Using consensus OPCRIT diagnoses
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The Operational Criteria Checklist (OPCRIT) generates diagnoses according to 12 operational diagnostic systems (e.g. DSM-III, DSM-III-R, Research Diagnostic Criteria, ICD-10).To examine the agreement between diagnoses generated by the OPCRIT, as completed by the interviewer, with a best-estimate lifetime procedure using the OPCRIT.Subjects came from large multi-generational bipolar or schizophrenia pedigrees (n = 100), and from a sample of unrelated subjects with schizophrenia (n = 40). We analysed the diagnostic agreement between OPCRIT diagnoses generated by the interviewer and our best-estimate OPCRIT diagnoses, according to DSM-III-R and ICD-10, using Cohen kappa statistics.Excellent agreement was found between interviewer OPCRIT diagnoses and OPCRIT diagnoses made by the best-estimate lifetime consensus procedure for DSM-III-R (kappa = 0.83) and ICD-10 (kappa = 0.81).Results suggest that this procedure for diagnostic assessment is an efficient alternative to classic best-estimate diagnosis procedures.Keywords:
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Cohen's kappa
Interview
Objectives. To evaluate the test-retest reliability of a complex questionnaire administered by Audio Computer-assisted Self-interviewing to recently diagnosed human immunodeficiency virus-positive patients. Methods. Thirty-seven English-speaking and 32 Spanish-speaking participants completed both test and retest interviews. Pearson correlation coefficients (r) and kappa (κ) and weighted kappa (κ) statistics were obtained for individual questions. From these, overall κ and Pearson correlation coefficients were calculated across all variables and for groups of questions. Results. Overall measures of reliability were κ = 0.767,r = 0.728. Some variation in reliability existed for different response formats, question content groups, and languages of the participants. Differences in overall reliability by Spanish compared with English participants were small and not statistically significant. Conclusions. Audio Computer-assisted Self-interviewing provides reliable measures for items assessed in the Antiretroviral Treatment and Access Study baseline questionnaire. Some differences exist as a result of question content, interview language, and response format, requiring assessment in future studies and consideration in designing Audio Computer-assisted Self-interviewing systems and questionnaires.
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Objective. To examine interrater agreement for classifying emergency medical services transports as medically unnecessary using emergency department diagnosis as the sole determining factor. Methods. Three emergency physicians andtwo family medicine physicians classified 913 International Classification of Diseases, Ninth Revision (ICD-9) codes as medically necessary, unnecessary, or uncertain. Overall agreement, interrater agreement, andagreement within 17 major disease categories were measured using κ statistics in SAS. Results. Physicians rated between 25% and65% of diagnoses codes as medically unnecessary. Overall agreement was fair (κ = 0.31). Agreement within specialties was higher among family medicine–trained physicians than among emergency physicians (κ = 0.52 andκ = 0.22, respectively). Agreement across all raters was highest for diseases classified as symptoms, signs, andill-defined conditions (κ = 0.40) andlowest for diseases of the blood andblood-forming organs (κ = −0.17). Agreement was observably better between physicians with more experience. Conclusions. Considerable doubts about the utility of emergency department diagnosis as a criterion are raised from study findings. Further development of Neely Conference criteria is needed. Priority should be given to testing andvalidation of criteria as well as exploration of differences in judgment between specialists representative of the medical director profession.
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Objective To validat the Rating Test for Health and Disease and its logical verdict system(RTHD-LVS)as an diagnostic instrument for assessing the patients with schizophrenia.Methods A total of 106 patients who met CCMD-3 criteria of paranoid or undifferentiated schizophrenia were assessed by using RTHD,and then were rediagnosed by RTHD-LVS.The logical diagnoses of research version(RV) and clinical version(CV) were compared.Results The number of patients had the RV Axis 1 diagnosis of schizophrenia was 99(93.4%),and the number of patients had the CV Axis 1 diagnosis of schizophrenia was 100(94.3%).As to paranoid schizophrenia,KAPPA for the RV Axis 1 diagnosis and that of CV was 0.83.As to undifferentiated schizophrenia Kappa for RV and CV was 0.92,Kappa for RV Axis 1 diagnosis or CV of Axis 1 diagnosis and that of clinical diagnosis were 0.92-0.61.Conclusion RTHD-LVS is a valid and reliable tool to evaluate the patients with schizophrenia.The logical diagnoses of both versions are consistent with the clinical diagnoses.
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Paranoid schizophrenia
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Medical insurance claims are increasingly important as a source of data in monitoring health care utilization and patient outcomes and in identifying patient cohorts for research. In a study that attempted to verify that those with Medicaid claims for treatment of schizophrenia did indeed have the disorder, two psychiatrists evaluated clinical information obtained from primary mental health care providers in relation to DSM-III-R criteria. The psychiatrists classifid 86.8 percent of 319 patients with claims for treatment of schizophrenia and 27.5 percent of 156 patients with claims for treatment of other psychiatric diagnoses as definitely or probably having schizophrenia. The authors conclude that most diagnoses of schizophrenia listed on Medicaid claims are accurate, but that a substantial number of individuals with schizophrenia may not be identified by claims data.
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Objective The DSM-5 Field Trials were designed to obtain precise (standard error <0.1) estimates of the intraclass kappa as a measure of the degree to which two clinicians could independently agree on the presence or absence of selected DSM-5 diagnoses when the same patient was interviewed on separate occasions, in clinical settings, and evaluated with usual clinical interview methods. Method Eleven academic centers in the United States and Canada were selected, and each was assigned several target diagnoses frequently treated in that setting. Consecutive patients visiting a site during the study were screened and stratified on the basis of DSM-IV diagnoses or symptomatic presentations. Patients were randomly assigned to two clinicians for a diagnostic interview; clinicians were blind to any previous diagnosis. All data were entered directly via an Internet-based software system to a secure central server. Detailed research design and statistical methods are presented in an accompanying article. Results There were a total of 15 adult and eight child/adolescent diagnoses for which adequate sample sizes were obtained to report adequately precise estimates of the intraclass kappa. Overall, five diagnoses were in the very good range (kappa=0.60–0.79), nine in the good range (kappa=0.40–0.59), six in the questionable range (kappa=0.20–0.39), and three in the unacceptable range (kappa values <0.20). Eight diagnoses had insufficient sample sizes to generate precise kappa estimates at any site. Conclusions Most diagnoses adequately tested had good to very good reliability with these representative clinical populations assessed with usual clinical interview methods. Some diagnoses that were revised to encompass a broader spectrum of symptom expression or had a more dimensional approach tested in the good to very good range.
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There is a need for psychiatric assessment instruments that enable reliable diagnoses in persons with hearing loss who have sign language as their primary language. The objective of this study was to assess the validity of the Norwegian Sign Language (NSL) version of the Mini International Neuropsychiatric Interview (MINI). The MINI was translated into NSL. Forty-one signing patients consecutively referred to two specialised psychiatric units were assessed with a diagnostic interview by clinical experts and with the MINI. Inter-rater reliability was assessed with Cohen's kappa and "observed agreement". There was 65% agreement between MINI diagnoses and clinical expert diagnoses. Kappa values indicated fair to moderate agreement, and observed agreement was above 76% for all diagnoses. The MINI diagnosed more co-morbid conditions than did the clinical expert interview (mean diagnoses: 1.9 versus 1.2). Kappa values indicated moderate to substantial agreement, and "observed agreement" was above 88%. The NSL version performs similarly to other MINI versions and demonstrates adequate reliability and validity as a diagnostic instrument for assessing mental disorders in persons who have sign language as their primary and preferred language.
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Objective To validate the rating test for health and disease and its logical verdict system (RTHD-LVS) as a diagnostic instrument for assessing the patients with schizophrenia. Methods A total of 106 patients who met CCMD-3 criteria of paranoid or undifferentiated schizophrenia were assessed by using RTHD, and then were rediagnosed by RTHD-LVS. The logical diagnoses of research version(RV) and clinical version(CV) were compared. Results The number of patients had the RV axis I diagnosis of schizophrenia was 99(93.4%), and the number of patients had the CV axis I diagnosis of schizophrenia was 100(94.3%). As to paranoid schizophrenia, Kappa for the RV axis I diagnosis and that of CV was 0.83. As to undifferentiated schizophrenia, KAPPA for RV and CV was 0.92. RTHD-LVS also assessed other axes, the results showed: Seventy three (68.8%) patients were introverted. Twenty (18.9%) had experienced important negative life events in the prior year. Eighty one(76.4%) had grossly inadequate current functioning and 106(100%) had poor or grossly at the time of their worst episode, Forty (37.7%) had experienced no effects or deteriorated. Conclusions RTHD-LVS is a valid and reliable tool to evaluate the patients with schizophrenia. The logical diagnoses of both versions were greatly consistent with the clinical diagnoses.
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Paranoid schizophrenia
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The Renard Diagnostic Interview and the Feighner criteria were used to obtain research diagnoses for VA psychiatric inpatients with hospital diagnoses of both schizophrenia and alcoholism, schizophrenia without alcoholism, and alcoholism without schizophrenia. Hospital diagnoses were confirmed in 69% of patients with schizophrenia and alcoholism and in 65% and 100% of designated schizophrenic and alcoholic patients, respectively. Differences in order of onset, additional psychiatric diagnoses and number and nature of schizophrenic symptoms in the three groups are described. The results of this study support earlier findings that alcoholism is a significant problem in the schizophrenic patient population; implications for treatment and future research are discussed.
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Research Diagnostic Criteria
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