The reliability and clinical utility of ICD-11 schizoaffective disorder: A field trial

Destiny L. Peterson, Christopher A. Webb, Jared W. Keeley, Wolfgang Gaebel, Juergen Zielasek, Tahilia J. Rebello, Rebeca Robles, Chihiro Matsumoto, Cary S. Kogan, Maya Kulygina, Saeed Farooq, Michael F. Green, Peter Falkai, Alkomiet Hasan, Silvana Galderisi, Veronica Larach, Valery Krasnov, Geoffrey M. Reed

Research output: Contribution to journalArticlepeer-review

12 Scopus citations


A major goal for the revision of the International Classification of Diseases and Related Health Problems, Tenth Edition (ICD-10)is to increase the clinical utility of the diagnostic system. Schizoaffective disorder has a history of poor diagnostic reliability due to the similarities and overlap in symptoms that it shares with other disorders, especially primary psychotic and mood disorders. The present study was part of the case-controlled field trials for ICD-11 and examines how the proposed changes for schizoaffective disorder may improve differential diagnosis and diagnostic accuracy. Clinicians from around the globe (n = 873)were provided with either ICD-10 or ICD-11 diagnostic guidelines and asked to apply them to case vignettes comparing schizoaffective disorder to schizophrenia and mood disorders with psychotic symptoms. Participants were asked to respond to follow-up diagnostic questions to determine which components of the diagnostic guidelines affected diagnostic accuracy. Overall, clinicians showed small improvements in accurately diagnosing vignettes using ICD-11 over ICD-10. Results suggest the discrepancy in diagnosing schizoaffective disorder is related primarily to the presence of mood symptoms and discrepancies about whether those symptoms are more consistent with schizoaffective disorder or a mood disorder diagnosis. Continuing to identify ways to more accurately capture this symptom picture will be important in the future as well as systematic efforts to educate clinicians about differential diagnosis.

Original languageEnglish
Pages (from-to)235-241
Number of pages7
JournalSchizophrenia Research
StatePublished - Jun 2019
Externally publishedYes

Bibliographical note

Funding Information:
Most of the authors on this paper were members of the World Health Organization Working Group on Schizophrenia and Other Primary Psychotic Disorders and/or members of or consultants to the Field Studies Coordination Group for ICD-11 Mental and Behavioural Disorders. Geoffrey Reed is a member of the WHO Secretariat. Opinions expressed in this article are those of the authors and do not represent the official policies or positions of the World Health Organization. Jared Keeley received financial support from WHO to conduct field studies for the ICD-11 development, including the study reported in this manuscript. Alkomiet Hasan has received paid speakerships from Janssen Cilag, Otsuka, and Iunbeck, and is on the advisory board of Roche. Authors have no other conflicts of interest to report.

Funding Information:
The authors would like to thank the following individuals for their contributions to translation and implementation of the study: Philippa Garety, Ana Fresan, Ivan Arango, Nicolas Martinez, Ricardo Saracco, Raul Escamilla, Tecelli Domiguez, Jean Grenier, Anne-Claire Stona, Hirohiko Harima, Hidemichi Suga, Akiko Kawaguchi, Sousuke Suga, Takeshi Yamasaki, Toshiaki Baba, Kanna Sugiura, Kumi Aoyama, Shuichi Kato, Ryo Okubo, Naoki Hashimoto, Taketo Cho, Hironori Kuga, Na Zong, Pavel Ponizovsky, Olga Karpenko, Maria Orlova, Alexandr Schmukler, Alexey Bobrov, and Maria Semiglazova.

Publisher Copyright:
© 2019 Elsevier B.V.


  • Diagnosis
  • ICD-11
  • Mood disorders
  • Reliability
  • Schizoaffective disorder
  • Schizophrenia


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