Undiagnosed Psychiatric Patients Part 1: Record Study

Abstract

Among patients admitted to psychiatric hospitals are some who are discharged undiagnosed. It can be expected that psychiatric patients, as patients in other medical specialties, who do not meet the criteria for any of the established diagnostic groups, will be considered as undiagnosed until the course of their illness and clinical picture makes the diagnosis evident. The undiagnosed patients are a diagnostic and therapeutic challenge. Because in a space of five years, 256 patients left undiagnosed, it was felt that this group merited investigation.

Royal Park Multidiagnostic Instrument for Psychosis: Part I. Rationale and Review

“…Blashfield (1973) has demonstrated an inverse relationship between reliability and coverage, and since both are important criteria in the evaluation of a classification, some method of resolving the apparent conflict is necessary. As a consequence of this reciprocal relationship, some operational definitions such as the Feighner criteria are highly reliable but low in coverage, with the result that many patients remain undiagnosed (Welner et al 1972). On the other hand, systems characterized by vague or broadly defined classes such as DSM-II (American Psychiatric Association 1968) or ICD-9 (World Health Organization 1978) possess excellent coverage but in the process sacrifice reliability.…”

Racial Differences in DSM Diagnosis Using a Semi-Structured Instrument: The Importance of Clinical Judgment in the Diagnosis of African Americans

“…Clinicians unaware of cultural variations in paranoia may view mistrust as evidence of psychosis instead of depression (Whaley 2002;Whaley 1997). Studies indicate that African Americans show less affect or more flat affect than whites, which may also increase the likelihood of receiving a diagnosis of schizophrenia Welner, Liss and Robins 1973;Welner et al 1972). Clinicians may see something that resembles "blunted affect" but may not assess the cultural accuracy of that perception by considering possible differences in the ways that African Americans and whites display emotions.…”

“…First, the concern is grounded in a particular line of reasoning in interpreting existing diagnostic evidence. Many studies that look at diagnosis within a hospital setting have found that schizophrenia is diagnosed more frequently among African Americans and that mood disorders are diagnosed more often among whites (Lipton and Simon 1985;Liss et al 1973;Mukherjee et al 1983;Neighbors et al 1999;Raskin, Crook and Herman 1975;Simon et al 1973;Snowden and Cheung 1990;Strakowski et al 1996;Tonks, Paykel and Klerman 1970;Welner, Liss and Robins 1973;Welner et al 1972). The term "over-diagnosis" has been used to refer to the findings related to schizophrenia while "under-diagnosis" has been used to describe the findings on mood disorders.…”

“…From this standpoint, making modifications to the diagnostic criteria of DSM-III on the basis of patient race meant opening the door to stereotypes, bias, and ultimately misdiagnosis. DSM-III's attempt to limit clinical discretion was seen as a positive step because the diagnostic habits of clinicians working with African Americans had been suspect for quite some time (Fischer 1969;Garb 1997;Griffith 1996;Jones and Gray 1986;Kramer, Rosen, and Willis 1973;Raskin, Crook, and Herman 1975;Simon et al 1973;Strakowski et al 1996; Thomas and Sillen 1972;Welner et al 1972).…”

Diagnostic concordance in functional psychosis revisited: a study of inter-relationships between alternative concepts of psychotic disorder

“…Blashfield (1973) demonstrated an inverse relationship between reliability and coverage, so that operational definitions such as the Feighner criteria (Feighner et al 1972) are highly reliable but low in coverage, with the result that many patients remain undiagnosed • Carpenter et al 1973. (Welner et al 1972). Other definitions, such as DSM-III, achieve spuriously high levels of coverage due to the inclusion of residual categories.…”