Differences in diagnostic patterns in Britain and America

Since 1935, it has been repeatedly noted that English psychiatrists diagnose affective disorders, particularly manic depressive psychosis, more often on first admission than American psychiatrists.^1,2 They diagnose schizophrenia less frequently.The first systematic review of these differences was done by Kramer in 1961.^3,4 He observed that overall first admission rates in the United States and United Kingdom were reasonably close, but in the United Kingdom schizophrenia was diagnosed 50% less often and manic depressive psychosis nearly 900% more often than in the United States.In a study at the New York Psychiatric Institute, it was noted that the diagnosis of schizophrenia increased rapidly in the 1940s and peaked about 1952.⁵ When charts were reviewed and rediagnosed by a British-trained psychiatrist, the number of cases diagnosed as schizophrenia decreased. These and other observations led naturally to speculation.Are hospitalized patients different in Britain or is the difference only one of diagnostic criteria? If the patients are different, is the difference in first admission diagnosts the result of toleration of different forms of mental aberration or are different diagnoses kept at home in the two countries? Is the major difference in psychiatric training? These questions seemed to present an excellent, naturally occurring opportunity to study patient pathology, psychiatric criteria for diagnosis, and the cultural attitudes and tolerance toward varying forms of mental aberration.