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The purpose of this survey was to describe the impact of the diagnosis of schizophrenia on the lives of people who receive the diagnosis.
The purpose of this survey was to describe the impact of the diagnosis of schizophrenia on the lives of people who receive the diagnosis.
The authors designed a questionnaire to investigate attitudes to and experiences of the diagnosis of schizophrenia. After a pilot study, they made the questionnaire available online and, through a network of service user and other organisations, solicited responses.
Of the 470 responses, 27.4 per cent were from service users. Content analysis of their responses revealed three main categories: concern with the consequences of the diagnosis and its negative impact on their lives, the life contexts of individuals before receiving the diagnosis, and concerns with medication and treatment. This paper deals with the first two.
It is impossible to generalise the results of this survey because respondents self‐selected, and thus might be expected to have strong feelings against (or for) the diagnosis of schizophrenia.
The diagnosis of schizophrenia in this sample had devastating negative implications. It was experienced as harmful and stigmatising. Very few people understood their experiences as a biomedical disorder.
A gulf exists between the experiences of people diagnosed with schizophrenia and the concerns of academics and others currently involved in debates about the merits of different systems of diagnosis.
This survey is valuable because it draws attention to experiences of diagnosis that are easily lost in the storm of academic controversies about diagnosis in psychiatry.
This paper aims to provide an overview of the policy guidance and will begin with an introduction and overview of policy development during this period; then focus on the…
This paper aims to provide an overview of the policy guidance and will begin with an introduction and overview of policy development during this period; then focus on the more specific guidance in four broad areas: dual diagnosis specific guidance, risk, training, and service specific ‐ guidance. Assessment and treatment are cross‐cutting themes and key messages in relation to these areas will also be highlighted. Having outlined the policy guidance, consideration will be given to how effective it has been in changing service delivery and suggestions made as to what might be required to ensure more consistent implementation.
The purpose of this paper is to highlight the difficulties in identifying adults with autism spectrum disorder (ASD) and to illustrate the consequences of late diagnoses…
The purpose of this paper is to highlight the difficulties in identifying adults with autism spectrum disorder (ASD) and to illustrate the consequences of late diagnoses in forensic settings.
This paper presents an overview of the literature relevant to the topic and presents the details of three clinical cases.
Delayed diagnosis is not uncommon in forensic services. Cases may remain unidentified for considerable periods despite being under evaluation from clinical teams. Diagnosis in forensic settings is challenged by case complexity. Barriers to prompt diagnosis include time, resources and clinical competency. Timely diagnosis may lessen the risk of future offences, improves clinical risk management and can bring direct benefits to those with the condition.
This is the first case series which explores the issue of late diagnosis in forensic settings. The illustration of the extent to which a diagnosis can be missed may prompt clinicians to review and identify missed cases. The discussion of the issue may also support services to review their approach to screening and diagnosis of ASD.
The Diagnostic Criteria for Psychiatric Disorders for Use with Adults with Learning Disabilities/Mental Retardation (DC‐LD) was introduced in 2003 in an attempt to improve…
The Diagnostic Criteria for Psychiatric Disorders for Use with Adults with Learning Disabilities/Mental Retardation (DC‐LD) was introduced in 2003 in an attempt to improve accuracy of diagnosis in the intellectual disability population. The paper aims to apply this system to a sample of a population with intellectual disability to further investigate its usefulness in the clinical setting.
A sample of 50 patients within an intellectual disability service was identified. Each individual was interviewed by a registrar in psychiatry of intellectual disability in the presence of their key worker or a carer that knew the individual well. Chart notes were extensively reviewed for clearly documented history of psychiatric symptoms and behavioural difficulties. The information gathered was applied as per the DC‐LD criteria to identify appropriate diagnoses. Previously documented diagnoses were also recorded for comparison purposes.
There was considerable discrepancy between the rates of psychiatric diagnoses after application of DC‐LD and rates of previously documented diagnoses within the sample. Use of DC‐LD led to the reclassification of many previously documented diagnoses, mainly as behavioural disorders. There were also discrepancies between rates of diagnosis of pervasive developmental disorders and Alzheimer's disease before and after use of DC‐LD.
This study adds to the evidence regarding the usefulness of DC‐LD in the intellectual disability population and also highlights the shortcomings of non‐systematic methods of diagnosis. It was agreed that DC‐LD criteria be applied to all service users in this population in the future.
Anecdotal feedback obtained from alcohol and drug and mental health staff across the eastern metropolitan region of Melbourne, Australia suggests that attitudes towards…
Anecdotal feedback obtained from alcohol and drug and mental health staff across the eastern metropolitan region of Melbourne, Australia suggests that attitudes towards working with people experiencing a dual diagnosis are becoming more positive. The purpose of this paper is to understand if dual diagnosis-specific training delivered to staff within mental health and alcohol and other drug services was a factor positively influencing attitudes.
No formal evaluation assessing the impact of dual diagnosis-specific training on staff attitudes had previously occurred within this region of Australia. Access to staff on two occasions from three distinct sectors provided an opportunity to examine if and, to what degree, attitudes can be influenced by dual diagnosis-specific training. Using a co-designed attitudes survey, information was gathered from mental health and alcohol and drug staff on their attitudes to working with people with co-occurring mental health and substance use problems.
Two surveys were conducted involving 186 staff in 2012 and 110 staff in 2016. The dual diagnosis attitudes survey showed that positive attitudes to working with people experiencing a dual diagnosis were associated with recency of training. While attitudes may be improved by dual diagnosis training, these findings cannot exclude the impact of other dual diagnosis capacity building activities.
This study highlights the benefits of a regional partnership between mental health and alcohol and drug services and people with lived experience of dual diagnosis and the benefit of recent co-designed dual diagnosis training on longitudinally assessed worker attitudes.
Purpose – The purpose of this chapter is to theorize the relationship between diagnosis and medicalization through an examination of the medicalization of childhood gender variance and the Gender Identity Disorder of Childhood diagnosis.
Methodology/approach – The chapter examines textual data (published clinical and research literatures, and critiques of the diagnosis appearing in a range of venues) to track how childhood gender variance is medicalized over time and the role of diagnosis in that medicalization.
Findings – While diagnosis certainly plays a role in shoring up medicalization, this case study reveals the many ways in which diagnoses may also become key tools in attempts to curtail medicalization.
Research limitations/implications – As a case study, the findings are not generalizable to all diagnoses. As a study of an instance of the medicalization of deviance, these findings may be particularly applicable to analogous cases.
Social implications – These findings show the sometimes tenuous nature of medicalization processes, and the social uses of diagnoses in those processes.
Originality/value of paper – This chapter sheds light on a relationship that is often assumed to be unidirectional (e.g., that the formation of diagnosis results in increased medicalization), and answers calls for a more nuanced sociology of diagnosis, including greater attention to the relationship between diagnosis and medicalization.
Purpose – To examine debates within the transgender rights movement over the GID diagnosis in order to demonstrate how diagnosis can be resisted as a source of stigma and…
Purpose – To examine debates within the transgender rights movement over the GID diagnosis in order to demonstrate how diagnosis can be resisted as a source of stigma and social control at the same time that it is embraced as a means of legitimating experience and gaining access to resources, including medical services.
Methodology/approach – This chapter draws on qualitative data from: in-depth interviews with transgender rights activists and advocates, participant observation in transgender health care and activism settings, and content analysis of print and web-based materials on transgender health.
Findings – Transgender rights activists and advocates overwhelmingly reject the pathologization of gender variance. However, some actors advocate complete demedicalization, while others advocate diagnostic reform. Actors' advocacy for each position is influenced by the perceived costs versus benefits of diagnosis.
Social implications – The findings of this research shed light on the multiple and often contradictory effects of diagnosis. Diagnoses can both normalize and stigmatize. They can function to allow or deny access to medical services and they can support or act as barriers to legal rights and protections. Understanding these contradictory effects is essential to understanding contests over diagnosis, including the contemporary debate over GID.
Originality/value of paper – Through examination of an intra-constituent contest over diagnosis, this research demonstrates the need to distinguish medicalization from pathologization and illustrates the importance of examining the multiple and contradictory effects of diagnosis, both in and outside of medical settings.
An adverse health event can affect women’s work capacity as they need time to recover. The institutional framework in the Netherlands provides employment protection during…
An adverse health event can affect women’s work capacity as they need time to recover. The institutional framework in the Netherlands provides employment protection during the first two years after the diagnosis. In this study, we have assessed the extent to which women’s employment is affected in the short- and long term by an adverse health event. We have used administrative Dutch data which follow women aged 25 to 55 years for four years after a medical diagnosis. We found that diagnosed women start leaving employment during the protection period and four years later they were about one percentage point less likely to be employed. Women in permanent employment did not reduce their employment during the protection period and reduced their employment with less than 0.5 percentage points thereafter. Furthermore, we found minor adjustments in the working hours in the short term and no adjustments in the long term. Lastly, we found that for wages, and not for employment and hours, adjustments could be related to the severity of the health condition: women diagnosed with temporary health conditions experienced a short-term wage penalty of about 0.5–1.7 percent and those diagnosed with chronic and incapacitating conditions experienced a long-term wage penalty of about 0.5 percent, while women diagnosed with some chronic and nonincapacitating conditions, such as respiratory conditions, experienced no wage changes in the short or long term.
Purpose – This chapter discusses the proposed changes in the Diagnostic and Statistical Manual of Mental Disorders (DSM-V), which eliminates Asperger's disorder (AD) and…
Purpose – This chapter discusses the proposed changes in the Diagnostic and Statistical Manual of Mental Disorders (DSM-V), which eliminates Asperger's disorder (AD) and replaces it as “autism spectrum disorder.” Implications of these changes on the identity of adults with AD and the influence of everyday life experiences will be addressed.
Methodology/approach – This research is based on 19 interviews with adults diagnosed or self-diagnosed with AD. Central themes surrounding issues of identity and everyday life experiences were determined using grounded theory approaches.
Findings – This study demonstrates how the diagnosis and self-diagnosis of AD is fused with individual identity. It also shows how Asperger identity is positively embraced. The proposed changes to eliminate AD in DSM-V threaten these assertions of Asperger identity, which could potentially enhance stigma experienced by people with AD. Regardless of its removal, Asperger identity must be considered within the broader context of people's everyday lives and how experiences in social interaction and communication can be strong agents of identity construction.
Social implications – The proposed changes to eliminate AD in DSM-V is a social issue that will impact individuals with Asperger's and their families, as well as health-care professionals, health insurers, researchers, state agencies, and educational providers.
Originality/value of paper – This chapter offers a unique insight into identity construction based on the diagnosis and self-diagnosis of AD.
I discuss the formal attention deficit hyperactivity disorder (ADHD) diagnosis process and whether the Black–White differences found in this process are the results of…
I discuss the formal attention deficit hyperactivity disorder (ADHD) diagnosis process and whether the Black–White differences found in this process are the results of unmet needs or conscious decisions.
First, I offer a new analytic framework for understanding the “ADHD process.” The proposed framework breaks ADHD diagnoses down into three stages: the informal diagnosis, the formal diagnosis, and treatment. This approach reveals certain racial trends in the ADHD literature. Second, I use the 2007 National Health Interview Survey (total n = 75,764) to address racial differences.
I find that blacks are less likely to hold a formal ADHD diagnosis than whites. Third, nested logistic models reveal that this racial difference is not explained by health insurance status, family income, or family educational level. New explanatory models for the black–white difference in ADHD should stray from a strict reliance on the “unmet need” discourse, and instead focus on other factors that may affect the decision-making process in diverse families.
This chapter makes three contributions to the wider literature on ADHD and race.