Persistent discrepancy in international diagnostic practice since 1970.

Area of Science:

• Psychiatry and Mental Health Statistics
• International Health Classification Systems

Background:

• Analysis of national admission statistics from seven WHO member countries since 1970.
• Examination of adherence to the International Classification of Diseases (ICD) 8th revision and its subsequent updates.

Purpose of the Study:

• To assess the practical application and acceptance of specific ICD-8 diagnostic categories across different countries.
• To identify trends in diagnostic distribution and understand factors influencing classification choices.
• To evaluate the impact of local diagnostic systems on international standardization efforts.

Main Methods:

• Comparative analysis of national psychiatric admission data.
• Review of adherence rates to ICD categories in practice versus official adoption.
• Identification of trends in diagnostic terminology and category usage.

Main Results:

• Limited adherence to ICD-8 categories in practice, with low acceptance of new categories like 'Other psychosis' (298) and specific schizophrenia subgroups.
• Persistent diagnostic discrepancies, notably broad definitions of schizophrenia in the USA and depressive illness in England.
• A significant rise in non-psychotic admissions coinciding with a decline in hospital populations, suggesting avoidance of 'psychosis' stigma.

Conclusions:

• Continued challenges in achieving consistent international diagnostic classification despite ICD adoption.
• The need for improved training on WHO diagnostic guidelines and terminology.
• Local diagnostic systems (e.g., DSM-III) may hinder international standardization and consensus.