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Psychogenic (reactive) and hysterical psychoses: a cross-system reliability study
1Department of Psychiatry and Psychological Medicine, Federal University of Sao Paulo, Brazil.
Acta Psychiatrica Scandinavica
|February 1, 1997
Summary
This study found low agreement between ICD-9 diagnoses of reactive and hysterical psychoses and those from DSM and ICD-10 systems. Current diagnostic criteria poorly reflect the original concepts of these psychoses.
Area of Science:
- Psychiatry
- Psychopathology
- Diagnostic Systems
Background:
- Reactive and hysterical psychoses are historically recognized diagnostic concepts.
- Standardized diagnostic systems (ICD-9, DSM-III-R, DSM-IV, ICD-10) aim to classify psychiatric disorders consistently.
- The classification of reactive and hysterical psychoses has evolved, necessitating an evaluation of diagnostic agreement.
Purpose of the Study:
- To investigate the concepts of reactive and hysterical psychoses.
- To assess the classification of these psychoses across different standardized diagnostic systems.
- To evaluate the agreement between ICD-9 diagnoses and those from DSM-III-R, DSM-IV, ICD-10, and the PSE/CATEGO program.
Main Methods:
- Identified patients diagnosed with psychogenic psychosis, reactive psychosis, hysterical psychosis, or hysteria using ICD-9 criteria.
- Re-examined case notes using DSM-III-R, DSM-IV, and ICD-10 criteria.
- Applied the Present State Examination (PSE)/CATEGO computer program for diagnostic classification.
- Utilized the kappa coefficient to measure inter-rater reliability and diagnostic agreement.
Main Results:
- A very low level of agreement was found between ICD-9 diagnoses and those from DSM-III-R and PSE/CATEGO.
- DSM-III-R, DSM-IV, and ICD-10 yielded diagnoses such as psychotic disorder NOS, brief reactive psychosis, mood disorder, and acute/transient psychotic disorder.
- The PSE/CATEGO program most frequently diagnosed schizophrenia, uncertain psychosis, and mixed/manic affective disorder.
Conclusions:
- Current diagnostic criteria in DSM-III-R, DSM-IV, and ICD-10 for brief reactive psychosis or acute/transient psychotic disorder show little relationship to the original concept.
- Despite its systematic approach to symptomatology, the PSE/CATEGO program's diagnostic classes have limited clinical utility for these conditions.
- There is a significant lack of diagnostic consistency for reactive and hysterical psychoses across major classification systems.