Diagnosis of Severely III Inpatients in China

The purpose of this project was to investigate any differences in diagnostic practice between Chinese psychiatry and Western psychiatry with regard to severe psychiatric illness among Chinese inpatients. Specifically, the project aimed to look at differences between the Chinese diagnostic system and DSM-III. This study stemmed partly from a desire to investigate the supposed “overdiagnosis” of schizophrenia in China relative to the West. A second objective was to use a structured interview format to obtain clinical data for DSM-III and to decide whether a translated version of such an interview offered promise for future transcultural psychiatric research. Forty-two inpatients on a psychiatric ward in China were interviewed by an American psychiatrist assisted by a Chinese faculty translator and a diagnosis was made using the Structured Clinical Interview for DSM-III. A Chinese professor of psychiatry who was blind to the structured interview results interviewed each patient independently and assigned a diagnosis within the current Chinese system. Followup data was obtained on 69% of the patients after 16 months to check for stability of diagnosis. Results of the study pointed to less diagnostic disagreement than previous work had predicted. On cases where there was disagreement, DSM-III diagnoses tended toward affective disorders or atypical forms of psychosis while the Chinese diagnosis tended towards schizophrenia. Conclusions about using a structured interview in a culturally foreign setting were the following: a) There was some indication that using DSM-III in a structured interview format amplifies affective symptoms to make them more important in arriving at a diagnosis than is the current practice in China; b) There is a problem in the accurate definition of the time relationship between symptoms in using such structured formats, and understanding these time relationships is crucial in the process leading to a diagnosis.