Psychiatric Diagnosis and Classification - ResearchGate

THE APA CLASSIFICATION OF MENTAL DISORDERS 51
Medicine, led by Eli Robins and Samuel Guze, developed the first set of St.
Louis diagnostic criteria for research, named the ``Feighner Criteria'', after
the senior author of the paper presenting the criteria [13]. Going back to the
Kraepelinian principles of classifying patients based on a description of
symptoms that co-occur across groups of patients, diagnostic criteria were
provided for 16 diagnostic categories. A few years later, as part of the
National Institute of Mental Health NIMH) collaborative project on the
psychobiology of depression, Robert L. Spitzer and colleagues modified
the Feighner criteria and added criteria for several additional disorders.
The resulting classification was called the Research Diagnostic Criteria
RDC) [14].
In order to facilitate the reliable application of these newly defined diagnostic
criteria, structured interviews were developed to help researchers
elicit the symptoms necessary for determining whether criteria were met.
For the Feighner criteria, an interview called the Renard Diagnostic Interview
was developed [15]; for the RDC, the interview was known as the
Schedule for Affective Disorders and Schizophrenia SADS) [16]. Both the
RDC and the associated interview schedules became popular among researchers
and were frequently used in research on psychotic and mood
disorders.
To develop the mental disorders section for ICD-9, WHO initiated an
intensive program aiming to identify problems encountered by psychiatrists
in different countries in the use of the mental disorders section of ICD-8 and
to formulate recommendations for their solutions. A series of eight international
seminars were held annually from 1965 to 1972, each of which
focused on a recognized problem in psychiatric diagnosis. The outcome of
the seminars formed the basis for the recommendations made for ICD-9,
which was ultimately published in 1978.
In 1974, after reviewing early drafts of ICD-9, the APA opted to develop a
third edition of the Diagnostic and Statistical Manual DSM-III) because of
concerns that the specificity and subtyping were inadequate, and that the
glossary of ICD-9 did not take advantage of the then-recent innovations,
such as explicit diagnostic criteria and a multiaxial system [17]. Under the
leadership of Robert L. Spitzer, successive drafts of DSM-III were prepared
by 14 advisory committees composed of professionals with special expertise.
The drafts were distributed among American and international psychiatrists
for comments and review. Many of the DSM-III criteria sets were
based on the RDC criteria, with additional criteria sets developed based on
expert clinical consensus.
The improvement in reliability over DSM-II which provided only glossary
definitions) was demonstrated by a large NIMH supported field trial in
which clinicians were asked to independently evaluate patients using drafts
of the DSM-III criteria Appendix F: pp. 467±481). The two main innovations