Non-standard diagnostic assessment reliability in psychiatry: a study in a Brazilian outpatient setting using Kappa

Rocha Neto, Helio G.; Lessa, José Luiz Martins; Koiller, Luisa Mendez; Pereira, Amanda Machado; de Souza Gomes, Bianca Marques; Veloso Filho, Carlos Linhares; Telleria, Carlos Henrique Casado; Cavalcanti, Maria T.; Telles-Correia, Diogo

doi:10.1007/s00406-023-01730-7

Cited by 1 publication

(2 citation statements)

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“…However, it is not customary in daily practice to verify the presence or absence of diagnostic operational criteria, but rather to assign the code based on the identified prototype. IPUB’s outpatient functioning, Brazilian specialist training, and how prototypes are developed by residents were explained elsewhere ( 16 , 18 )⁠.…”

Section: Methodsmentioning

confidence: 99%

“…However, SDIs are not practiced in clinical scenarios ( 14 )⁠, and operational criteria are neither observed as part of clinical practice ( 3 , 15 , 16 )⁠ nor described as how to be applied in the diagnostic process. Clinicians do not usually identify the disorder constructs described in operational criteria manuals, but rather disorder prototypes, which are nearer to clinicians’ reasoning ( 7 , 17 )⁠ and can be reasonably reliable between different clinicians ( 18 ).…”

Section: Introductionmentioning

confidence: 99%

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Operational criteria application does not change clinicians’ opinion on the diagnosis of mental disorder: a pre- and post-intervention validity study

Rocha Neto,

Lessa,

Koiller

et al. 2024

Front. Psychiatry

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ObjectiveOur objective was to check if the ICD-10 operational criteria application changes non-operational, prototype-based diagnoses obtained in a real-life scenario.MethodsPsychiatry residents applied the diagnostic criteria of the ICD-10 as a “diagnostic test” to five outpatient patients they were already following who had a prototype-based diagnosis. Tests were used to ascertain whether changes in opinion were significant and if any of the diagnostic groups were more prone to change than others. The present paper is part of the study with UTN U1111-1260-1212.ResultsSeventeen residents reviewed their last five case files, retrieving 85 diagnostic pairs of non-operational-based vs. operational-based diagnoses. The Stuart–Maxwell test did not indicate a significant opinion change (χ2 = 5.25, p = 0.39; power = 0.94) besides 30% of diagnostic changes. Despite not being statistically significant, 20.2% of all evaluations resulted in a change that would affect treatment choices. Using ICD-10 operational criteria slightly increased the number of observed diagnoses, but probably without clinical relevance. None of the non-operational diagnoses have a higher tendency to change with operational criteria application (χ2 = 11.6, p = 0.07). The female gender was associated with a higher diagnostic change tendency.ConclusionApplying ICD-10 operational criteria as a diagnostic test does not induce a statistically significant diagnostic opinion change in residents and no diagnostic group seems more sensible to diagnostic change. Gender-related differences in diagnostic opinion changes might be evidence of sunk cost bias. Although not statistically significant, using operational criteria after diagnostic elaboration might help to deal with subjects without adequate treatment response.

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Section: Methodsmentioning

confidence: 99%