Diagnostic accuracy and confusability analyses: An application to the Diagnostic Interview for Genetic Studies

S. V. Faraone, M. Blehar, J. Pepple, S. O. Moldin, J. Norton, J. I. Nurnberger, D. Malaspina, C. A. Kaufmann, T. Reich, C. R. Cloninger, J. R. Depaulo, K. Berg, E. S. Gershon, D. G. Kirch, M. T. Tsuang

Research output: Contribution to journalArticlepeer-review

77 Scopus citations

Abstract

The dominant, contemporary paradigm for developing and refining diagnoses relies heavily on assessing reliability with kappa coefficients and virtually ignores a core component of psychometric practice: the theory of latent structures. This article describes a psychometric approach to psychiatric nosology that emphasizes the diagnostic accuracy and confusability of diagnostic categories. We apply these methods to the Diagnostic Interview for Genetic Studies (DIGS), a structured psychiatric interview designed by the NIMH Genetics Initiative for genetic studies of schizophrenia and bipolar disorder. Our results show that sensitivity and specificity were excellent for both DSM-III-R and RDC diagnoses of major depression, bipolar disorder, and schizophrenia. In contrast, diagnostic accuracy was substantially lower for subtypes of schizoaffective disorder - especially for the DSM-III-R definitions. Both the bipolar and depressed subtypes of DSM-III-R schizoaffective disorder had excellent specificity but poor sensitivity. The RDC definitions also had excellent specificity but were more sensitive than the DSM-III-R schizoaffective diagnoses. The source of low sensitivity for schizoaffective subtypes differed for the two diagnostic systems. For RDC criteria, the schizoaffective subtypes were frequently confused with one another; they were less frequently confused with other diagnoses. In contrast, the DSM-III-R subtypes were often confused with schizophrenia, but not with each other.

Original languageEnglish (US)
Pages (from-to)401-410
Number of pages10
JournalPsychological Medicine
Volume26
Issue number2
DOIs
StatePublished - Mar 1996
Externally publishedYes

ASJC Scopus subject areas

  • Applied Psychology
  • Psychiatry and Mental health

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