Testing the Comparability of Psychiatric Diagnoses in ICD-10 and DSM-III-R

Abstract

The compatibility of the classification systems ICD-10 and DSM-III-R was investigated in a sample of 100 psychiatric inpatients with severe affective and psychotic disorders. Four independent raters assessed diagnoses by means of checklists from psychopathological descriptions of case records. Congruence between ICD-10 and DSM-III-R was good for depressive disorders with agreement rates above 80% and fair for bipolar disorders with rates above 60%. Less consistent findings were obtained for schizophrenia with rates of 57.5% for ICD-10 diagnoses and 82.6% for DSM-III-R diagnoses. Agreement for schizoaffective disorder was below 40% and thus insufficient. The results indicate that even small differences in the definitions of mental disorders may result in considerable inconsistencies.

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

“…Three studies reported interrater reliability values within the range of the present study [17,23,24] . However, other studies found considerably higher values [2,13,15,21,[25][26][27][28][29][30] .…”

“…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.…”

“…Since ICD-10 diagnostic criteria for schizophrenia do not exclude an occurrence of affective symptoms, the differential diagnosis between schizophrenia and schizoaffective disorder is perhaps more difficult in ICD-10, which would favor a larger disagreement between interviewers. In one study [17] , the diagnosis of schizoaffective disorder was associated with a low interrater reliability in both DSM-III-R and ICD-10. The results of another study [2] were contradictory in relation to ours: a high kappa value in ICD-10, and a low one in DSM-III-R. Other studies found a high [28] and a reasonable [24] interrater reliability in DSM-IV.…”

“…Indeed, ICD-10 seems to favor the diagnosis of schizophrenia over the diagnoses of schizoaffective and mood disorders. Two studies found that schizoaffective disorder diagnosis was more frequent in ICD-10 than in DSM-IV or DSM-III-R [11,17] . Nevertheless, other studies did not detect any frequency difference between the two classificatory systems in schizoaffective disorder [2] , bipolar disorder [2,17] and unipolar depression [2,17] .…”

Prescribing of Antipsychotic Medication in a Medicaid Population: Use of Polytherapy and Off-Label Dosages

“…Furthermore, the reliability of using diagnosis codes from medical claims to identify schizophrenia and related disorders may be questionable. 28,29 Though not specifically recommended in the product labeling or in current treatment guidelines for schizophrenia 30 or bipolar disorder, 31 the use of polytherapy with multiple atypical antipsychotic medications has been identified as an increasingly common practice. 15,17,32,33 Thus, we were not surprised to find that many patients were receiving multiple antipsychotic medications concomitantly.…”