Clinical diagnostic practice reviewed. A comparison of clinical and RDC diagnoses

A total of 368 clinical diagnoses were given to 298 patients hospitalized in two Swiss psychiatric institutions during the years 1960-1981. Clinical charts of these patients were scrutinized and all patients were diagnosed anew using the Research Diagnostic Criteria. The clinical diagnoses, strongly influenced by Bleuler and expressed in ICD-9 nomenclature, as well as the diagnoses obtained with the help of RDC, were compared with each other. Considerable differences were found regarding the diagnostic agreement in different diagnostic categories investigated. The most important finding of the study is a tendency to overdiagnose schizophrenic disorders clinically to the disadvantage of affective - mainly depressive - disorders and to overvalue the schizophrenic as compared with the affective - first of all depressive - symptomatology, respectively. This finding may have practical therapeutic consequences.