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Diagnostic Systems and Prognostic Validity-Reply

R. E. Kendell, MD; J. P. Leff, MD, FRCP, MRCPsych
Arch Gen Psychiatry. 1980;37(2):229. doi:10.1001/archpsyc.1980.01780150119014.
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—We would like to respond to the number of comments on the design and findings of our study, and also to their "flexible system" for the diagnosis of schizophrenia that Carpenter et al presented. We are puzzled by some of the things they say. We had assumed that their flexible system was intended to be an operational definition of schizophrenia that was analogous to those proposed by Feighner, Astrachan, and Spitzer, and in fact we found it to be a more effective predictor of poor outcome than several of the other definitions we studied. They now say, however, that "it is not a free-standing system for identifying schizophrenic patients or for differential diagnosis" and that "it must be embedded in a broad clinical diagnostic evaluation." They are, of course, perfectly entitled to insist that their system should only be used in this way. But if they do intend it to


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