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Diagnostic accuracy and confusability analyses: an application to the Diagnostic Interview for Genetic Studies

Published online by Cambridge University Press:  09 July 2009

S. V. Faraone ,
M. Blehar ,
J. Pepple ,
S. O. Moldin ,
J. Norton ,
J. I. Nurnberger ,
D. Malaspina ,
C. A. Kaufmann ,
T. Reich  and
C. R. Cloninger
...Show all authors
S. V. Faraone*
Affiliation:
Harvard Institute of Psychiatric Epidemiology and Genetics, Harvard Medical School Department of Psychiatry at the Massachusetts Medical Health Center, Department of Epidemiology, Harvard School of Public Health and Pediatric Psychopharmacology Unit, Psychiatry Service, Massachusetts General Hospital, Boston, Brockton–West Roxbury Veterans Affairs Medical Center, Brockton, MA; National Institute of Mental Health Extramural Research Program, National Institute of Mental Health Intramural Research Program, Bethesda and Department of Psychiatry, Johns Hopkins University, Baltimore, MD; Department of Psychiatry, Washington University, St Louis, MO; Department of Psychiatry, Indiana University, IN; Department of Psychiatry, Columbia University, New York, NY; and Medical College of Georgia, Augusta, GA, USA
M. Blehar
Affiliation:
Harvard Institute of Psychiatric Epidemiology and Genetics, Harvard Medical School Department of Psychiatry at the Massachusetts Medical Health Center, Department of Epidemiology, Harvard School of Public Health and Pediatric Psychopharmacology Unit, Psychiatry Service, Massachusetts General Hospital, Boston, Brockton–West Roxbury Veterans Affairs Medical Center, Brockton, MA; National Institute of Mental Health Extramural Research Program, National Institute of Mental Health Intramural Research Program, Bethesda and Department of Psychiatry, Johns Hopkins University, Baltimore, MD; Department of Psychiatry, Washington University, St Louis, MO; Department of Psychiatry, Indiana University, IN; Department of Psychiatry, Columbia University, New York, NY; and Medical College of Georgia, Augusta, GA, USA
J. Pepple
Affiliation:
Harvard Institute of Psychiatric Epidemiology and Genetics, Harvard Medical School Department of Psychiatry at the Massachusetts Medical Health Center, Department of Epidemiology, Harvard School of Public Health and Pediatric Psychopharmacology Unit, Psychiatry Service, Massachusetts General Hospital, Boston, Brockton–West Roxbury Veterans Affairs Medical Center, Brockton, MA; National Institute of Mental Health Extramural Research Program, National Institute of Mental Health Intramural Research Program, Bethesda and Department of Psychiatry, Johns Hopkins University, Baltimore, MD; Department of Psychiatry, Washington University, St Louis, MO; Department of Psychiatry, Indiana University, IN; Department of Psychiatry, Columbia University, New York, NY; and Medical College of Georgia, Augusta, GA, USA
S. O. Moldin
Affiliation:
Harvard Institute of Psychiatric Epidemiology and Genetics, Harvard Medical School Department of Psychiatry at the Massachusetts Medical Health Center, Department of Epidemiology, Harvard School of Public Health and Pediatric Psychopharmacology Unit, Psychiatry Service, Massachusetts General Hospital, Boston, Brockton–West Roxbury Veterans Affairs Medical Center, Brockton, MA; National Institute of Mental Health Extramural Research Program, National Institute of Mental Health Intramural Research Program, Bethesda and Department of Psychiatry, Johns Hopkins University, Baltimore, MD; Department of Psychiatry, Washington University, St Louis, MO; Department of Psychiatry, Indiana University, IN; Department of Psychiatry, Columbia University, New York, NY; and Medical College of Georgia, Augusta, GA, USA
J. Norton
Affiliation:
Harvard Institute of Psychiatric Epidemiology and Genetics, Harvard Medical School Department of Psychiatry at the Massachusetts Medical Health Center, Department of Epidemiology, Harvard School of Public Health and Pediatric Psychopharmacology Unit, Psychiatry Service, Massachusetts General Hospital, Boston, Brockton–West Roxbury Veterans Affairs Medical Center, Brockton, MA; National Institute of Mental Health Extramural Research Program, National Institute of Mental Health Intramural Research Program, Bethesda and Department of Psychiatry, Johns Hopkins University, Baltimore, MD; Department of Psychiatry, Washington University, St Louis, MO; Department of Psychiatry, Indiana University, IN; Department of Psychiatry, Columbia University, New York, NY; and Medical College of Georgia, Augusta, GA, USA
J. I. Nurnberger
Affiliation:
Harvard Institute of Psychiatric Epidemiology and Genetics, Harvard Medical School Department of Psychiatry at the Massachusetts Medical Health Center, Department of Epidemiology, Harvard School of Public Health and Pediatric Psychopharmacology Unit, Psychiatry Service, Massachusetts General Hospital, Boston, Brockton–West Roxbury Veterans Affairs Medical Center, Brockton, MA; National Institute of Mental Health Extramural Research Program, National Institute of Mental Health Intramural Research Program, Bethesda and Department of Psychiatry, Johns Hopkins University, Baltimore, MD; Department of Psychiatry, Washington University, St Louis, MO; Department of Psychiatry, Indiana University, IN; Department of Psychiatry, Columbia University, New York, NY; and Medical College of Georgia, Augusta, GA, USA
D. Malaspina
Affiliation:
Harvard Institute of Psychiatric Epidemiology and Genetics, Harvard Medical School Department of Psychiatry at the Massachusetts Medical Health Center, Department of Epidemiology, Harvard School of Public Health and Pediatric Psychopharmacology Unit, Psychiatry Service, Massachusetts General Hospital, Boston, Brockton–West Roxbury Veterans Affairs Medical Center, Brockton, MA; National Institute of Mental Health Extramural Research Program, National Institute of Mental Health Intramural Research Program, Bethesda and Department of Psychiatry, Johns Hopkins University, Baltimore, MD; Department of Psychiatry, Washington University, St Louis, MO; Department of Psychiatry, Indiana University, IN; Department of Psychiatry, Columbia University, New York, NY; and Medical College of Georgia, Augusta, GA, USA
C. A. Kaufmann
Affiliation:
Harvard Institute of Psychiatric Epidemiology and Genetics, Harvard Medical School Department of Psychiatry at the Massachusetts Medical Health Center, Department of Epidemiology, Harvard School of Public Health and Pediatric Psychopharmacology Unit, Psychiatry Service, Massachusetts General Hospital, Boston, Brockton–West Roxbury Veterans Affairs Medical Center, Brockton, MA; National Institute of Mental Health Extramural Research Program, National Institute of Mental Health Intramural Research Program, Bethesda and Department of Psychiatry, Johns Hopkins University, Baltimore, MD; Department of Psychiatry, Washington University, St Louis, MO; Department of Psychiatry, Indiana University, IN; Department of Psychiatry, Columbia University, New York, NY; and Medical College of Georgia, Augusta, GA, USA
T. Reich
Affiliation:
Harvard Institute of Psychiatric Epidemiology and Genetics, Harvard Medical School Department of Psychiatry at the Massachusetts Medical Health Center, Department of Epidemiology, Harvard School of Public Health and Pediatric Psychopharmacology Unit, Psychiatry Service, Massachusetts General Hospital, Boston, Brockton–West Roxbury Veterans Affairs Medical Center, Brockton, MA; National Institute of Mental Health Extramural Research Program, National Institute of Mental Health Intramural Research Program, Bethesda and Department of Psychiatry, Johns Hopkins University, Baltimore, MD; Department of Psychiatry, Washington University, St Louis, MO; Department of Psychiatry, Indiana University, IN; Department of Psychiatry, Columbia University, New York, NY; and Medical College of Georgia, Augusta, GA, USA
C. R. Cloninger
Affiliation:
Harvard Institute of Psychiatric Epidemiology and Genetics, Harvard Medical School Department of Psychiatry at the Massachusetts Medical Health Center, Department of Epidemiology, Harvard School of Public Health and Pediatric Psychopharmacology Unit, Psychiatry Service, Massachusetts General Hospital, Boston, Brockton–West Roxbury Veterans Affairs Medical Center, Brockton, MA; National Institute of Mental Health Extramural Research Program, National Institute of Mental Health Intramural Research Program, Bethesda and Department of Psychiatry, Johns Hopkins University, Baltimore, MD; Department of Psychiatry, Washington University, St Louis, MO; Department of Psychiatry, Indiana University, IN; Department of Psychiatry, Columbia University, New York, NY; and Medical College of Georgia, Augusta, GA, USA
J. R. DePaulo
Affiliation:
Harvard Institute of Psychiatric Epidemiology and Genetics, Harvard Medical School Department of Psychiatry at the Massachusetts Medical Health Center, Department of Epidemiology, Harvard School of Public Health and Pediatric Psychopharmacology Unit, Psychiatry Service, Massachusetts General Hospital, Boston, Brockton–West Roxbury Veterans Affairs Medical Center, Brockton, MA; National Institute of Mental Health Extramural Research Program, National Institute of Mental Health Intramural Research Program, Bethesda and Department of Psychiatry, Johns Hopkins University, Baltimore, MD; Department of Psychiatry, Washington University, St Louis, MO; Department of Psychiatry, Indiana University, IN; Department of Psychiatry, Columbia University, New York, NY; and Medical College of Georgia, Augusta, GA, USA
K. Berg
Affiliation:
Harvard Institute of Psychiatric Epidemiology and Genetics, Harvard Medical School Department of Psychiatry at the Massachusetts Medical Health Center, Department of Epidemiology, Harvard School of Public Health and Pediatric Psychopharmacology Unit, Psychiatry Service, Massachusetts General Hospital, Boston, Brockton–West Roxbury Veterans Affairs Medical Center, Brockton, MA; National Institute of Mental Health Extramural Research Program, National Institute of Mental Health Intramural Research Program, Bethesda and Department of Psychiatry, Johns Hopkins University, Baltimore, MD; Department of Psychiatry, Washington University, St Louis, MO; Department of Psychiatry, Indiana University, IN; Department of Psychiatry, Columbia University, New York, NY; and Medical College of Georgia, Augusta, GA, USA
E. S. Gershon
Affiliation:
Harvard Institute of Psychiatric Epidemiology and Genetics, Harvard Medical School Department of Psychiatry at the Massachusetts Medical Health Center, Department of Epidemiology, Harvard School of Public Health and Pediatric Psychopharmacology Unit, Psychiatry Service, Massachusetts General Hospital, Boston, Brockton–West Roxbury Veterans Affairs Medical Center, Brockton, MA; National Institute of Mental Health Extramural Research Program, National Institute of Mental Health Intramural Research Program, Bethesda and Department of Psychiatry, Johns Hopkins University, Baltimore, MD; Department of Psychiatry, Washington University, St Louis, MO; Department of Psychiatry, Indiana University, IN; Department of Psychiatry, Columbia University, New York, NY; and Medical College of Georgia, Augusta, GA, USA
D. G. Kirch
Affiliation:
Harvard Institute of Psychiatric Epidemiology and Genetics, Harvard Medical School Department of Psychiatry at the Massachusetts Medical Health Center, Department of Epidemiology, Harvard School of Public Health and Pediatric Psychopharmacology Unit, Psychiatry Service, Massachusetts General Hospital, Boston, Brockton–West Roxbury Veterans Affairs Medical Center, Brockton, MA; National Institute of Mental Health Extramural Research Program, National Institute of Mental Health Intramural Research Program, Bethesda and Department of Psychiatry, Johns Hopkins University, Baltimore, MD; Department of Psychiatry, Washington University, St Louis, MO; Department of Psychiatry, Indiana University, IN; Department of Psychiatry, Columbia University, New York, NY; and Medical College of Georgia, Augusta, GA, USA
M. T. Tsuang
Affiliation:
Harvard Institute of Psychiatric Epidemiology and Genetics, Harvard Medical School Department of Psychiatry at the Massachusetts Medical Health Center, Department of Epidemiology, Harvard School of Public Health and Pediatric Psychopharmacology Unit, Psychiatry Service, Massachusetts General Hospital, Boston, Brockton–West Roxbury Veterans Affairs Medical Center, Brockton, MA; National Institute of Mental Health Extramural Research Program, National Institute of Mental Health Intramural Research Program, Bethesda and Department of Psychiatry, Johns Hopkins University, Baltimore, MD; Department of Psychiatry, Washington University, St Louis, MO; Department of Psychiatry, Indiana University, IN; Department of Psychiatry, Columbia University, New York, NY; and Medical College of Georgia, Augusta, GA, USA
*
1Address for correspondence: Dr Stephen V. Faraone, Psychiatry Service (116A), Veterans Affairs Medical Center, 940 Belmont Street, Brockton, MA 02401, USA.
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Synopsis

The dominant, contemporary paradigm for developing and refining diagnoses relies heavily on assessing reliability with kappa coefficients and virtually ignores a core component of psychometric practice: the theory of latent structures. This article describes a psychometric approach to psychiatric nosology that emphasizes the diagnostic accuracy and confusability of diagnostic categories. We apply these methods to the Diagnostic Interview for Genetic Studies (DIGS), a structured psychiatric interview designed by the NIMH Genetics Initiative for genetic studies of schizophrenia and bipolar disorder. Our results show that sensitivity and specificity were excellent for both DSM-III-R and RDC diagnoses of major depression, bipolar disorder, and schizophrenia. In contrast, diagnostic accuracy was substantially lower for subtypes of schizoaffective disorder – especially for the DSM-III-R definitions. Both the bipolar and depressed subtypes of DSM-III-R schizoaffective disorder had excellent specificity but poor sensitivity. The RDC definitions also had excellent specificity but were more sensitive than the DSM-III-R schizoaffective diagnoses. The source of low sensitivity for schizoaffective subtypes differed for the two diagnostic systems. For RDC criteria, the schizoaffective subtypes were frequently confused with one another; they were less frequently confused with other diagnoses. In contrast, the DSM-III-R subtypes were often confused with schizophrenia, but not with each other.

Type
Original Articles
Information
Psychological Medicine , Volume 26 , Issue 2 , March 1996 , pp. 401 - 410
Copyright
Copyright © Cambridge University Press 1996

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References

REFERENCES

American Psychiatric Association (1987). Diagnostic and Statistical Manual of Mental Disorders, 3rd edn, revised. American Psychiatric Association: Washington, DC.Google Scholar
Andreasen, N. C., Flaum, M. & Arndt, S. (1992). The comprehensive assessment of symptoms and history (CASH). Archives of General Psychiatry 432, 615–623.CrossRefGoogle Scholar
Blacker, D., Lavori, P. W., Faraone, S. V. & Tsuang, M. T. (1993). Unipolar relatives in bipolar pedigrees: a search for indicators underlying bipolarity. American Journal of Medical Genetics, Neuropsychiatric Genetics 48 192–199.CrossRefGoogle ScholarPubMed
Chen, W. J., Faraone, S. V. & Tsuang, M. T. (1992). Linkage studies of schizophrenia: a simulation study of statistical power. Genetic Epidemiology 9, 123–139.CrossRefGoogle ScholarPubMed
Clogg, C. C. (1977). Unrestricted and Restricted Maximum Likelihood Latent Class Analysis: A Manual for Users. Pennsylvania State University Press: University Park, PA.Google Scholar
Deutsch, C. K., Matthysse, S., Swanson, J. M. & Farkas, L. G. (1990). Genetic latent structure analysis of dysmorphology in attention deficit disorder. Journal of the American Academy of Child and Adolescent Psychiatry 29, 189–194.CrossRefGoogle ScholarPubMed
Diamond, G. A., Rozanski, A., Forrester, J. S., Morris, D., Pollock, B. H., Staniloff, H. M., Berman, D. S. & Swan, H. J. C. (1986). A model for assessing the sensitivity and specificity of tests subject to selection bias. Journal of Chronic Diseases 39, 343–355.CrossRefGoogle Scholar
Espeland, M. A. & Handelman, S. L. (1989). Using latent class models to characterize and assess relative error in discrete measurements. Biometrics 45, 587–599.CrossRefGoogle ScholarPubMed
Espeland, M. A., Murphy, W. C. & Leverett, D. H. (1988). Assessing diagnostic reliability and estimating incidence rates associated with a strictly progressive disease: dental caries. Statistics in Medicine 7, 403–416.CrossRefGoogle ScholarPubMed
Faraone, S. V. & Tsuang, M. T. (1994). Measuring diagnostic accuracy in the absence of a gold standard. American Journal of Psychiatry 151, 650–657.Google ScholarPubMed
Faraone, S. V., Biederman, J., Sprich, S., Chen, W. J. & Tsuang, M. T. (1993). Efficiency of diagnostic criteria for attention deficit disorder: toward an empirical approach to designing and validating diagnostic algorithms. Journal of the American Academy of Child and Adolescent Psychiatry 32, 166–174.CrossRefGoogle ScholarPubMed
Faraone, S. V., Seidman, L. J., Kremen, W. S., Pepple, J. R., Lyons, M. J. & Tsuang, M. T. (1995). Neuropsychological functioning among the nonpsychotic relatives of schizophrenic patients: a diagnostic efficiency analysis. Journal of Abnormal Psychology 104, 286–304.CrossRefGoogle ScholarPubMed
Gastwirth, J. L. (1987). The statistical precision of medical screening procedures: application to polygraph and AIDS antibodies test data. Statistical Science 2, 213–238.Google Scholar
Greenberg, D. A. (1992). There is more than one way to collect data for linkage analysis. What a study of epilepsy can tell us about linkage strategy for psychiatric disease. Archives of General Psychiatry 49, 745–750.CrossRefGoogle ScholarPubMed
Grove, W. M., Andreasen, N. C., McDonald-Scott, P., Keller, M. B. & Shapiro, R. W. (1981). Reliability studies of psychiatric diagnosis. Theory and practice. Archives of General Psychiatry 38, 408–413.CrossRefGoogle ScholarPubMed
Henkelman, R. M., Kay, I. & Bronskill, M. J. (1990). Receiver operating characteristic (ROC) analysis without truth. Medical Decision Making 10, 24–29.CrossRefGoogle ScholarPubMed
Holzman, P. S., Kringlen, E., Matthysse, S., Falanagan, S. D., Lipton, R. B., Cramer, G., Levin, S., Lange, K. & Levy, D. L. (1988). A single dominant gene can account for eye tracking dysfunctions and schizophrenia in offspring of discordant twins. Archives of General Psychiatry 45, 641–647.CrossRefGoogle ScholarPubMed
Hui, S. L. & Walter, S. D. (1980). Estimating the error rates of diagnostic tests. Biometrics 36, 167–171.CrossRefGoogle ScholarPubMed
Kraemer, H. C. (1992). Evaluating Medical Tests: Objective and Quantitative Guidelines. Sage Publications: Newbury Park, CA.Google Scholar
Landis, J. R. & Koch, G. G. (1977). The measurement of observer agreement for categorical data. Biometrics 33, 159–174.CrossRefGoogle ScholarPubMed
Lau, T. S. (1989). On repeated screening tests. Biometrics 45, 891–898.CrossRefGoogle ScholarPubMed
Lau, T. S. (1991). On dependent repeated screening tests. Biometrics 47, 77–86.CrossRefGoogle ScholarPubMed
Lazarsfeld, P. F. & Henry, N. W. (1968). Latent Structure Analysis. Houghton Mifflin Company: New York.Google Scholar
Leboyer, M., Babron, M. C. & Clerget-Darpoux, F. (1990). Sampling strategy in linkage studies of affective disorders. Psychological Medicine 20, 573–579.CrossRefGoogle ScholarPubMed
LeBoyer, M., Maier, W., Teherani, M., Lichtermann, D., D'Amato, T., Franke, P., Lepine, J., Minges, J. & McGuffin, P. (1991). The reliability of the SADS-LA in a family study setting. European Archives of Psychiatry and Clinical Neuroscience 241, 165–169.CrossRefGoogle Scholar
Leckman, J. F., Sholomska, D., Thompson, W. D., Belanger, A. & Weissman, M. M. (1982). Best estimate of lifetime diagnosis: a methodological study. Archives of General Psychiatry 39, 879–883.CrossRefGoogle ScholarPubMed
Lord, F. M. (1980). Applications of Item Response Theory to Practical Testing Problems. Lawrence Erlbaum Associates: Hillsdale, NJ.Google Scholar
Lord, F. M. & Novick, M. R. (1968). Statistical Theories of Mental Test Scores. Addison-Wesley: Reading, MA.Google Scholar
McClish, D. & Quade, D. (1985). Improving estimates of prevalence by repeated testing. Biometrics 41, 81–89.CrossRefGoogle ScholarPubMed
Marneros, A. & Tsuang, M. T., eds. (1986). Schizoaffective Psychoses. Springer-Verlag: Berlin.CrossRefGoogle Scholar
Martinez, M., Khlat, M., Leboyer, M. & Clerget-Darpoux, F. (1989). Performance of linkage analysis under misclassification error when the genetic model is unknown. Genetic Epidemiology 6, 253–258.CrossRefGoogle ScholarPubMed
Matthysse, S., Holzman, P. S. & Lange, K. (1986). The genetic transmission of schizophrenia: application of Mendelian latent structure analysis to eye tracking dysfunctions in schizophrenia and affective disorder. Journal of Psychiatric Research 20, 57–76.CrossRefGoogle ScholarPubMed
Meehl, P. & Rosen, A. (1955). Antecedent probability and the efficiency of psychometric signs, patterns, or cutting scores. Psychological Bulletin 52, 194–216.CrossRefGoogle ScholarPubMed
Nurnberger, J. I. Jr., Blehar, M. C., Kaufmann, C. A., York-Cooler, C., Simpson, S. G., Harkavy-Friedman, J., Severe, J. B., Malaspina, D., Reich, T., Miller, M., Bowman, E. S., DePaulo, J. R., Cloninger, C. R., Robinson, G., Moldin, S., Gershon, E. S., Maxwell, E., Guroff, J. J., Kirch, D., Wynne, D., Berg, K., Tsuang, M. T., Faraone, S. V., Pepple, J. R. & Ritz, A. L. (1994). Diagnostic interview for genetic studies. Rationale, unique features, and training. Archives of General Psychiatry 51, 849–859.CrossRefGoogle ScholarPubMed
Ott, J. (1991). Genetic linkage analysis under uncertain disease definition. In Banbury Report 33: Genetics and Biology of Alcoholism (ed. Cloninger, C. R. and Begleiter, H.), pp. 327–331. Cold Spring Harbor Laboratory Press: Cold Spring Harbor, NY.Google Scholar
Politser, P. (1982). Reliability, decision rules, and the value of repeated tests. Medical Decision Making 2, 47–69.CrossRefGoogle ScholarPubMed
Quade, D., Lachenbruch, P. A., Whaley, F. S., McClish, D. K. & Haley, R. W. (1980). Effects of misclassifications on statistical inferences in epidemiology. American Journal of Epidemiology 111, 503–515.CrossRefGoogle ScholarPubMed
Rice, J. P., McDonald-Scott, P., Endicott, J., Coryell, W., Grove, W. M., Keller, M. B. & Altis, D. (1986). The stability of diagnosis with an application to bipolar II disorder. Psychiatry Research 19, 285–296.CrossRefGoogle ScholarPubMed
Rice, J. P., Endicott, J., Knesevich, M. A. & Rochberg, N. (1987). The estimation of diagnostic sensitivity using stability data: an application to major depressive disorder. Journal of Psychiatric Research 21, 337–345.CrossRefGoogle ScholarPubMed
Rice, J. P., Rochberg, N., Endicott, J., Lavori, P. W. & Miller, C. (1992). Stability of psychiatric diagnoses. An application to the affective disorders. Archives of General Psychiatry 49, 824–830.CrossRefGoogle Scholar
Robins, E. & Guze, S. B. (1970). Establishment of diagnostic validity in psychiatric illness: its application to schizophrenia. American Journal of Psychiatry 126, 983–987.CrossRefGoogle ScholarPubMed
Schulzer, M., Anderson, D. R. & Drance, S. M. (1991). Sensitivity and specificity of a diagnostic test determined by repeated observations in the absence of an external standard. Journal of Clinical Epidemiology 44, 1167–1179.CrossRefGoogle ScholarPubMed
Spitzer, R. L., Endicott, J. & Robins, E. (1978). Research diagnostic criteria: rationale and reliability. Archives of General Psychiatry 35, 773–782.CrossRefGoogle ScholarPubMed
Spitznagel, E. L. & Helzer, J. E. (1985). A proposed solution to the base rate problem in the kappa statistic. Archives of General Psychiatry 42, 725–728.CrossRefGoogle Scholar
Tsuang, M. T., Gilbertson, M. W. & Faraone, S. V. (1991). The genetics of schizophrenia: current knowledge and future directions. Schizophrenia Research 4, 157–171.CrossRefGoogle ScholarPubMed
Tsuang, M. T., Faraone, S. V. & Lyons, M. J. (1993 a). Advances in psychiatric genetics. In International Review of Psychiatry, Volume I (ed. Costa e Silva, J. A., Nadelson, C. C., Andreasen, N. C. and Sato, M.), pp. 395–440. American Psychiatric Press: Washington, DC.Google Scholar
Tsuang, M. T., Faraone, S. V. & Lyons, M. J. (1993 b). Identification of the phenotype in psychiatric genetics. European Archives of Psychiatry and Clinical Neuroscience 243, 131–142.CrossRefGoogle ScholarPubMed
Übersax, J. S. (1983). Structural analysis of diagnostic disagreements. Journal of Nervous and Mental Disease 171, 199–206.CrossRefGoogle Scholar
Williams, J. B. W., Gibbon, M., First, M. B., Spitzer, R. L., Davies, M., Borus, J., Howes, M. J., Kane, J., Poper, H. G., Rounsaville, B. & Wittchen, H. (1992). The structured clinical interview for DSM-III-R(SCID). II. Multisite Test–Retest Reliability. Archives of General Psychiatry 49, 630–636.CrossRefGoogle Scholar
Young, M. A. (1982/1983). Evaluating diagnostic criteria: a latent class paradigm. Journal of Psychiatric Research 17, 285–296.CrossRefGoogle ScholarPubMed