Confirmation of the diagnosis of schizophrenia after death using DSM-IV: a Victorian experience.
OBJECTIVE
This study examines the reliability of antemortem diagnoses of schizophrenia using DSM-IV criteria.


METHODS
The case histories of 83 subjects with a provisional diagnosis of schizophrenia at autopsy were retrospectively reviewed using a semi-structured chart review and application of DSM-IV criteria. Agreement between antemortem and postmortem diagnoses of schizophrenia was examined, as well as the concordance between DSM-IV diagnoses and previously obtained diagnoses using DSM-III-R and ICD-10 criteria for schizophrenia.


RESULTS
According to DSM-IV, 30.1% of cases did not have schizophrenia, compared to 36.1% using DSM-III-R criteria and 51.8% of cases using ICD-10 criteria. Concordance between DSM-IV and DSM-III-R diagnoses of schizophrenia was excellent (kappa = 0.81), but only fair between DSM-IV and ICD-10 (kappa = 0.57). Of the cases that did not meet the formal criteria for schizophrenia, the majority were reassigned diagnoses of schizoaffective disorder and affective disorder.


CONCLUSIONS
The use of human brain tissue in postmortem studies of schizophrenia must be linked to standardised diagnostic assessment procedures. Diagnoses can be upgraded with the development of new criteria, providing sufficient clinical data is available in case histories.
Roberts
S B
SB
Mental Health Research Institute of Victoria, Melbourne, Australia.
Hill
C A
CA
Dean
B
B
Keks
N A
NA
Opeskin
K
K
Copolov
D L
DL
D000328:Adult; D001344:Autopsy / Q000331:legislation & jurisprudence; D001921:Brain / Q000473:pathology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D011569:Psychiatric Status Rating Scales / Q000706:statistics & numerical data*; D011594:Psychometrics; D015203:Reproducibility of Results; D012559:Schizophrenia / Q000145:classification / Q000175:diagnosis* / Q000473:pathology; D012565:Schizophrenic Psychology; D013405:Suicide / Q000331:legislation & jurisprudence* / Q000523:psychology