Attitudes of mental health clinicians toward perceived inaccuracy of a schizophrenia diagnosis in routine clinical practice

Bitan, Dana Tzur; Giron, Ariella Grossman; Alon, Gady; Mendlovic, Shlomo; Bloch, Yuval; Segev, Aviv

doi:10.1186/s12888-018-1897-2

Cited by 12 publications

(5 citation statements)

References 43 publications

(21 reference statements)

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“…This is because in Ethiopia professionals without psychiatry specialty as well as diploma and degree level trained psychiatry nurses were involved in the care, diagnosis, and treatment of patients with mental disorders because of the scarcity of specialized manpower [ 48 ]. The perception of the professionals that inaccurate diagnoses might benefit the patients or it has been assigned due to diagnostic considerations (for example, the presence of negative symptoms for schizophrenia) are the other possible reasons for the increased rates of misdiagnosis [ 49 ]. Finally, the diagnostic instability and the change from one disorder to the other disorder over time might be the other possible attributing factor for the misdiagnosis.…”

Section: Discussionmentioning

confidence: 99%

Misdiagnosis, detection rate, and associated factors of severe psychiatric disorders in specialized psychiatry centers in Ethiopia

Ayano

Demelash

Yohannes³

et al. 2021

Ann Gen Psychiatry

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Background There are limited studies on the prevalence of misdiagnosis as well as detection rates of severe psychiatric disorders in specialized and non-specialized healthcare settings. To the best of our knowledge, this is the first study to determine the prevalence of misdiagnosis and detection rates of severe psychiatric disorders including schizophrenia, schizoaffective, bipolar, and depressive disorders in a specialized psychiatric setting. Method In this cross-sectional study, a random sample of 309 patients with severe psychiatric disorders was selected by systematic sampling technique. Severe psychiatric disorders were assessed using the Structured Clinical Interview for DSM-IV (SCID). The potential determinates of misdiagnosis were explored using univariable and multivariable logistic regression models, adjusting for the potential confounding factors. Result This study revealed that more than a third of patients with severe psychiatric disorders were misdiagnosed (39.16%). The commonly misdiagnosed disorder was found to be a schizoaffective disorder (75%) followed by major depressive disorder (54.72%), schizophrenia (23.71%), and bipolar disorder (17.78%). Among the patients detected with the interview by SCID criteria, the highest level of the correct diagnosis was recorded in the medical record for schizophrenia (76.29%) followed by bipolar (72.22%), depressive (42.40%), and schizoaffective (25%) disorders with detection rate (sensitivity) of 0.76 (95% CI 0.69–0.84), 0.42 (95% CI 0.32–0.53), 0.72 (95% CI 0.60–0.84), and 0.25 (95% CI 0.09–0.41), respectively for schizophrenia, depressive, bipolar, and schizoaffective disorders. Patients with bipolar disorder were more likely to be misdiagnosed as having schizophrenia (60%), whereas schizophrenic patients were more likely to be misdiagnosed as having bipolar disorder (56.25%) and patients with depressive disorders were more likely to be misdiagnosed as having schizophrenia (54.72%). Having a diagnosis of schizoaffective and depressive disorders, as well as suicidal ideation, was found to be significant predictors of misdiagnosis. Conclusion This study showed that roughly four out of ten patients with severe psychiatric disorders had been misdiagnosed in a specialized psychiatric setting in Ethiopia. The highest rate of misdiagnosis was observed for schizoaffective disorder (3 out of 4), followed by major depressive disorder (1 out of 2), schizophrenia (1 out of 4), and bipolar disorders (1 in 5). The detection rates were highest for schizophrenia, followed by bipolar, depressive, and schizoaffective disorders. Having a diagnosis of schizoaffective and depressive disorders as well as suicidal ideation was found to be significant predictors of misdiagnosis.

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Section: Discussionmentioning

confidence: 99%

Misdiagnosis, detection rate, and associated factors of severe psychiatric disorders in specialized psychiatry centers in Ethiopia

Ayano

Demelash

Yohannes³

et al. 2021

Ann Gen Psychiatry

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“…Schizophrenia diagnosis has largely been deemed fairly stable and definitive, but mental health care professionals report that inaccurate and controversial diagnosis of schizophrenia in their clinical practice takes place frequently (35). Accordingly, the results of a WHO survey demonstrate that clinicians rate the ease of use and goodness of fit of schizophrenia no higher than other diagnoses, such as depressive and bipolar disorders (36).…”

Section: The Illusion Of Clinical Utilitymentioning

confidence: 99%

En attendant Godot: Waiting for the Funeral of “Schizophrenia” and the Baby Shower of the Psychosis Spectrum

Gülöksüz

2021

Front. Psychiatry

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“…However, the nuances of an individual's symptom profile hold important information that can guide clinical decision-making (51)(52)(53)(54)(55)(56)(57)(58). Second, it results in inaccurate, not otherwise specified (NOS) or mixed diagnoses (59)(60)(61)(62)(63) where those with symptom profiles that are a poor fit for the clinical criteria, may have to embark on a long struggle to find effective treatment (64). Third, from a research perspective, studies aiming to develop new therapies and medications for mental health disorders typically select participants based on a diagnosis, whereas this group may be substantially heterogeneous in terms of their symptom profiles, and therefore outcomes (19,21).…”

Section: Introductionmentioning

confidence: 99%

Poor Separation of Clinical Symptom Profiles by DSM-5 Disorder Criteria

Newson¹,

Pastukh²,

Thiagarajan³

2021

Front. Psychiatry

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Assessment of mental illness typically relies on a disorder classification system that is considered to be at odds with the vast disorder comorbidity and symptom heterogeneity that exists within and across patients. Patients with the same disorder diagnosis exhibit diverse symptom profiles and comorbidities creating numerous clinical and research challenges. Here we provide a quantitative analysis of the symptom heterogeneity and disorder comorbidity across a sample of 107,349 adult individuals (aged 18–85 years) from 8 English-speaking countries. Data were acquired using the Mental Health Quotient, an anonymous, online, self-report tool that comprehensively evaluates symptom profiles across 10 common mental health disorders. Dissimilarity of symptom profiles within and between disorders was then computed. We found a continuum of symptom prevalence rather than a clear separation of normal and disordered. While 58.7% of those with 5 or more clinically significant symptoms did not map to the diagnostic criteria of any of the 10 DSM-5 disorders studied, those with symptom profiles that mapped to at least one disorder had, on average, 20 clinically significant symptoms. Within this group, the heterogeneity of symptom profiles was almost as high within a disorder label as between 2 disorder labels and not separable from randomly selected groups of individuals with at least one of any of the 10 disorders. Overall, these results quantify the scale of misalignment between clinical symptom profiles and DSM-5 disorder labels and demonstrate that DSM-5 disorder criteria do not separate individuals from random when the complete mental health symptom profile of an individual is considered. Greater emphasis on empirical, disorder agnostic approaches to symptom profiling would help overcome existing challenges with heterogeneity and comorbidity, aiding clinical and research outcomes.

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Attitudes of mental health clinicians toward perceived inaccuracy of a schizophrenia diagnosis in routine clinical practice

Cited by 12 publications

References 43 publications

Misdiagnosis, detection rate, and associated factors of severe psychiatric disorders in specialized psychiatry centers in Ethiopia

Misdiagnosis, detection rate, and associated factors of severe psychiatric disorders in specialized psychiatry centers in Ethiopia

En attendant Godot: Waiting for the Funeral of “Schizophrenia” and the Baby Shower of the Psychosis Spectrum

Poor Separation of Clinical Symptom Profiles by DSM-5 Disorder Criteria

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