • suggests → Diagnosis label = schema

  • INSTEAD should focus on individual's specific behaviours + problems

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Reliability and validity

What does Rosenhan (1973) tell us about the problems of reliability of diagnosis?

LACKS reliability:

  • Definitions need to be more operationalised, rigid, and structures

  • Demonstrates psychiatrists cannot reliably tell the difference b/w sane and insane people

COUNTER-POINT:

  • Invalid - admitted when they didn't have schizophrenia but pretend they did - hospitals are more likely to say 'better safe than sorry' (not discharge someone who isn't ready)

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Reliability and validity

What is validity in schizophrenia?

The extent to which a diagnosis represents the disorder it is measuring, that is distinct from other disorders

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Reliability and validity

Validity: what is gender bias in diagnosis?

  • Clinicians can base judgements of diagnosis on stereotypical beliefs about gender

  • Eg: Boverman et al (1970) → women less likely to be diagnosed than men

  • In USA, definitions of a mentally healthy adult = a mentally healthy male (androcentric) → led people to believe women = less healthy bcs deviate (from 'male' behaviour) BUT may be bcs differences in help-seeking behaviour → measuring gender behaviours NOT disorder

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Reliability and validity

Validity: what is symptom overlap? What is the issue with it?

  • ICD and DSM have been known to be unsuccessful when it comes to differentiating between symptoms of S and other disorders

  • This lack of distinction calls into question validity of classification/diagnosis of S, + if S = UNIQUE disorder, or if S/DID/Bipolar = part of the same branch of disorder

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Reliability and validity

Validity: examples of symptom overlap

Ellson and Ross (1995):

  • People w/ DID have more S symptoms than people diagnosed w/ S

  • both have positive and negative symptoms

Read (2004):

  • most people with schizophrenia have sufficient symptoms to receive at least one other diagnosis (Eg: bipolar disorder shares positive symptoms like delusions, + negative symptoms like avolition.

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Reliability and validity

Validity: what is co-morbidity?

  • when two conditions co-occur - common in schizophrenic patients

  • 50% have depression

  • 12% have OCD

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Reliability and validity

What does Rosenhan (1973) tell us about the problems of validity of diagnosis?

  • They weren’t able to recognise what disorder it was

  • Behaviour was often misinterpreted in terms of diagnosis (eg: patients waiting for lunch)

  • SUGGESTING definition of schizophrenia is not clear enough

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Reliability and validity

Evaluation: diagnosis has low reliability

diagnosis has low reliability, (consistency of a study) If a study = inconsistent → lack reliability. Reiger et al (2013): DSM-V's S kappa score = 0.46, suggesting low reliability → inconsistency b/w mental health professionals = limitation of the diagnosis → suggests DSM-V = invalid

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Reliability and validity

Evaluation: diagnosis has low validity

Limitation of diagnosis = low validity →  standard assessment = is criterion validity (do different assessments systems give same diagnosis for same patient?) → Ellason + Ross (1995) found people w/ DID have more S symptoms than people diagnosed as S → questions if schizophrenia is a UNIQUE disorder, or if schizophrenia/DID/Bipolar are part of the same branch of disorder

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Reliability and validity

Evaluation: symptom variations = issue w/ validity

two people w/ S diagnosis can share NO SYMPTOMS w/ each other → questions validity of classification tools in accurately representing/describing the disorders it attempts to

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Reliability and validity

Evaluation: Gender bias

Longnecker et al (2010)'s meta-analysis of schizophrenia prevalence found men are diagnosed more often than women since the 1980s, so gender bias means that people with similar symptoms are receiving different diagnosis's

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Reliability and validity

Evaluation: Culture bias

People of African origin are more likely to be diagnosed w/ schizophrenia in the UK, and rates are lower in Africa/West Indies - so not bcs of genetics, but rather bcs of culture bias meaning symptoms in the UK, but considered 'normal' in African cultures (eg: AVH) - issue w/ validity