Psychiatric diagnosis in a state hospital: Manhattan state revisited

Studies have documented the predeliction of New York hospitals to overdiagnose schizophrenia and to underdiagnose affective disorders. To further investigate that predeliction following the introduction of DSM-III diagnostic criteria, seven clinical experts at the Manhattan Psychiatric Center reevaluated the charts of 131 randomly selected patients and conducted clinical reviews of two subgroups of the sample. Rediagnosis essentially reversed the ratio of schizophrenia to affective disorder shown in the charts, indicated a lack of documented DSM-III criteria for the chart diagnoses, and revealed significant numbers of undiagnosed disorders. The diagnostic, prognostic, and treatment implications of the findings are discussed, especially the need for more precise differential diagnosis according to DSM-III criteria.