Diagnostic Agreement of Schizophrenia Spectrum Disorders among Chronic Patients with Functional Psychoses

Jakobsen, Klaus D.; Frederiksen, J.N.; Parnas, Josef; Werge, Thomas

doi:10.1159/000095731

Cited by 27 publications

(23 citation statements)

References 22 publications

(14 reference statements)

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“…The higher frequency of diagnosis of schizophrenia according to ICD-10 than DSM-IV or DSM-III-R has also been reported in two additional studies [17,18] , although other studies failed to detect this difference [2,13,[19][20][21] . Indeed, ICD-10 criteria for schizophrenia seem to be less restrictive.…”

Section: Discussionmentioning

confidence: 60%

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The Diagnoses of Schizophrenia, Schizoaffective Disorder, Bipolar Disorder and Unipolar Depression: Interrater Reliability and Congruence between DSM-IV and ICD-10

2009

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Background: The present study investigated the interrater reliability of the diagnoses of schizophrenia (SCH), schizoaffective disorder (SAD), bipolar disorder (BPD) and unipolar depression (UPD) according to both DSM-IV and ICD-10, as well as the diagnostic congruence between the two classificatory systems. Sampling and Methods: Using the Composite International Diagnostic Interview, two trained psychiatrists simultaneously evaluated 100 inpatients and independently assessed the psychiatric diagnoses. The Cohen’s kappa coefficient was employed to estimate interrater reliability and diagnostic congruence between DSM-IV and ICD-10. Results: SCH was more frequent according to ICD-10 than DSM-IV criteria. Considering both diagnostic systems, all the four nosological categories, but ICD-10 SAD and DSM-IV UPD, were associated with interrater reliability coefficients above 0.50. The coefficient of the diagnostic congruence between DSM-IV and ICD-10 was inferior to 0.50 only for SAD. BPD was associated with the highest degrees of both interrater reliability and diagnostic congruence. Conclusions: The lack of an item excluding the occurrence of an affective syndrome among ICD-10 diagnostic criteria for SCH can account for: the larger frequency of SCH according to ICD-10 than DSM-IV; the unsatisfactory interrater reliability for the diagnosis of ICD-10 SAD, and the low diagnostic congruence for SAD.

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Section: Discussionmentioning

confidence: 60%

“…Two other studies found a high congruence, with kappa values of 0.86 and 0.87 [20,34] . However, it should be noted that the sample of one of these studies [20] was composed by chronic patients.…”

Section: Discussionmentioning

confidence: 83%

The Diagnoses of Schizophrenia, Schizoaffective Disorder, Bipolar Disorder and Unipolar Depression: Interrater Reliability and Congruence between DSM-IV and ICD-10

2009

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“…SDs were assessed with the EASE scale, conducted by one of us (Julie Nordgaard), an experienced psychiatrist with psychometric research experience [45,46] and trained to expert level in the use and teaching of the EASE scale. For the purpose of the analysis, we looked only for the presence or absence (not severity or duration) of the EASE items (i.e.…”

Section: Methodsmentioning

confidence: 99%

Self-Disorders, Neurocognition and Rationality in Schizophrenia: A Preliminary Study

Nordgaard

Revsbech²,

Henriksen³

2015

Psychopathology

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Background/Aims: Although the very idea that the generative disorder in schizophrenia is a disturbance of the self is as old as the schizophrenia concept itself, empirical studies have only recently emerged, documenting that anomalous self-experiences (i.e. self-disorders, SDs) aggregate in schizophrenia spectrum disorders but not in other mental disorders. The aim of this study is to explore potential associations between SDs, neurocognitive performance, rationality and IQ in patients with schizophrenia. Methods: The sample comprises 31 patients diagnosed with schizophrenia (DSM-IV). All patients underwent comprehensive evaluation. SDs were assessed with the Examination of Anomalous Self-Experience scale. Neurocognitive performance was measured with 4 PC-implemented subtests from the Cambridge Neuropsychological Test Automated Battery. Rationality was measured using syllogism tests. The IQ was indexed by a summary score of 4 IST-2000-R computerized subtests. Results: No correlation was found between SDs and neurocognitive performance or between SDs and IQ. SDs were found to correlate with rationality. Neurocognitive performance correlated with rationality, and both correlated with IQ, respectively. Conclusions: The lack of correlation between SDs and neurocognitive performance is consistent with the results from the only previous study exploring this issue, suggesting that SDs depict something essential to schizophrenia, whereas neurocognitive impairment does not. The correlation between SDs and rationality indicates that the syllogism tests reflect something central for schizophrenia, but the result needs further corroboration from larger, empirical studies.

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“…The issue of validity has been the object of a number of studies [12,13], and has also been questioned by many scholars, who lamented the marginalization of the knowledge of classical psychopathology and the decline in psychiatrists' expertise and capacity for individualized, person-centred assessment and treatment [14,15,16]. Indeed, vast domains of human experience have been deleted from the official nosography, resulting in a lack of a comprehensive account of human subjectivity [17].…”

Section: Introductionmentioning

confidence: 99%

Association between Clinician's Subjective Experience during Patient Evaluation and Psychiatric Diagnosis

Pallagrosi

Fonzi²,

Picardi³

et al. 2016

Psychopathology

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Background: Classical psychopathology greatly valued the interaction between clinician and patient, and assigned to the clinician's subjective experience a significant role in the diagnostic process. Psychoanalysis, too, ascribed a privileged position to the clinician's feelings and empathic participation in the assessment and deep understanding of the patient. This study aimed at testing the traditional, though still relatively unexplored empirically, tenet that particular diagnostic groups elicit distinct and diagnostically useful reactions from clinicians. Sampling and Methods: The study was performed in several psychiatric inpatient and outpatient units in Rome, Italy. The clinicians completed the Assessment of Clinician's Subjective Experience (ACSE) questionnaire and other standardized assessment instruments when they evaluated a previously unknown patient. All adult patients diagnosed with schizophrenia (n = 119), cluster B personality disorder (n = 114), manic or mixed bipolar I episode (n = 59), and unipolar depression or anxiety disorder (n = 130) were included in the study, for a total of 422 patients evaluated by 35 clinicians. Results: We found a significant and theoretically consistent relationship between the clinicians' pattern of subjective experience during the first visit and patients' clinical diagnoses. Patients with unipolar depression/anxiety showed significantly lower scores than the other groups on all ACSE scales except engagement; patients with schizophrenia displayed significantly higher scores than the other groups on difficulty in attunement, and significantly higher scores than patients with cluster B personality disorder on impotence. Compared with the other groups, the patients with cluster B personality disorder displayed significantly lower scores on engagement, and significantly higher scores on disconfirmation. In multivariate models controlling for patient's age and education, symptom severity, clinician's sex, duration of visit and setting, diagnosis remained a significant predictor of scores on all ACSE scales except for impotence. Conclusions: The main limitations of the study are its reliance on clinical diagnoses and the non-independence of assessments. Further studies based on diagnoses made by a third observer through standardized instruments are needed to provide a most stringent test of the hypothesis that different diagnoses are associated with distinct profiles of clinicians' subjective experience. This study provided intriguing, though preliminary, evidence that the clinician's subjective experience may play a useful role in the diagnostic process. Time may have come to reintroduce the concept of intersubjectivity at the core of the diagnostic process.

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Diagnostic Agreement of Schizophrenia Spectrum Disorders among Chronic Patients with Functional Psychoses

Cited by 27 publications

References 22 publications

The Diagnoses of Schizophrenia, Schizoaffective Disorder, Bipolar Disorder and Unipolar Depression: Interrater Reliability and Congruence between DSM-IV and ICD-10

The Diagnoses of Schizophrenia, Schizoaffective Disorder, Bipolar Disorder and Unipolar Depression: Interrater Reliability and Congruence between DSM-IV and ICD-10

Self-Disorders, Neurocognition and Rationality in Schizophrenia: A Preliminary Study

Association between Clinician's Subjective Experience during Patient Evaluation and Psychiatric Diagnosis

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