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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
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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 

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