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Am J Psychiatry 1994; 151:1423-1429
Copyright © 1994 by American Psychiatric Association
Comparison of facility and research diagnoses in first-admission psychotic patients
S Fennig, TJ Craig, M Tanenberg-Karant and EJ Bromet
Department of Psychiatry, State University of New York at Stony Brook 11794-8790.
OBJECTIVE: The present study investigated the concordance of clinical and
research-based DSM-III-R diagnoses in community, public, and university
hospital first-admission patients. In addition to demographic
characteristics, information and criterion variance were assessed as
explanations for the diagnostic disagreements. METHOD: As part of the
Suffolk County (New York) Mental Health Project, 223 first- admission
subjects with a psychotic disorder were interviewed with the Structured
Clinical Interview for DSM-III-R, and consensus diagnosis was made by two
project psychiatrists. Clinical diagnoses were abstracted from discharge
summaries obtained subsequent to the research diagnoses, and reasons for
disagreement between the two diagnoses were determined. RESULTS: Moderate
overall agreement between facility and research diagnoses was found, with
highest agreement with the university facility, lowest with the public
facilities, and intermediate agreement with the community facilities.
Demographic variables were not significantly associated with diagnostic
discordance. Apparent reasons for diagnostic disagreement included evidence
of variability in information available to clinicians and research
psychiatrists (N = 39 or 48% of cases with disagreement), as well as in
clinical judgment in the application of DSM-III-R criteria (N = 42 or 52%
of cases with disagreement). CONCLUSIONS: Considerable differences between
facility and research diagnoses remain, especially in the public and
community sectors; these differences can be attributed to information and
criterion variance. Longitudinal follow- up is necessary to establish the
predictive validity of the initial clinical and research diagnoses. Future
research should also address other possible reasons for these
discrepancies.
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