Diagnostic differences in psychogeriatric patients in London and New York: United Kingdom - United States diagnostic project

Abstract

A group of 50 patients over 65 yr representing consecutive admissions to the hospitals serving Camberwell, London, was compared with an analogous group of 50 patients admitted to mental hospitals serving Queens County, New York. The object was to study the high incidence of organic disease diagnoses made in New York in the aged admitted for psychiatric reasons. A specially prepared Geriatric Mental State Schedule was used and consensus diagnoses took account also of the results of physical examinations, social data, pathological reports and X rays. Consistent diagnostic criteria and significant questions for individual interviews were agreed upon. The patients were examined soon after their admission and again 1 and 3 mth later, using the same rating systems, either in hospital or at home. Whereas the hospital diagnoses for the same patients showed, as expected, considerable differences between the two countries in agreement with the national statistics, no such differences came to light in the project diagnoses. Also while in Camberwell there was little difference between hospital and project diagnoses, in Queens County this difference was considerable. Inasmuch as the results can be generalized, it would appear that the differences between the relative incidence of various diagnoses in the aged admitted to New York and London hospitals are attributable to different diagnostic criteria employed in the two countries. In New York psychiatrists tend to favor the diagnosis of an organic illness and this might perhaps lead to some measure of neglect as regards the treatment of affective disorders in the aged.