Cross-National Study of Diagnosis of the Mental Disorders: A Comparison of the Diagnoses of Elderly Psychiatric Patients Admitted to Mental Hospitals serving Queens County, New York, and the former Borough of Camberwell, London

A consecutive series of 75 patients over the age of 65 admitted to psychiatric hospitals serving Camberwell, London, was compared with a similar series of 50 patients admitted to psychiatric hospitals serving Queens County, New York City, in order to examine the reported preponderance of organic diagnoses made in New York among patients of this age group. A special schedule for mental state was developed for the aged, and satisfactory reliability for the items of this schedule was shown between the two teams. Psychological and social measures were also taken (to be reported else-where), and physical examinations were under-taken on a proportion of patients, including laboratory tests and X-rays. Patients were examined shortly after admission and one month and three months later, using all the measures, either in the hospital or at home in the community. Results showed that, while the hospitals' diagnosis in Camberwell and Queens on the patients examined differed as expected according to the national statistics, there were no significant differences in the diagnostic proportions found by the Project on either side. Agreement between Project and hospital in Camberwell was good, while that between Project and hospital in Queens showed a significant difference for the organic patients. A tendency for the Project to diagnose more organic patients in Queens than in Camberwell was not significant. When a sample of patients examined in a similar manner in the Camberwell geriatric hospitals and considered as mentally ill by the Project was added to the psychiatric hospital patients, the tendency for there to be a higher proportion of organic patients in the Queens hospitals disappeared. This suggests that in Camberwell, some psychiatric cases of organic origin were being admitted to the geriatric hospitals. Some evidence is produced for the validity of the Project diagnosis for depression and dementia, in terms of symptom profiles, discharge rates and days spent in hospital. Disorientation is the symptom likely to distinguish most clearly between dementia and depression, and poor memory that most likely to cause confusion; in affective patients, poor memory was in fact the organic symptom most likely to show improvement at follow-up.