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December 28, 2004
Post mortem research
Reliability of psychiatric diagnosis in postmortem research.
Deep-Soboslay A, Akil M, Martin CE, Bigelow LB, Herman MM, Hyde TM, Kleinman JE.
Background: To further understand how the brain works in various diseases, postmortem (after death) research is very important. Such studies look at a person’s brain after death to examine genetic, molecular, cellular, and neurochemical characteristics. Such postmortem research is only done if permission is given to donate the brain for research.
One challenge that many of these post mortem researchers face, is determining psychiatric diagnoses after death. Some researchers tend to do thorough psychiatric record reviews retrospectively, using structured questionnaires such as the Diagnostic Evaluation After Death, while other researchers conduct postmortem family interviews (i.e., the psychologic autopsy). The purpose of this study was to see what the level of agreement is between these two diagnostic ways of determining psychiatric diagnosis after death.
Methods: The researchers got informed consent to look at the donated brains from next of kin. After starting with 119 subjects with a history of psychiatric illness or substance abuse, they were able to obtain both psychiatric records and postmortem family interviews for a total of 37 subjects. The family interviews were completed within about 2 years of the donor’s death. Interviews were structured and semistructured and gathered information such as demographic, educational, social, occupational, and psychological information, as well as information regarding family history, suicide history, and medical history related to circumstances and cause of death. Requests for written authorization for release of medical records were sent to families after completion of the family interviews. Once records were obtained, the Diagnostic Evaluation After Death questionnaire was used to extract information systematically from psychiatric records, and the last psychiatric diagnosis available before death was recorded. Then, psychiatric diagnoses from family interviews were compared with the last available psychiatric record diagnoses.
Results: The rate of agreement between psychiatric diagnoses derived from record reviews and diagnoses derived from postmortem family interviews was relatively high for subjects with a diagnosis of schizophrenia, but the rate of agreement for subjects with mood disorders was only moderate.
Interpretations and Limitations: It seems that record reviews alone may be adequate for arriving at the postmortem psychiatric diagnosis for schizophrenia. This could be because individuals with schizophrenia generally have more frequent and lengthy inpatient admissions, longer medical records, and more problems in social, educational, and occupational functioning that are more severe and therefore more identifiable by doctors and family members. On the other hand, those with mood disorders (eg depression) may have more subtleties in such areas and for them it may be more difficult to come up with a postmortem diagnosis. Limitations in this study include: lack of 100% agreement with final cohort diagnoses (record diagnoses =70.3% and family interview diagnoses=78.4%) and long time lag between dates of death and postmortem family interviews (which was done out of respect for family’s grieving process). Overall, it seems that although the family interviews can provoke powerful emotions to surface, families are generally grateful for an opportunity to discuss their family member’s mental illness and to make a contribution to psychiatric research.
This research was supported by the Section on Neuropathology of the Clinical Brain Disorders Branch, in the Intramural Research Program at the National Institute of Mental Health (NIMH) in Bethesda, MarylandPosted by Farzin at December 28, 2004 02:46 PM | TrackBack