RELIABILITY OF POSTMORTEM CHART DIAGNOSES OF SCHIZOPHRENIA AND DEMENTIA

The reliability of psychiatric diagnosis has a direct effect on the va lidity of post-mortem analyses of neuropathological data, yet little i s known about the reliability of retrospective diagnostic procedures w hich rely on review of medical records. In this paper, we report on th e reliability of DSM-III-R psychiatric diagnoses assigned by a pool of 8 raters to a set of 106 state hospital charts of elderly, chronic pa tients who had died while institutionalized and were autopsied. Diagno ses were grouped by general diagnostic class, and Kappa coefficients c omputed for agreement among raters, as well as for agreement between u ltimate consensus diagnoses and those made while subjects were living. Interrater agreement for those diagnoses that occurred most frequentl y in this sample (e.g. Schizophrenia and Dementia) was excellent, and comparable to the the agreement observed for ratings of live patients. Interrater agreement for less frequently occurring diagnoses (e.g. Me ntal Retardation, Mood Disorders, other non-Schizophrenic Psychoses) r anged from excellent to poor. We found high agreement between our rate rs diagnoses and those assigned by state hospital personnel while pati ents were living, although post-mortem review produced lower rates of diagnosis of both schizophrenia and Alzheimer-type dementias. Overall, results suggest that the reliability of chart review diagnosis is com parable to that obtained from interviews of live patients when experie nced raters are used and diagnostic base rates are high enough to prod uce stable estimates of reliability.