PubMed · 1242836
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1975. Schizophrenia: a multinational study. Design.. https://pubmed.ncbi.nlm.nih.gov/1242836/
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OBJECTIVE: Diagnosis-specific, proven efficacious treatments are a major recent advance in psychiatry. Appropriate use of such treatments presupposes patients who meet the diagnostic criteria and clinicians who have accurately diagnosed the target disorder and comorbid conditions. Since little is known about whether these prerequisites are commonly met, the authors conducted a study at two community treatment sites to determine the frequency of various axis I diagnoses and the concordance between the diagnoses recorded in patient charts and those obtained by a structured interview. Given that a DSM diagnosis may not be sufficient to understand a patient's problems, the authors also obtained ratings of interpersonal functioning. METHOD: The subjects were 164 nonpsychotic patients who were seen at a rural (N=114) or urban (N=50) community treatment facility. Raters trained to reliably use the Structured Clinical Interview for DSM-IV (SCID) conducted diagnostic interviews. Clinical charts were reviewed to obtain clinical diagnoses. Patients completed questionnaires regarding interpersonal functioning. RESULTS: Most (N=145, 88%) of the patients met the SCID criteria for a current axis I diagnosis, and 53% (N=87) met the criteria for two or more disorders. Clinical and SCID diagnoses had poor agreement. Evidence was found for interpersonal dysfunction. CONCLUSIONS: Most patients met the diagnostic criteria for conditions for which there are proven treatments; however, inaccurate diagnosis proved common. This barrier to optimal treatment could be ameliorated with the use of structured interviews for common diagnoses. Scores on social/interpersonal measures support the premise that DSM symptoms provide only part of the relevant information about patients' conditions.
Long lasting, low intensity depressive episodes have been diversely integrated according to the classifications types or the psychodynamic points of view. The concept of anxious persistent lasting depression, neurotic depressive states, neurotic depression ... have been unified into the dysthymic disorder category of the DSM classification. This concept unification have been a topic of dispute considering that dysthymic disorder was a restrictive, heterogeneous an extensively comorbid diagnosis. Nevertheless the definition of this category offers the opportunity to place the notions of temperament, personality, adjustment disorder. Including dysthymic disorders as a category inside of the mood disorders classification suggests the interest of using an antidepressive medication in presence of chronic depressive states not included in the major depressive disorder category.
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