Diagnostic reliability among French psychiatrists using DSM-III criteria

The reliability of French psychiatrists using DSM-III axis I disorders was studied using videotaped semi-structured diagnostic interviews, 136 psychiatrists with different levels of clinical experience classified 11 cases into six preselected diagnostic categories: Schizophrenia, Major Depressive Episode, Dysthymic Disorder, Cyclothymic Disorder, Other Psychiatric Diagnosis, No Present Psychiatric Diagnosis. A modified Kappa coefficient for multiple observers was used to calculate agreement and thereby estimate reliability. We obtained an overall Kappa of 0.55 for six categories, and when the Dysthymic and Cyclothymic Disorders were combined into one class, i.e. other specific affective disorders, the Kappa value increased to 0.64. The Kappa value for individual categories was best for Schizophrenia and Major Depressive Episode, and poor for Dysthymic and Cyclothymic Disorders. Clinical experience or prior knowledge of DSM-III criteria did not have a significant effect on reliability.