Comparison of clinical and best-estimate research DSM-IV diagnoses in a Finnish sample of first-admission psychosis and severe affective disorder.
The purpose of this study was to investigate diagnostic agreement between clinicians and a research group in a sample of first-admission psychosis and severe affective disorder patients. Clinical DSM-IV discharge diagnoses and best-estimate DSM-IV research diagnoses were compared in 116 first-episode patients in the city of Turku, Finland. The best-estimate research diagnoses were made at consensus meetings by integrating longitudinal data; patients' medical records; and findings of a clinical interview, the structured SCAN-interview, and symptom severity ratings. Overall diagnostic agreement was moderate, with a kappa value 0.51 (95% confidence interval (CI), 0.39- 0.63). Of the diagnostic groups, schizophrenic disorders had the lowest kappa value of 0.44 (95% CI, 0.26-0.63). Clinicians had a tendency to miss depressive symptoms in psychotic patients; to overdiagnose psychotic symptoms in depressive patients; and to fail to discover earlier hypomanic or depressive episodes in depressive patients. In conclusion, hospital diagnoses were not reliable in first-episode patients. Inappropriate diagnoses may compromise both treatment and epidemiologic findings based on discharge diagnoses.
Taiminen
T
T
Department of Psychiatry, University of Turku, Rakennus 9, III kerros, Kunnallissairaalantie 20, FI-20700 Turku, Finland.
Ranta
K
K
Karlsson
H
H
Lauerma
H
H
Leinonen
K M
KM
Wallenius
E
E
Kaljonen
A
A
Salokangas
R K
RK
D000293:Adolescent; D000328:Adult; D001714:Bipolar Disorder / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology; D005260:Female; D005387:Finland / Q000453:epidemiology; D006760:Hospitalization; D006778:Hospitals, Psychiatric; D006801:Humans; D008297:Male; D008875:Middle Aged; D019964:Mood Disorders / Q000175:diagnosis* / Q000453:epidemiology; D010343:Patient Admission / Q000706:statistics & numerical data*; D011237:Predictive Value of Tests; D011569:Psychiatric Status Rating Scales; D011618:Psychotic Disorders / Q000453:epidemiology / Q000209:etiology / Q000534:rehabilitation*; D012559:Schizophrenia / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology; D012720:Severity of Illness Index