The reassessment of chronic patients previously diagnosed as schizophrenic

Abstract

Sixty-one outpatients with clinical diagnoses of schizophrenia or schizoaffective disorder were systematically reevaluated with a structured historical diagnostic interview, the Schedule for Affective Disorders and Schizophrenia-Lifetime Version, and with a review of their charts. Research diagnoses were then constructed by applying Research Diagnostic Criteria (RDC) to the interview data and seven diagnostic systems to the chart data. Of the 61 patients, 43 (70.5%) were again recognized to be schizophrenic by the RDC applied to the interview data and 39 (63.5%) met chart criteria. Fifty-one patients (83.6%) were rediagnosed as schizophrenic by at least one of these approaches (excluding the NHSI chart criteria). There was, however, great variation in rediagnostic assignment because of variations in the diagnostic criteria and chart data. Many of the patients who did not meet criteria for schizophrenia met criteria for affective disorder. Patients were assigned to one of four categories according to whether interview or chart rediagnosis was positive or negative for schizophrenia. This categorization was used to search for factors that might account for patients who did not receive a rediagnosis of schizophrenia.