The reliability of psychiatric diagnoses made by psychiatric residents
in the general emergency department of a university hospital was assessed
by comparing those diagnoses with the inpatient discharge diagnoses of
patients referred to the hospital's inpatient service from the emergency
department. In both settings diagnoses were based on DSM- III-R criteria,
but structured diagnostic instruments were not used. Retrospective review
of the records of 190 inpatients over a six-month period showed excellent
to moderate concordance between principal axis 1 diagnoses in four
categories--major depression, schizophrenic disorders, bipolar disorder,
and substance abuse and dependence disorders. Kappa values ranged from .64
for major depression to .87 for substance abuse and dependence
disorders.
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