A comparison of clinical and research DSM-III-R diagnoses of schizophrenia in a Finnish national birth cohort

Clinical and research diagnoses of schizophrenia
  • M. Isohanni
  • T. Mäkikyrö
  • J. Moring
  • P. Räsanen
  • H. Hakko
  • U. Partanen
  • M. Koiranen
  • P. Jones
Original Paper


As a prerequisite to the use of the Finnish National Hospital Discharge Register in psychiatric epidemiological research, we studied the diagnostic reliability of the register in terms of the psychiatric morbidity experienced by a national birth cohort. We investigated all entries to the register for a sample based upon the Northern Finland 1966 birth cohort at the age of 16 years (n=11017). Until the end of 1993 (age 27 years), a total of 563 subjects had a register diagnosis indicating a psychiatric illness, 37 of them being schizophrenia. When operational criteria (DSM-III-R) were applied to clinical information in the available original hospital records for cases of psychosis, personality disorder and substance abuse (n=249), 71 fulfilled criteria for schizophrenia, including all of the 37 cases in the register and an additional 34 (48% false-negatives), most frequently diagnosed in the register as schizophreniform or other psychosis. Despite the official use of DSM-III-R nomenclature, it appears that the clinical concept of schizophrenia in Finland, manifest within the register, remains very restrictive. The application of operational criteria is a necessary prerequisite for scientific research on schizophrenia.


Schizophrenia Substance Abuse Hospital Discharge Clinical Information Birth Cohort 
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  1. 1.
    Mähönen M (1993) Poistoilmoitusrekisteri sepelvaltimotaudin epidemiologisen tutkimuksen tietolähteenä. (The reliability of hospital discharge data as a tool for epidemiologic research on ischemic heart disease). National Research and Development Centre for Welfare and Health, vol 28. Helsinki (English summary)Google Scholar
  2. 2.
    Koskenvuo M, Kaprio J, Romo M, Langinvainio H (1981) Incidence and prognosis of ischaemic heart disease with respect to marital status and social class. J Epidemiol Community Health 35: 192–196Google Scholar
  3. 3.
    Poikolainen K (1983) Accuracy of hospital discharge data five alcohol-related diseases. Drug Alcohol Depend 12: 315–322Google Scholar
  4. 4.
    Keskimäki I, Aro S (1991) The accuracy of data on diagnoses, procedures and accidents in the Finnish Hospital Discharge Register. Int J Health Sci 2: 15–21Google Scholar
  5. 5.
    Aro S, Aro H, Salinto M, Keskimäki I (1995) Educational level and hospital use in mental disorders. Acta Psychiatr Scand 91: 305–321Google Scholar
  6. 6.
    WHO (1977) Manual of the international statistical classification of diseases, injuries and causes of death, 9th revision, vol 1. WHO, GenevaGoogle Scholar
  7. 7.
    Kuoppasalmi K, Lönnqvist J, Pylkkänen K, Huttunen M (1989) Classification of mental disorders in Finland. A comparison of the Finnish classification of mental disorders in 1987 with DSM-III-R. Psychiatr Fenn 20: 65–81Google Scholar
  8. 8.
    American Psychiatric Association (1987) DSM-III-R: diagnostic and statistical manual of mental disorders, 3rd edn, revised. American Psychiatric Association. Washington, DCGoogle Scholar
  9. 9.
    Rantakallio P (1988) The longitudinal study of the Northern Finland birth cohort of 1966. Pediatr Perinat Epidemiol 2: 59–88Google Scholar
  10. 10.
    Isohanni M, Oja H, Moilanen I, Koiranen M, Rantakallio P (1995) Smoking or quitting during pregnancy: associations with background and future social factors. Scand J Soc Med 23: 32–38Google Scholar
  11. 11.
    Rantakallio P, Myhrman A, Koiranen M (1995) Juvenile offenders, with special reference to sex differences. Soc Psychiatry Psychiatr Epidemiol 30: 113–120Google Scholar
  12. 12.
    McCuffin P, Farmer AE, Harvey I (1991) A polydiagnostic application of operational criteria in psychotic illness: development and reliability of the OPCRIT system. Arch Gen Psychiatry 48: 764–770Google Scholar
  13. 13.
    Tienari P, Wynne LC, Moring J, Wahlberg K-E, Sorri A, Naarala M, Lahti I (1993) Genetic vulnerability or family environment? Implications from the Finnish adoptive family study of schizophrenia. Psychiatr Fenn 24: 23–41Google Scholar
  14. 14.
    Jablensky A (1993) The epidemiology of schizophrenia. Curr Opin Psychiatry 6: 43–52Google Scholar
  15. 15.
    Faraone S, Chen WJ, Goldstein JM, Tsuang MT (1994) Gender differences in age at onset of schizophrenia. Br J Psychiatry 164: 625–629Google Scholar
  16. 16.
    Häfner H, Maurer K, Loffler W, Riechel-Rüssler A (1991) Schizophrenic und Lebensalter. Nervenarzt 62: 536–548Google Scholar
  17. 17.
    Lehtinen V, Joukamaa M (1987) Mental disorders in a sample representative of the whole Finnish adult population. In: Cooper B (ed) Psychiatric epidemiology, progress and prospects. Croom Helm, London, pp 43–54Google Scholar
  18. 18.
    Lehtinen V, Väisänen E (1981) Epidemiology of psychiatric disorders in Finland. A five-year follow-up. Soc Psychiatry 16: 171–180Google Scholar
  19. 19.
    Väisänen E (1975) Psychiatric disorders in Finland. Acta Psychiatr Scand 263 [Suppl]: 22–33Google Scholar
  20. 20.
    Keith SJ, Regier DA, Rae DS (1991) Schizophrenic disorders. In: Robins LN, Regier DA (eds) Psychiatric disorders in America. Free Press, New York, pp 33–52Google Scholar
  21. 21.
    Andreasen NC, Carpenter WT (1993) Diagnosis and classification of schizophrenia. Schizophr Bull 19: 199–214Google Scholar
  22. 22.
    Jones P, Rodgers B, Murray R, Marmot M (1994) Child developmental risk factors for adult schizophrenia in the British 1946 birth cohort. Lancet 344: 1398–1402Google Scholar
  23. 23.
    Cohen SI (1995) Overdiagnosis of schizophrenia: role of alcohol and drug misuse. Lancet 346: 1541–1542Google Scholar
  24. 24.
    World Health Organization (1973) The international pilot study of schizophrenia. WHO, GenevaGoogle Scholar
  25. 25.
    Robins LN, Ratcliff KS, Seyfried W (1982) Validity of the Diagnostic Interview Schedule, version II: DSM-III diagnoses. Psychol Med 12: 855–870Google Scholar
  26. 26.
    Erdman HP, Klein MH, Greist JH, Bass SM, Bires JK, Mactinger PE (1987) A comparison of the Diagnostic Interview Schedule and clinical diagnosis. Am J Psychiatry 144: 1477–1780Google Scholar
  27. 27.
    Fenning S, Craig TJ, Tanenberg-Karant M, Bromet EJ (1994) Comparison of facility and research diagnoses in first admission psychotic patients. Am J Psychiatry 151: 1423–1429Google Scholar
  28. 28.
    Pakaslahti A (1986) Principles and practices in diagnosine schizophrenia (dissertation). Publications of the Social Insurance Institution ML 57, HelsinkiGoogle Scholar
  29. 29.
    Kuusi K (1986) Skitsofreenisten psykoosien ennuste Helsingissä 1975–1983 (dissertation). (Prognosis of schizophrenic psychoses in Helsinki 1975–1983.) Monographs of Psychiatria Fennica 13, HelsinkiGoogle Scholar
  30. 30.
    Nieminen P, Isohanni M, Winblad I (1994) Length of hospitalization in an acute patients' therapeutic community ward. Acta Psychiatr Scand 90: 466–472Google Scholar

Copyright information

© Springer-Verlag 1997

Authors and Affiliations

  • M. Isohanni
    • 1
  • T. Mäkikyrö
    • 1
  • J. Moring
    • 1
  • P. Räsanen
    • 1
  • H. Hakko
    • 1
  • U. Partanen
    • 1
  • M. Koiranen
    • 2
  • P. Jones
    • 3
  1. 1.Department of PsychiatryUniversity of OuluOuluFinland
  2. 2.Department of Public Health Science and General PracticeUniversity of OuluFinland
  3. 3.Department of PsychiatryUniversity of NottinghamNottinghamUK

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