Reliability of psychiatric diagnosis in postmortem research.
BACKGROUND
Postmortem human brain research is an important approach for identifying the cellular, molecular, and genetic pathways involved in the pathophysiology of psychiatric disorders. One critical component in postmortem research is the reliability of psychiatric diagnoses used to define study cohorts. Finding reliable methods for assessing lifetime psychiatric diagnoses in subjects after death is extremely challenging.


METHODS
Two commonly used approaches were compared: psychiatric record reviews and postmortem family interviews. We hypothesized that these two methods would lead to more diagnostic agreement for subjects with schizophrenia than those with mood disorders. For 37 cases, psychiatric records were reviewed retrospectively using the Diagnostic Evaluation After Death, and family members were interviewed using the Structured Clinical Interview for DSM-IV.


RESULTS
Comparison of diagnoses derived from these two approaches generated an overall kappa coefficient of .67. Kappa coefficients for the schizophrenia cohort were .94, .68 for the major depressive disorder cohort, and .58 for the bipolar disorder cohort.


CONCLUSIONS
Thus, although it may be sufficient to establish the postmortem diagnosis of schizophrenia using one of the two methods, the best method for reaching an accurate postmortem diagnosis for mood disorders is more difficult to determine and requires further study.
Deep-Soboslay
Amy
A
Section on Neuropathology, Clinical Brain Disorders Branch, National Institute of Mental Health/NIH, 10 Center Drive, Bethesda, MD 20892, USA.
Akil
Mayada
M
Martin
Catherine E
CE
Bigelow
Llewelyn B
LB
Herman
Mary M
MM
Hyde
Thomas M
TM
Kleinman
Joel E
JE
D000328:Adult; D001344:Autopsy / Q000379:methods; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005260:Female; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000145:classification / Q000175:diagnosis*; D008875:Middle Aged; D011180:Postmortem Changes; D011569:Psychiatric Status Rating Scales; D015203:Reproducibility of Results