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The significance of diagnostic criteria in psychiatric research

In modern clinical and research psychiatry, two classifications have been widely used. The International Classification of Diseases Tenth Edition (ICD 10) - Mental Disorders can be regarded mainly as a product of the European psychiatric school, based mostly upon the German psychiatric tradition. This classification relies upon the phenomenological approach described in general psychopathology, assuming that diagnosis will be done by highly specialized professionals. Diagnostic and Statistical Manual of Mental Disorders Fourth Edition (DSM IV), officially used in the USA, is designed to meet diagnostic as well as statistical needs, as indicated by its name. In order to achieve a high level of statistical reliability, symptoms are less frequently used as diagnostic criteria, thus enabling less specialized professionals to make a diagnosis. These differences in diagnostic approaches are likely to create different subsets of patients when creating groups for neurobiologic or other psychiatric research, depending on the classification used. The aim of the study was to compare the two classifications in making the diagnosis of Posttraumatic Stress Disorder (PTSD). The diagnosis of PTSD was made by general practitioners and patients referred to two independent research psychiatrists after giving their informed consent on taking part in the study. Each patient was re-diagnosed according to both ICD 10 and DSM-IV criteria by two research psychiatrists. The level of reliability between the two research psychiatrists was 90% for DSM-IV and 94% for ICD 10 criteria. A total of 138 patients were included in the study. In 96 of them, the diagnosis was confirmed according to DSM IV and in 107 according to ICD 10 criteria. 72 The study has shown that despite the high reliability between the researchers, there is a significant difference between PTSD diagnoses made according to the two recent classifications. These differences have to be taken into consideration when designing groups of patients for research purposes.

diagnostic criteria; psychiatric research

Indexed/Abstracted in: Neuroscience Citation Index ; EMBASE/Excerpta Medica