Operational criteria application does not change clinicians' opinion on the diagnosis of mental disorder: a pre- and post-intervention validity study

Helio G Rocha Neto; José Luiz Martins Lessa; Luisa Mendez Koiller; Amanda Machado Pereira; Bianca Marques de Souza Gomes; Carlos Linhares Veloso Filho; Carlos Henrique Casado Telleria; Maria T Cavalcanti; Diogo Telles-Correia

doi:10.3389/fpsyt.2024.1303007

Operational criteria application does not change clinicians' opinion on the diagnosis of mental disorder: a pre- and post-intervention validity study

Front Psychiatry. 2024 Apr 15:15:1303007. doi: 10.3389/fpsyt.2024.1303007. eCollection 2024.

Affiliations

¹ Programa de Pós Graduação em Psiquiatria e Saúde Mental (PROPSAM), Instituto de Psiquiatria, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil.
² Programa de Doutoramento do Centro Acadêmico de Medicina da Universidade de Lisboa (PhD CAML), Lisbon, Portugal.
³ Instituto de Psiquiatria, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil.
⁴ Medicine Faculty, Centro de Ciências da Saúde (CCS), Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil.
⁵ Clinica Universitária de Psiquiatria e Psicologia Médica, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal.

^# Contributed equally.

Abstract

Objective: Our objective was to check if the ICD-10 operational criteria application changes non-operational, prototype-based diagnoses obtained in a real-life scenario.

Methods: Psychiatry residents applied the diagnostic criteria of the ICD-10 as a "diagnostic test" to five outpatient patients they were already following who had a prototype-based diagnosis. Tests were used to ascertain whether changes in opinion were significant and if any of the diagnostic groups were more prone to change than others. The present paper is part of the study with UTN U1111-1260-1212.

Results: Seventeen residents reviewed their last five case files, retrieving 85 diagnostic pairs of non-operational-based vs. operational-based diagnoses. The Stuart-Maxwell test did not indicate a significant opinion change (χ² = 5.25, p = 0.39; power = 0.94) besides 30% of diagnostic changes. Despite not being statistically significant, 20.2% of all evaluations resulted in a change that would affect treatment choices. Using ICD-10 operational criteria slightly increased the number of observed diagnoses, but probably without clinical relevance. None of the non-operational diagnoses have a higher tendency to change with operational criteria application (χ² = 11.6, p = 0.07). The female gender was associated with a higher diagnostic change tendency.

Conclusion: Applying ICD-10 operational criteria as a diagnostic test does not induce a statistically significant diagnostic opinion change in residents and no diagnostic group seems more sensible to diagnostic change. Gender-related differences in diagnostic opinion changes might be evidence of sunk cost bias. Although not statistically significant, using operational criteria after diagnostic elaboration might help to deal with subjects without adequate treatment response.

Keywords: ICD-10; bias; categorical diagnosis; diagnosis; dimensional diagnosis; mental disorders; prototype; reliability and validity.

Grants and funding

The author(s) declare financial support was received for the research, authorship, and/or publication of this article. This study was financed in part by the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior – Brasil (CAPES) – Finance Code 001.