A Re-analysis of the Reliability of Psychiatric Diagnosis

  title={A Re-analysis of the Reliability of Psychiatric Diagnosis},
  author={Robert L. Spitzer and Joseph L. Fleiss},
  journal={British Journal of Psychiatry},
  pages={341 - 347}
Classification systems such as diagnosis have two primary properties, reliability and validity. Reliability refers to the consistency with which subjects are classified; validity, to the utility of the system for its various purposes. In the case of psychiatric diagnosis, the purposes of the classification system are communication about clinical features, aetiology, course of illness and treatment. A necessary constraint on the validity of a system is its reliability. There is no guarantee that… 
Reliability of psychiatric diagnosis. I. A methodological review.
Three basic methodological issues are raised, including: importance of structured interviews and objective diagnostic criteria, the importance of a test/retest vs an interviewer/observer design, and the calculation of reliability in a way that takes chance agreement into account.
Clinical criteria for psychiatric diagnosis and DSM-III.
It is suggested that including specified criteria in the next edition of APA's Diagnostic and Statistical Manual of Mental Disorders (DSM-III) would improve the reliability and validity of routine psychiatric diagnosis.
The reliability of the ICD-10 psychiatric diagnoses
The authors discuss the reasons behind the variability in the diagnostic judgements and the means by which the reliability of psychiatric diagnoses in developing countries can be further improved.
Reliability of psychiatric diagnosis. II. The test/retest reliability of diagnostic classification.
In a study of interrater diagnostic reliability, 101 psychiatric inpatients were independently interviewed by physicians using a structured interview and diagnostic agreement was found to be high, despite the fact that in most previous investigations diagnoses were not made independently.
Diagnosis of schizophrenia: a critical review of current diagnostic systems.
Clinicians and researchers alike are advised to exercise caution and openmindedness in their use of DSM-III, as there is as yet no evidence that its criteria for schizophrenia are either less arbitrary or better than those of other systems or DSM-II.
Research diagnostic criteria: rationale and reliability.
The development and initial reliability studies of a set of specific diagnostic criteria for a selected group of functional psychiatric disorders, the Research Diagnostic Criteria (RDC), indicate high reliability for diagnostic judgments made using these criteria.
The discriminative validity of the Whitaker Index of Schizophrenic Thinking.
An attempt was made to assess the discriminative validity of the WIST with a sample of psychiatric inpatients, and a reliable and valid system was used to establish the criterion diagnosis of schizophrenia.
A symptom analysis of the DSM-III definition of schizophrenia.
The experiment reported examined the DSM-III definition of schizophrenia by analyzing the characteristics of the individual symptoms, and recommendations are made as to how the definition might be strengthened.
Problems associated with the classification and diagnosis of psychiatric disorders
  • H. Möller
  • Psychology, Medicine
    The world journal of biological psychiatry : the official journal of the World Federation of Societies of Biological Psychiatry
  • 2005
Several methodological issues of classification of psychiatric disorders are addressed and the advantages and disadvantages of the syndromatological and nosological classifications are broadly described.


Reliability of a Procedure for Measuring and Classifying “Present Psychiatric State”
A structured "present state" interview has been developed and tested and introduces a degree of standardization and precision which suggests that more of the diagnostic process might be brought under control with obvious benefit to clinical practice and research.
The reliability of psychiatric diagnosis.
No observation can be incorporated satisfactorily in a body of knowledge unless its reliability, however defined, is also known. In psychiatry, the concept of reliability has in great measure been
The reliability of psychiatric diagnosis; a new look.
“Each of 426 state hospital patients was diagnosed independently by pairs of psychiatrists using official psychiatric nomenclature. Reliability of the schizophrenic diagnosis was indicated by values
Quantification of agreement in psychiatric diagnosis. A new approach.
As generally used, all of the methods used for quantifying the salient features of the data suffer from one or more deficiencies which are illustrated using the hypothetical data of Table 1.
Reliability of psychiatric diagnosis. 2. A study of consistency of clinical judgments and ratings.
An investigation of the reliability of psychiatric diagnoses was designed to minimize factors that would artificially lower or inflate the rate of concordance and it was found that the diagnosticians may have been closer in their appraisals than indicated by the scoring of only the preferred diagnoses.
Constraints on the validity of computer diagnosis.
Issues in the constraints on the validity of computerized psychiatric diagnosis are illustrated by the analysis of diagnoses produced by treating clinicians, expert diagnosticians, and the DIAGNO III
Diagnostic criteria for use in psychiatric research.
Diagnostic criteria for 14 psychiatric illnesses along with the validating evidence for these diagnostic categories comes from workers outside the authors' group as well as from those within; it consists of studies of both outpatients and inpatients, of family studies, and of follow-up studies.
The psychiatric status schedule. A technique for evaluating psychopathology and impairment in role functioning.
The second edition of the Psychiatric Status Schedule (PSS) is described, an instrument designed to overcome limitations of existing instruments designed to assess alcoholism, drug addiction, and psychopathic behavior.
Quantification of agreement in multiple psychiatric diagnosis.
To deal with the problem of indexing diagnostic agreement when clinicians make multiple diagnoses on the same case, an algorithm for calculating a specific level of disagreement for an individual
Mental status schedule. Properties of factor-analytically derived scales.
The latest version of the MSS, designated Form A, is currently being used in a number of projects involving such varied problems as the research evaluation of treatment, case finding, routine admission assessment, and the phenomenology of mental disorders.