Diagnosis of nonpsychotic patients in community clinics.
OBJECTIVE
Diagnosis-specific, proven efficacious treatments are a major recent advance in psychiatry. Appropriate use of such treatments presupposes patients who meet the diagnostic criteria and clinicians who have accurately diagnosed the target disorder and comorbid conditions. Since little is known about whether these prerequisites are commonly met, the authors conducted a study at two community treatment sites to determine the frequency of various axis I diagnoses and the concordance between the diagnoses recorded in patient charts and those obtained by a structured interview. Given that a DSM diagnosis may not be sufficient to understand a patient's problems, the authors also obtained ratings of interpersonal functioning.


METHODS
The subjects were 164 nonpsychotic patients who were seen at a rural (N=114) or urban (N=50) community treatment facility. Raters trained to reliably use the Structured Clinical Interview for DSM-IV (SCID) conducted diagnostic interviews. Clinical charts were reviewed to obtain clinical diagnoses. Patients completed questionnaires regarding interpersonal functioning.


RESULTS
Most (N=145, 88%) of the patients met the SCID criteria for a current axis I diagnosis, and 53% (N=87) met the criteria for two or more disorders. Clinical and SCID diagnoses had poor agreement. Evidence was found for interpersonal dysfunction.


CONCLUSIONS
Most patients met the diagnostic criteria for conditions for which there are proven treatments; however, inaccurate diagnosis proved common. This barrier to optimal treatment could be ameliorated with the use of structured interviews for common diagnoses. Scores on social/interpersonal measures support the premise that DSM symptoms provide only part of the relevant information about patients' conditions.
Shear
M K
MK
Clinical Services Research Program for Women, Department of Psychiatry, University of Pittsburgh Medical Center, Pittsburgh, 15213, USA.
Greeno
C
C
Kang
J
J
Ludewig
D
D
Frank
E
E
Swartz
H A
HA
Hanekamp
M
M
D000275:Adjustment Disorders / Q000175:diagnosis / Q000453:epidemiology; D000293:Adolescent; D000328:Adult; D000368:Aged; D001008:Anxiety Disorders / Q000175:diagnosis / Q000453:epidemiology; D003155:Community Mental Health Centers; D015897:Comorbidity; D003866:Depressive Disorder / Q000175:diagnosis / Q000453:epidemiology; D003951:Diagnostic Errors; D005260:Female; D006801:Humans; D007398:Interpersonal Relations; D008297:Male; D008499:Medical Records / Q000706:statistics & numerical data; D001523:Mental Disorders / Q000175:diagnosis* / Q000453:epidemiology; D008875:Middle Aged; D019964:Mood Disorders / Q000175:diagnosis / Q000453:epidemiology; D018579:Patient Selection; D010414:Pennsylvania / Q000453:epidemiology; D011569:Psychiatric Status Rating Scales / Q000706:statistics & numerical data; D011594:Psychometrics; D012720:Severity of Illness Index; D012737:Sex Factors; D012917:Social Adjustment; D012944:Social Support; D011795:Surveys and Questionnaires; D014505:Urban Population