Persistent discrepancy in international diagnostic practice since 1970

Abstract

National admission statistics by diagnosis since 1970, were available from seven WHO member countries. All had officially introduced the ICD 8, but only two countries strictly adhered to the ICD categories in practice. The new 3-digit category 298 (Other psychosis) has met with no success, nor did the new subgroups of schizophrenia with a favourable outcome (295.4, 295.5 and 295.7) gain much acceptance. The discrepancy in diagnostic distribution is virtually unchanged from that before 1970 with a persistent wide concept of schizophrenia in U.S.A. and of depressive illness in England. A new feature is the striking increase in non-psychotic admissions at a time when there is a marked decline in the hospital population. This is taken to indicate that the social stigma attached to the term psychosis persists, and is met with evasion. A preference for unspecified terms (fourth digit 9) is evident, as is the use of terms which leave open whether the patient is psychotic or not (311 in ICD 9). Evidently, instruction in the use of the WHO glossary is called for. In the U.S.A. the replacement of the ICD by the local classification DSM-III is likely to accelerate the reluctance to accept international standards. Moreover, the development of local diagnostic systems for research purposes in England and U.S.A. is not without problems, as there is a disturbing lack of consensus in diagnosis between these two national systems. Obviously, we need the ICD with its clear concepts, and above all the ICD is valuable for securing continuity in diagnostic classification.

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