An evaluation of the multidisciplinary approach to psychiatric diagnosis in elderly people.

Abstract

Objective-To determine the accuracy of psychiatric diagnoses made by two community psychogeriatric teams operating a multidisciplinary assessment procedure.Design-Comparison of team diagnosis with independent formal assessment and consensus diagnosis by research psychiatrists.Setting-Two community psychogeriatric teams with similar operational policies in an inner London health district.Subjects-100 people aged 65-90 (70 women) newly referred to the teams.Main outcome measures-Concordance between team and research diagnoses.Results-Agreement between team and research diagnoses ranged from 90% to 99% for the specific psychiatric disorders studied. There was no significant difference between medical and non-medical team members in their diagnostic performance compared with the research psychiatrists. Increased diagnostic accuracy by team members was associated with longer experience ofteam working, regardless ofthe team members' professional background.Conclusions-The multidisciplinary approach to the assessment of referrals to these community teams for the elderly is not associated with misdiagnosis ofpsychiatric disorder.

National trends and local delivery in old age mental health services: towards an evidence base. A mixed-methodology study of the balance of care approach, community mental health teams and specialist mental health outreach to care homes

“…Over 75% of studies had a local focus, covering 57 teams. Ten publications 25,[188][189][190][191][192][193][194][195][196] related to just three of these teams which can be regarded as 'exemplars': early well-resourced teams, established by research active consultants, wanting to test new service delivery approaches. Local studies offered a level of detail not available in the broader national/ regional literature.…”

“…50,163,179 The changing role of consultants within teams is considered by 11 studies. 19,[46][47][48]180,190,[202][203][204]209,210 They suggested a shift from leadership to membership over time, ranging from 40% at the turn of the century to 93% more recently 46,47,73 reflecting policy guidance.…”

“…All were local studies, four 188,[190][191][192] referring to exemplar teams. Three examined referral/access arrangements, three others considered assessment or immediate post-assessment issues, and one focused on longer term support.…”

“…Other aspects of assessment were its setting, with general agreement that domiciliary assessments were vital to gathering accurate information on people's needs; 19,46,47,179,189,190,199,217 and the extent of multidisciplinary involvement. 19,46,47,179,208,218 National reports suggested that such practice occurred in only a minority of teams, varied greatly, and most frequently involved doctors and nurses only.…”

National Dementia Strategy: well intentioned — but how well founded and how well directed?

“…In contrast, publications from the Guy's Hospital Community Mental Health Service for Older People, demonstrated some years ago that differential diagnosis can be achieved accurately by generic team members. 21 It is important that all patients receive a comprehensive review of their general health and current treatment, and some may require additional investigations, such as brain scans. 22 These are necessary to identify treatable causative or associated pathologies including depression, and to avoid false-positive diagnoses of dementia when altered memory is a benign associate of ageing.…”