Late paraphrenia and ICD 10

Abstract

AbstractAs part of a field study of the latest draft of WHO'S ICD 10 classification, two clinicians, one familiar with ICD 9 and one with DSM‐111, rated 36 cases previously diagnosed as ‘late paraphrenia’ using ICD 9. When raters adhered closely to the diagnostic guidelines issued with the new classification, complete agreement was achieved and most cases received a diagnosis of paranoid schizophrenia. However, both raters were uncomfortable with the low threshold for this diagnosis and when freed from the need to give primacy to schizophrenia preferred a much wider range of diagnoses which included a number of subcategories of delusional disorder. ‘Persistent delusional disorder’ and ‘other persistent delusional disorder’ produced the best fit but up to eight cases were given two diagnoses. Levels of confidence in the diagnosis and ease of achieving this are also given. There was an acceptable level of agreement (kappa = 0.756) when this procedure was employed. It is argued that retrieval of such cases would be facilitated either by providing a code for age of onset or by restoring a separate category for late onset schizophrenia or late paraphrenia.