Hostname: page-component-586b7cd67f-vdxz6 Total loading time: 0 Render date: 2024-11-25T10:05:49.199Z Has data issue: false hasContentIssue false
  • English
  • Français

The predictive validity of a diagnosis of schizophrenia

A report from the International Study of Schizophrenia (ISoS) coordinated by the World Health Organization and the Department of Psychiatry, University of Nottingham

Published online by Cambridge University Press:  03 January 2018

Peter Mason ,
Glynn Harrison ,
Tim Croudace ,
Cristine Glazebrook  and
Ian Medley
Peter Mason*
Affiliation:
Academic Department of Psychiatry, University of Nottingham; I. MEDLEY, MRCPsych, Mandala Centre, Nottingham, UK
Glynn Harrison
Affiliation:
Academic Department of Psychiatry, University of Nottingham; I. MEDLEY, MRCPsych, Mandala Centre, Nottingham, UK
Tim Croudace
Affiliation:
Academic Department of Psychiatry, University of Nottingham; I. MEDLEY, MRCPsych, Mandala Centre, Nottingham, UK
Cristine Glazebrook
Affiliation:
Academic Department of Psychiatry, University of Nottingham; I. MEDLEY, MRCPsych, Mandala Centre, Nottingham, UK
Ian Medley
Affiliation:
Academic Department of Psychiatry, University of Nottingham; I. MEDLEY, MRCPsych, Mandala Centre, Nottingham, UK
*
Dr P. Mason, Department of Psychiatry, Royal Liverpool University Hospital, Liverpool L69 3BX
Get access Rights & Permissions [Opens in a new window]

Abstract

Background

Outcome is important in the validation of psychiatric diagnosis, as most disorders lack clinicopathological correlates. We describe the predictive validity of four definitions of schizophrenia (DSM-III-R, ICD-10, ICD-9 and CATEGO S+), in a representative cohort of patients selected during their first episode of psychosis.

Method

Each definition of schizophrenia was applied to 99 patients. Their respective ability to predict 13-year outcome (Global Assessment of Functioning scales) was assessed.

Results

DSM-III-Rand ICD-10 diagnoses of schizophrenia have high predictive validity for long-term outcome, and both provide relatively stable diagnoses. ICD-9 is reasonably good at predicting disability, but not symptoms, and CATEGO S+ showed no predictive validity. Adding six-month duration criteria to ICD-10, ICD-9 and CATEGO S+ improved their predictive validity, and removing the six-month duration criterion from DSM-III-R commensurately reduced predictive validity.

Conclusions

Modern diagnostic systems (DSM-III-Rand ICD-10) have high predictive validity, and are superior to ICD-9. The six-month duration criterion of DSM-III-R schizophrenia accounts for its predictive validity and stability over 13 years, but restricts its use in first-episode studies. The one-month duration criterion of ICD-10 is less restrictive, without major compromises in predictive validity or stability.

Type
Papers
Information
The British Journal of Psychiatry , Volume 170 , Issue 4 , April 1997 , pp. 321 - 327
Copyright
Copyright © 1997 The Royal College of Psychiatrists 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

American Psychiatric Association (1980) Diagnostic and Statistical Manual of Mental Disorders (3rd edn) (DSM-III). Washington. DC: APA.Google Scholar
American Psychiatric Association (1987) Diagnostic and Statistical Manual of Mental Disorders (3rd edn. revised) (DSM-III-R). Washington, DC: APA Google Scholar
Astrachan, B. M., Harrow, M., Adler, EX., et al (1972) A checklist for the diagnosis of schizophrenia. British Journal of Psychiatry, 121, 529–539.Google Scholar
Bland, R. C. & Orn, H. (1979) Schizophrenia: diagnostic criteria and outcome. British Journal of Psychiatry, 134, 34–38.Google Scholar
Bleuler, E. (1950) Dementia Praecoxor the Group of Schizophrenias (trans, J. Zint). New York: International University Press Google Scholar
Endicott, J., Spitzer, R. L., Fleiss, J. L., et al (1976) The Global Assessment Scale. & procedure of measuring overall severity of psychiatric disturbance. Archives of General Psychiatry, 33, 766–771.CrossRefGoogle ScholarPubMed
American Psychiatric Association, Nee, J., Cohen, J., et al (1986) Diagnosis of schizophrenia: prediction of short-term outcome. Archives of General Psychiatry, 43, 13–19.Google Scholar
Feighner, J. P., Robins, E., Guze, S. B., et al (1972) Diagnostic criteria for use in psychiatric research. Archives of General Psychiatry, 26, 57–63.CrossRefGoogle ScholarPubMed
Fennig, S., Kovasznay, B., Rich, C., et al (1994) Six-month stability of psychiatric diagnoses in first-admission patients with psychosis. American Journal of Psychiatry, 151, 1200–1208.Google ScholarPubMed
Harrison, G., Mason, P., Glazebrook, C., et al (1994) Residence of incident cohort of psychotic patients after 13 years of follow-up. British Medical Journal, 308, 813–816.Google Scholar
Harrison, G., Mason, P., Glazebrook, C., Croudace, T., Mason, P., et al (1996) Predicting the long-term outcome of schizophrenia. Psychological Medicine, 26, 697–705.CrossRefGoogle ScholarPubMed
Hawk, A. B., Carpenter, W. T. & Strauss, J. S. (1975) Da-gnostic criteria and five-year outcome in schizophrenia. Archives of General Psychiatry, 32, 343–347.Google Scholar
Helzer, J. E., Brockington, I. F. & Kendell, R. E. (1981) Predictive validity of DSM-III and Feighner definitions of schizophrenia. & comparison with research diagnostic criteria and CATEGO. Archives of General Psychiatry, 38, 791–797.CrossRefGoogle ScholarPubMed
Helzer, J. E., Brockington, I. F. & Kendell, R. E., Kendell, R. E. & Brockington, I. F. (1983) Contributions of the six-month criterion to the predictive validity of the DSM-III definition of schizophrenia. Archives of General Psychiatry. 40, 1277–1280.CrossRefGoogle Scholar
Jablensky, A., Schwarz, R. & Tomov, T. (1980) WHO collaborative study on impairments and disabilities associated with schizophrenic disorders. Acta Psychiatrica Scandinavica 62, (suppl. 285). 152–163.CrossRefGoogle Scholar
Jablensky, A., Schwarz, R. & Tomov, T., Sartorius, N., Ernberg, E., et al (1992) Schizophrenia: manifestations, incidence and course in different cultures. A World Health Organisation Ten Country Study. Psychological Medicine, Monograph Supplement 20. Cambridge: Cambridge University Press Google Scholar
Kendall, R. E., Brockington, L F. & Leff, J. P. (1979) Prognostic implications of six alternative definitions of schizophrenia. Archives of General Psychiatry, 36, 25–31.Google Scholar
Kleist, K. (1960) Schizophrenic symptoms and cerebral pathology. Journal of Mental Science, 106, 246–253.CrossRefGoogle ScholarPubMed
Kraepelin, E. (1919) Dementia Praecox (trans. Barclay, R. M.). Edinburgh: E. S. Livingstone.Google Scholar
Langfeldt, G. (1969) Schizophrenia: diagnosis and prognosis. Behavioural Science, 14, 173–182.CrossRefGoogle ScholarPubMed
Leonhard, K. (1961) The cycloid psychoses. Journal of Mental Science, 107, 633–648.Google Scholar
McGlashan, T. H. (1984) Testing four diagnostic systems for schizophrenia. Archives of General Psychiatry, 41, 141–144.Google Scholar
Mason, P., Harrison, G., Glazebrook, C., et al (1995) Characteristics of outcome in schizophrenia at 13 years. British Journal of Psychiatry, 167, 596–603.CrossRefGoogle Scholar
Pope, H. G. & Lipinsld, J. F. (1978) Diagnosis in schizophrenia and manic depressive illness. & reassessment of the specificity of schizophrenic symptoms in the light of current research. Archives of General Psychiatry, 35, 811–828.CrossRefGoogle ScholarPubMed
Robins, E. & Guze, S. B. (1970) Establishment of diagnostic validity in psychiatric illness: its implications to schizophrenia. American Journal of Psychiatry, 126, 983–987.Google Scholar
Sartorius, N., Gulbinat, W., Harrison, G., et al (1996) Long term follow-up of schizophrenia in 16 countries. & description of the International Study of Schizophrenia conducted by the World Health Organization. Social Psychiatry and Psychiatric Epidemiology, 31, 249–258.Google Scholar
Schneider, K. (1959) Clinical Psychopathology (trans. Hamilton, M. W. & Anderson, E. W.). New York: Grune & Stratton.Google Scholar
Stephens, J. H., Ota, K. Y., Carpenter, W. T., et al (1980) Diagnostic criteria for schizophrenia: prognostic implications and diagnostic overlap. Psychiatry Research, 2, 1–12.Google Scholar
Stephens, J. H., Ota, K. Y., Carpenter, W. T., Astrup, C., Carpenter, W. T., et al (1982) A comparison of nine systems to diagnose schizophrenia. Psychiatry Research, 6, 127–143.Google Scholar
Tsuang, M. T., Woolson, R. F., Winokur, G., et al (1981) Stability of psychiatric diagnosis. Archives of General Psychiatry, 38, 535–539.Google Scholar
Wing, J. K., Cooper, J. E. & Sartorius, N. (1974) The Measurement and Classification of Psychiatric Symptoms. Cambridge: Cambridge University Press.Google Scholar
World Health Organization (1978a) Mental Disorders: Glossary and Guide to their Classification in Accordance with the Ninth Revision of the International Classification of Diseases. Geneva: WHO.Google Scholar
World Health Organization (1978b) Psychiatric and Personal History Schedule, Geneva: WHO Google Scholar
World Health Organization (1979) Schizophrenia: An International Follow-up Study. New York: John Wiley Google Scholar
World Health Organization (1992a) The ICD-10 Classification of Mental and Behavioural Disorders. Geneva: WHO.Google Scholar
World Health Organization (1992b) Broad Rating Schedule. Geneva: WHO.Google Scholar
World Health Organization (1992c) Life Chart Schedule. Geneva: WHO Google Scholar
Submit a response

eLetters

No eLetters have been published for this article.