A Jamaican psychiatrist evaluates diagnoses at a London psychiatric hospital

Background Authors have suggested that the high rate of schizophrenia repor ted for African - Caribbeans living in the UK is due to misdiagnosis by Bri tish psychiatrists. Aims To compare the diagnoses made by a Black Jamaican psychiatrist with th ose of White British psychiatrists. Method All in-patients on four wards at the Maudsley hospital were approach ed for the study; 66 participated: 24 White, 29 Black African - Caribbeans and 13 Blacks from other countries of origin. F.W.H., a Black Jamaican psyc hiatrist, conducted his standard clinical assessment and performed the Pres ent State Examination (PSE) on these patients. His diagnoses were compared with the case note diagnoses made by British psychiatrists, and with the PS E CATEGO diagnoses. Results Of 29 African and African Caribbean patients diagnosed with schizop hrenia, the diagnoses of the British and the Jamaican psychiatrists agreed in 16 instances (55%) and disagreed in 13 (45%). Hence, interrater reliabil ity was poor (kappa=0.45). PSE CATEGO diagnosed a higher proportion of subj ects as having schizophrenia than the Jamaican psychiatrist did (chi(2)=3.7 4, P=0.052). Conclusions Agreement between the Jamaican psychiatrist and his UK counterp arts about which patients had schizophrenia was poor. PSE CATEGO may overes timate rates of schizophrenia. Declaration of interest F.W.H. received financial support from the Rhodes T rust and the Stanley Foundation.