Reliability of the draft diagnostic criteria for research of ICD-10 in comparison with ICD-10 and DSM-III-R

Variability in clinical diagnoses during the ICD-8 and ICD-10 era

AIMS

To explore whether the diagnostic homogeneity in a daily, routine clinical activity changed visibly over two historical periods (the ICD-8 and the ICD-10 era) across and within five psychiatric in-patient clinics.

METHODS

In this register study, we analyzed the discharge diagnoses from five university-affiliated departments of psychiatry in Denmark in two time periods: 1980-1985 (ICD-8) and 2001-2010 (ICD-10).

RESULTS

The synchronic inter-departmental diagnostic differences did not decrease in the ICD-10 era compared with ICD-8 era. Nor did the diachronic stability within each department become more homogeneous.

CONCLUSION

The diagnostic variability reflected by the diagnostic differences between the departments and by the diagnostic homogeneity within each department remained similar in the two historical periods with no evidence of an increased homogeneity of diagnostic habits after the introduction of the ICD-10.

LIMITATIONS

There is a myriad of variables that affects the diagnostic variability over time that we were not able to control.

A critique of the Diagnostic Criteria for Psychiatric Disorders for Use with Adults with Learning Disabilities/Mental Retardation (DC-LD) chapter on non-affective psychotic disorders

BACKGROUND

There has been a longstanding interest in the study of psychotic disorders in adults with intellectual disability. The DC-LD chapter for non-affective psychotic disorders provides operationalised criteria for use with this population.

METHODS

A detailed, structured review of the literature was carried out. Relevant papers were reviewed to provide a framework for a critique of the DC-LD criteria.

RESULTS

Most of the research literature focuses on psychotic disorders in adults with mild intellectural disability and suggests that this group experience clinical symptoms similar to those experienced by adults with average abilities. Although the DC-LD criteria for non-affective psychotic disorders are derived from the ICD-10 equivalent categories they are broader than other classification systems, which may affect their reliability, validity and utility.

CONCLUSIONS

At this stage, it is important that the DC-LD criteria are used alongside established systems to gather information about their use for clinical and research purposes.

A comparison of DSM-III-R, DSM-IV and ICD-10 substance use disorders diagnoses in 1922 men and women subjects in the COGA study. Collaborative Study on the Genetics of Alcoholism

A research interview was used to evaluate the relationships between DSM-IV, DSM-III-R and ICD-10 diagnostic criteria for substance use disorders. The sample of 1992 subjects, including both men and women, was composed of subjects and their relatives from the Collaborative Study on the Genetics of Alcoholism (COGA) study. With regard to diagnoses of substance dependence, the analyses revealed tha the proportions of individuals diagnosed in the three systems were similar, with the highest numbers observed for DSM-III-R, the lowest for ICD-10 and the figures for DSM-IV between the two. The kappas for dependence diagnoses ranged from 0.54 to 0.83, with the majority at 0.7 and higher, indicating that the same subjects were being given the same labels in the three systems. However, the criteria for abuse or harmful use resulted in rather disparate proportions labeled across the three systems, with kappas that rarely exceeded 0.10.

Comparative study of diagnostic systems: Chinese Classification of Mental Disorders-Second Edition versus DSM-III-R

We report on the diagnostic comparative study of the Chinese Classification of Mental Disorders-Second Edition (CCMD-2) and the DSM-III-R in a field trial in China. The Adult Diagnostic Interview Schedule-Second Edition (ADIS-2), a modified diagnostic interview schedule that can generate both CCMD-2 and DSM-III-R diagnoses, was used to test 254 psychiatric patients in China. It was found that the reliability and validity of the CCMD-2 and DSM-III-R are compatible in most diagnostic categories such as schizophrenia, delusional disorder, bipolar disorders, and depressive disorders. The discrepancies between Chinese and American diagnostic systems were found mainly in neurasthenia and hysterical neuroses. Such discrepancies may have resulted from frequent changes of the diagnostic terms in the West, such as the phenomenon of neurasthenia, or from creating a new disorder entity in CCMD-2, such as "Eastern gymnastic exercises-induced mental disorder. "Further cross-cultural studies focusing on these discrepant disorders are urgently needed to understand the cultural influences on diagnosis, as well as to improve the professional classification of mental disorders in different diagnostic systems.

Neopterin measurement provides evidence of altered cell-mediated immunity in patients with depression, but not with schizophrenia

Neopterin is a validated marker of the activation of cell-mediated immunity in a variety of disease states. We measured neopterin and creatinine concentrations in the plasma and urine of 22 schizophrenic and 26 depressed patients admitted acutely to hospital, and compared results with those in a large group of normal controls. Neopterin/creatinine ratios were normal in the schizophrenic patients, but significantly elevated in the plasma of depressed patients. In each diagnostic group, the use of psychotropic drugs before admission had no effect on the neopterin ratios observed. Our findings indicate altered cell-mediated immunity in depression.