Diagnosis of Schizophrenia in Russia: The Results of a Web-based Survey of Psychiatrists (Part 1. Use of the ICD-10 criteria)

The diagnostic guidelines for the ICD-10 Classification of Mental and Behavioral Disorders, which was published quarter of a century ago, contained significant innovations for that time.
Objectives of this study are to evaluate the application ICD-10 criteria of schizophrenia in Russia and attitudes of Russian psychiatrists to them.
Method: An online survey was conducted through the use of the web-site of the Russian Society of Psychiatrists (RSP). 807 psychiatrists, representing 78 regions of Russia, took part in
the survey. 33 % of them worked in inpatient departments, 39 % – in outpatient departments, 25 % – were researchers and university professors.
Results: 96 % of the participating psychiatrists indicated that they have used ICD-10 diagnostic criteria for schizophrenia in their day-to-day clinical practice during last year. But only
14 % of respondents checked the criteria in each case. Most psychiatrists did this only for difficult/unusual patients. On a 5-point scale, the respondents› mark of ease of use of the list
of diagnostic criteria ICD-10 for schizophrenia was 3.4 points and its correspondence with their clinical practice was 3.6 points (respondents who worked in hospitals gave higher marks).
Regarding special items of the criteria list respondents more often (67 % of answers) chose to leave them unchanged than to remove or reformulate them (28 % of answers). Only 11 % of
respondents favored more generalized formulation of criteria (similar to the DSM criteria) than it is in the list of ICD-10 criteria, 68 % of respondents were against generalization, because of
the possible loss of the criteria specificity. The greatest disagreement among participants was revealed in a diagnostic significance of the negative symptoms: 51 % of respondents recognize
negative symptoms as obligate symptoms of schizophrenia, 46 % – as not obligate. Social factors (including the stigmatization of the diagnosis, the need for social benefits for the patient,
etc.) have a significant impact on the diagnosis of schizophrenia. The confidence in personally established diagnoses among respondents was significantly higher than for the diagnoses which
made by the colleagues.
Conclusions: Despite the widespread utilization of ICD-10 codes, Russian psychiatrists use the ICD-10 diagnostic guidelines for schizophrenia mostly in a formal way, with poor ratings of its
quality. The revealed significant differences in the approaches used to diagnose schizophrenia in our country indicate the importance of developing a system of continuous medical education
to improve the consistency of diagnostic assessments.