A Jamaican psychiatrist evaluates diagnoses at a London psychiatric hospital

Background Authors have suggested that the high rate of schizophrenia reported for African - Caribbeans living in the UK is due to misdiagnosis by British psychiatrists. Aims To compare the diagnoses made by a Black Jamaican psychiatrist with those of White British psychiatrists. Method All in-patients on four wards at the Maudsley hospital were approached for the study; 66 participated: 24 White, 29 Black African - Caribbeans and 13 Blacks from other countries of origin. F.W.H., a Black Jamaican psychiatrist, conducted his standard clinical assessment and performed the Present State Examination (PSE) on these patients. His diagnoses were compared with the case note diagnoses made by British psychiatrists, and with the PSE CATEGO diagnoses. Results Of 29 African and African Caribbean patients diagnosed with schizophrenia, the diagnoses of the British and the Jamaican psychiatrists agreed in 16 instances (55%) and disagreed in 13 (45%). Hence, interrater reliability was poor (kappa=0.45). PSE CATEGO diagnosed a higher proportion of subjects as having schizophrenia than the Jamaican psychiatrist did (chi(2)=3.74, P=0.052). Conclusions Agreement between the Jamaican psychiatrist and his UK counterparts about which patients had schizophrenia was poor. PSE CATEGO may overestimate rates of schizophrenia. Declaration of interest F.W.H. received financial support from the Rhodes Trust and the Stanley Foundation.