Persistent discrepancy in international diagnostic practice since 1970

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Abstract
National admission statistics by diagnosis since 1970, were available from 7 WHO member countries. All had officially introduced the ICD 8 [International Classification of Diseases-8] but only 2 countries strictly adhered to the ICD categories in practice. The new 3-digit category 298 (other psychosis) has met with no success, nor did the new subgroups of schizophrenia with a favorable outcome (295.4, 295.5 and 295.7) gain much acceptance. The discrepancy in diagnostic distribution is virtually unchanged from that before 1970 with a persistent wide concept of schizophrenia in USA and of depressive illness in England [UK]. A new feature is the striking increase in non-psychotic admissions at a time when there is a marked decline in the hospital population. This is taken to indicate that the social stigma attached to the term psychosis persists, and is met with evasion. A preference for unspecified terms (4 digit 9) is evident, as is the use of terms which leave open whether the patient is psychotic or not (311 in ICD 9). Evidently, instruction in the use of the WHO glossary is called for. In the USA the replacement of the ICD by the local classification DMS-III [Diagnostic and Statistical Manual of Mental Disorders-III] may accelerate the reluctance to accept international standards. The development of local diagnostic systems for research purposes in England and USA is not without problems, as there is a disturbing lack of consensus in diagnosis between these 2 national systems. The ICD with its clear concepts is needed, and above all the ICD is valuable for securing continuity in diagnostic classification.

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