On changes in psychiatric diagnosis over time

Examined the factors determining diagnoses of types of mental illness. A survey of the age and diagnosis of 2,134 male psychiatric inpatients discharged from a single treatment facility in 1954, 1964, and 1974 revealed 3 major diagnostic trends: (a) the proportion of patients with affective disorders increased threefold, (b) patients with neuroses went from being the largest group to one of the smallest, and (c) schizophrenia increased significantly. In-depth examination of changes in the psychiatric process revealed that shifts in the patient population and symptomatology could not fully explain these trends. The relative importance of similar symptoms appeared to be interpreted differently at various historical times; diagnosis itself seemed to be relative to historical period. Possible causes include shifts in the patient population, increased treatment of neurotic patients on an outpatient basis, and changes in diagnostic categories due to increased clinical knowledge. It is suggested that the change in treatment emphasis from a psychological/psychoanalytic perspective to a psychopharmacological/medical one may be correlated with an increase in diagnoses more consistent with biological treatment (e.g., affective disorders and schizophrenia) and a decrease in categories less appropriate for this model (e.g., neurosis). (28 ref)