title: Accuracy of psychiatric diagnosis performed under indirect supervision.
abstract: This work aimed at comparing the accuracy of the psychiatric diagnoses made under indirect supervision to the diagnoses obtained through Structured Clinical Interview for DSM-III-R (SCID). The study was conducted in 3 university services (outpatient, inpatient and emergency). Data from the emergency service were collected 3 years later, after changes in the training process of the medical staff in psychiatric diagnosis. The sensitivity for Major Depression (outpatient 10.0%; inpatients 60.0%, emergency 90.0%) and Schizophrenia (44.4%; 55.0%; 80.0%) improved over time. The reliability was poor in the outpatient service (Kw = 0.18), and at admission to the inpatient service (Kw = 0.38). The diagnosis elaborated in the discharge of the inpatient service (Kw = 0.55) and in the emergency service (Kw = 0.63) was good. Systematic training of supervisors and residents in operational diagnostic criteria increased the accuracy of psychiatric diagnoses elaborated under indirect supervision, although excellent reliability was not achieved.
authors.affiliation: Department of Neurology, Psychiatry and Medical Psychology, Clinical Hospital, Faculty of Medicine of Ribeirão Preto, São Paulo University, Brazil. delben@fmrp.usp.br
authors.forename: Cristina Marta
authors.initials: CM
authors.lastname: Del-Ben
authors.forename: Jaime Eduardo Cecílio
authors.initials: JE
authors.lastname: Hallak
authors.forename: Alcion
authors.initials: A
authors.lastname: Sponholz
authors.forename: João Mazzoncini de Azevedo
authors.initials: JM
authors.lastname: Marques
authors.forename: Cybelli Morelo
authors.initials: CM
authors.lastname: Labate
authors.forename: José Onildo Betioli
authors.initials: JO
authors.lastname: Contel
authors.forename: Antonio Waldo
authors.initials: AW
authors.lastname: Zuardi
mesh_terms: D000328:Adult; D003865:Major Depressive Disorder / Q000175:diagnosis; D004637:Emergency Services, Psychiatric; D005260:Female; D006801:Humans; D007406:Interview, Psychological / Q000379:methods*; D008297:Male; D001523:Mental Disorders / Q000175:diagnosis*; D011569:Psychiatric Status Rating Scales; D012559:Schizophrenia / Q000175:diagnosis; D012680:Sensitivity and Specificity