Instituto de Psicoterapia e Investigación Psicosomática

Diagnostic stability of psychiatric disorders in clinical practice

Diagnostic stability of psychiatric disorders in clinical practice

Diagnosis is essential in clinical practice, research, training and public health. Definitions for psychiatric diagnoses are derived from expert opinion rather than the biological basis of the disorder. The modest knowledge base regarding the causation of disease has hindered the use of aetiological factors in psychiatric classification systems. The current classifications (American Psychiatric Association, 2000; World Health Organization, 1992) were designed to achieve high interrater reliability of diagnostic assessment. It is widely believed that if future editions of the DSM and the ICD are to be a significant improvement on their predecessors, the validity of the diagnostic
concepts they include will have to be enhanced (Kendell & Jablensky, 2003). Follow-up studies including evidence of diagnostic stability and diagnostic consistency over time have traditionally been proposed to test the validity of psychiatric diagnoses (Robins & Guze, 1970; Kendler, 1980; Andreasen, 1995). However, several authors have noted that as longitudinal data become available, significant fluctuations in diagnostic stability and changes in
clinical presentation are seen (Krishnan, 2005). The aim of our study was to evaluate the long-term stability of the most prevalent chronic psychiatric diagnoses according to ICD–10 in a range of clinical settings.