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Clinical validity*

  • R. E. Kendell (a1)


Few psychiatric disorders have yet been adequately validated and it is still an open issue whether there are genuine boundaries between the clinical syndromes recognized in contemporary classifications, or between these syndromes and normality. In the long run validation depends on the elucidation of aetiological processes. There are, however, a number of strategies which clinicians could use, but at present rarely do, in order to improve and validate existing classifications. Most of these involve studying populations which have been deliberately chosen to represent a broader grouping than a single diagnostic category, or even a group of related categories.


Corresponding author

Address for correspondence: Professor R. E. Kendell, University Department of Psychiatry, Royal Edinburgh Hospital, Edinburgh EHI0 5HF.


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This paper was originally delivered as the Paul Hoch Award Lecture at the 78th annual meeting of the American Psychopathological Association in New York City on 4 March 1988 It is published in The Validity of Psychiatric Diagnosis (ed. L. N. Robins and J. F. Barrett) American Psychopathological Association Series, Raven Press: New York, 1989.



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Abou-Saleh, M. T. & Coppen, A. (1984). Classification of depressive illnesses: clinico-psychological correlates. Journal of Affective Disorders 6, 5366.
American Psychiatric Association (1987). Diagnostic and Statistical Manual of Mental Disorders, 3rd ed. revised [DSM-III-R] American Psychiatric Association: Washington, D.C.
Ball, J. R. B. & Kiloh, L. G. (1959). A controlled trial of imipramine in treatment of depressive states. British Medical Journal ii, 10521055.
Baron, M., Gruen, R., Rainer, J. D., Kane, J., Asnis, L. & Lord, S. (1985). A family study of schizophrenic and normal control probands: implications for the spectrum concept of schizophrenia. American Journal of Psychiatry 142, 447455.
Beiser, M. (1989). Temporal stability in the major mental disorders. In The Validity of Diagnosis (ed. Robins, L. N. and Barrett, J. E.). Raven Press: New York. (in the press.)
Biehl, H., Maurer, K., Schubart, C., Krumm, B. & Jung, E. (1986). Prediction of outcome and utilisation of medical services in a prospective study of first onset schizophrenics. European Archives of Psychiatry and Neurological Sciences 236, 139147.
Brockington, I. F., Kendell, R. E., Wainwright, S., Hillier, V. F. & Walker, J. (1979). The distinction between the affective psychoses and schizophrenia. British Journal of Psychiatry 135, 243248.
Caine, E. D. & Shoulson, I. (1983). Psychiatric syndromes in Huntington's disease. American Journal of Psychiatry 140, 728733.
Cloninger, C. R., Martin, R. L., Guze, S. B. & Clayton, P. J. (1985). Diagnosis and prognosis in schizophrenia. Archives of General Psychiatry 42, 1525.
Everitt, B. S. (1974). Cluster Analysis. Heinemann: London.
Everitt, B. S., Gourlay, A. J. & Kendell, R. E. (1971). An attempt at validation of traditional psychiatric syndromes by cluster analysis. British Journal of Psychiatry 119, 339412.
Feighner, J. P., Robins, E., Guze, S. B., Woodruff, R. A., Winokur, G. & Munoz, R. (1972). Diagnostic criteria for use in psychiatric research. Archives of General Psychiatry 26, 5763.
Grayson, D. A. (1987). Can categorical and dimensional views of psychiatric illness be distinguished. British Journal of Psychiatry 151, 355361.
Grove, W. M. & Andreasen, N. C. (1989). Quantitative and qualitative distinctions between psychiatric disorders. In The Validity of Diagnosis (ed. Robins, L. N. and Barrett, J. E.). Raven Press: New York. (In the press.)
Johnstone, E. C., Owens, D. G. C., Frith, C. DMcPherson, K., Dowie, C., Riley, G. & Gold, A. (1980). Neurotic illness and its response to anxiolytic and antidepressant treatment. Psychological Medicine 10, 321328.
Johnstone, E. C., Crow, T. J., Frith, C. D. & Owens, D. G. C. (1988). The Northwick Park ‘Functional’ Psychosis Study: diagnosis and treatment response. Lancet ii, 119124
Kendell, R. E. & Gourlay, A. J. (1970). The clinical distinction between psychotic and neurotic depression. British Journal of Psychiatry 117, 257260.
Kendler, K. S., Gruenberg, A. M. & Tsuang, M. T. (1985). Psychiatric illness in first-degree relatives of schizophrenic and surgical control patients. Archives of General Psychiatry 42, 770779.
Klein, D. F. (1989). The pharmacological validation of psychiatric diagnosis. In The Validity of Diagnosis (ed. Robins, L. N. and Barrett, J. E.). Raven Press: New York. (In the press.)
Klein, D. F. & Fink, M. (1963). Multiple item factors as change measures in psychopharmacology. Psychopharmacologia 4, 4352.
Kovacs, M. & Gatonis, C. (1989). Stability and change in childhood onset depressive disorders: longitudinal course as a diagnostic validator. In The Validity of Diagnosis (ed. Robins, L. N. and Barrett, J. E.Raven Press: New York. (In the press.)
Lader, M., Lang, R. A. & Wilson, G D. (1987). Patterns of Improvement in Depressed In-Patienls. Maudsley Monograph No. 30. Oxford University Press: Oxford.
Lipman, R. S., Covi, L., Rickels, K., McNair, D. M., Downing, R., Kahn, R. J., Lasseter, V. K. & Faden, V. (1986). Imipramine and chlordiazepoxide in depressive and anxiety disorders. Archives of General Psychiatry 43, 6877 and 79–85.
McGuffin, P., Reveley, A. & Holland, A. (1982). Identical triplets: non-identical psychosis. British Journal of Psychiatry 140, 16.
McGuffin, P., Farmer, A. E., Gottesman, I. I., Murray, R. M. & Reveley, A. M. (1984). Twin concordance for operationally defined schizophrenia: confirmation of familiality and heritability. Archives of General Psychiatry 41, 541545.
Overall, J. E., Hollisler, L. E., Meyer, F., Kimbell, J. & Shelton, J. (1964). Imipramine and thioridazine in depressed and schizophrenic patients. Journal of the American Medical Association 189, 605608.
Pauls, D. L., Towbin, K. E., Leckman, J. F., Zahner, G. E. P. & Cohen, D. J. (1986). Gilles de la Tourette's syndrome and obsessive compulsive disorder. Archives of General Psychiatry 43, 11801182.
Robins, E. & Guze, S. B. (1970). Establishment of diagnostic validity in psychiatric illness: its application to schizophreni. American Journal of Psychiatry 126, 983987.
Sturt, E. (1981). Hierarchical patterns in the distribution of psychiatric symptoms. Psychological Medicine 11, 783794.
Tsuang, M. T., Winokur, G. & Crowe, R. R. (1980). Morbidity risks of schizophrenia and affective disorders among first degree relatives of patients with schizophrenia, mania, depression and surgical conditions. British Journal of Psychiatry 137, 497504.
Tyrer, P., Alexander, J., Remington, M. & Riley, P. (1987). Relationship between neurotic symptoms and neurotic diagnosis: a longitudinal study. Journal of Affective Disorders 13, 1321.
Weissman, M. M., Gershon, E. S., Kidd, K. K, Prusoff, B. A., Leckman, J. F., Dibble, E., Hamovit, J., Thompson, W. D., Pauls, D. L. & Guroff, J. J. (1984). Psychiatric disorders in the relatives of probands with affective disorders. Archives of General Psychiatry 41, 1321.
Young, M. A., Scheftner, W. AKlerman, G. L., Andreasen, N. C. & Hirschfeld, R. M. A. (1986). The endogenous sub-type of depression: a study of its internal construct validity. British Journal of Psychiatry 148, 257267.


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