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talkative increased involvement in pleasurable activities inflated self esteem lack of interest of pleasure periods of depression periods of mania psychomotor agitation sleep disturbance 1. lack of interest in pleasure and easily distracted are symptoms that overlap in all three disorders 2. The validity of diagnosis may be reduced due to symptom overlap because individuals may not show all symptoms for a disorder so it may be difficult to differentiate which disorder they have. They may also have another diagnosis that can impact the validity of their diagnosis if there is symptom overlap with their other diagnosis 3. The issue of comorbidity may affect the validity of diagnosing schizophrenia because there may be symptom overlaps between disorders so they may only 2 ● actually have one of the diagnosed conditions with other symptoms that are not part of the classification. It can also be hard to prescribe medication if two conditions are comorbid. For example, if a person is diagnosed with schizophrenia and depression due to symptom overlap they will have to take antipsychotics and antidepressants and if they only actually have one of these conditions in the case of misdiagnosis, they could end up developing symptoms of the condition. • inter-rater reliability o 0.46 kappa score when systems were first introduced (0.7/ 0.8 is considered good for diagnosis) o weak score for diagnosis o DSM in 2019 (Osorio) - inter rater score of 0.97 and test retest of 0.92 changes to the DSM o DSM 5 removed subtypes that were in DSM 4 due to low reliability and poor validity Classification ● • ICD 10 and DSM 5 have different diagnostic criteria problem for validity of diagnosis because different classification systems are used worldwide and people could receive different diagnoses depending on which diagnostic system was used • Jakobsen - 100 Danish patients with a history of psychosis were assessed using the ICD 10 and a concordance rate of 98% was obtained Gender bias • 4:1 male to female diagnosis o Cotton et al - women are undiagnosed due to more supportive relationships and often tend to be better at masking symptoms Reliability and validity in diagnosis 3 • most research is carried out on men so diagnostic criteria are based off of male sz - androcentric and beta bias • issue for reliability of diagnosis because gender bias can prevent women from being diagnosed/ causes men to be overdiagnosed with sz ● Loring and Powell (1988) - 290 male and female psychiatrists o two case studies but the gender of the case was changed in various ways o case studies described as male - 56% SZ o case studies described as female - 20% Sz o this difference was only found in male psychiatrists ✓Co-morbidity • Buckley et al - sz occurred alongside many other conditions like depression (50%) • makes it hard to separate the two different conditions are there may be a separate condition for 'schizophrenic depression' • issue for validity of diagnosis because it makes it hard to see sz as a unique condition Rosenhan • sent sane people to mental hospitals • all patients were diagnosed with an illness and hospitalised • the hospitals deemed mentally healthy participants to be 'insane' • showed no symptoms in the hospitals but took some participants a long time to be released • shows that diagnoses can be given even if no real symptoms are present Reliability and validity in diagnosis 4 • issue for validity of diagnosis because people were misdiagnosed because they were looking for symptoms - suggests that diagnosis criteria aren't accurate enough and are too subjective Symptom overlap • A lot of symptoms of sz overlap with symptoms of other mental illnesses • makes it hard to see sz as a unique condition • e.g anhedonia is also a symptom of depression • makes it hard to identify which condition a person has and makes misdiagnosis more likely more likely to have inconsistent diagnoses because symptom overlap leads to more subjectivity • problem for validity - hard to see sz as it's own condition ● ● Culture bias Copeland et al - 69% US diagnosis and 2% UK diagnosis for sz for the same case studies o didn't use the same classification system (link to classification problems) o large inconsistencies in diagnosis between countrues o suggests that an individual could get a different diagnosis depending on where they live • Pinto et al - higher rates of sz in British black Caribbeans have been linked with a number of social/ psychological factors including bias o British psychiatrists classified 65% of black Caribbean patients having sz but Jamaican psychiatrists classified 55% of black Caribbean patients as having SZ Reliability and validity in diagnosis 5 o African-Caribbean countries do not have higher diagnosis rates of sz - shows that Black Caribbean people are discriminated against in the UK and shows that Black Caribbean people are not genetically more likely to have sz o People with a black Caribbean background are around 9 times more likely to be diagnosed with sz ▪ people from different cultures may misinterpret 'symptoms' in people from other cultures because of a lack of understanding problem for reliability of diagnosis because people could get a different diagnosis depending on which country they get their diagnosis in which shows a lack of consistency within diagnoses. Reliability and validity in diagnosis 6