[Analysis of inter-judge concordance for the realization of psychiatric expertise in the use of guidelines].

Abstract

Objectives: The aim of this work is to measure the inter-judge concordance in thirteen psychiatric expertises for invalidity insurance.

Method: We analyzed thirteen interdisciplinary (somatic and psychiatric) expertise files, blinded for the patient identity. The patients had a first opinion of a "classic" psychiatric expertise and then a second opinion of other experts, from a center specialized for interdisciplinary expertises in Switzerland. The inter-experts' judgments were compared according to the complexity of every file, due to the intervention of four foreign independent experts with regard to the expertise process (France, Belgium, United States, Switzerland, Romania).

Results: A satisfactory inter-judge concordance in terms of diagnoses and to incapacities was observed in nine files out of thirteen, with a better consensus for the male patients (chi2 = 4.95; p = 0.026). Divergent opinions seem to be in relation with the lack of explicit expertise guidelines used by the first psychiatric experts. We highlight some general principles issued from guidelines of the Swiss Insurance Psychiatric Society for medical expertise of psychiatric disorders. In our opinion these principles would have been able to improve the inter-judge concordance in the thirteen analyzed expertises.

Discussion: In spite of his methodological limits, especially the reduced number of analyzed expertises, this work underlines the interest to use of certain guidelines for the realization of psychiatric expertises in terms of invalidity insurance.

Conclusion: The use of guidelines could improve the inter-judge concordance for the realization of psychiatric expertises about invalidity insurance.