Accuracy of psychiatric diagnosis performed under indirect supervision.
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.
Del-Ben
Cristina Marta
CM
Department of Neurology, Psychiatry and Medical Psychology, Clinical Hospital, Faculty of Medicine of Ribeirão Preto, São Paulo University, Brazil. delben@fmrp.usp.br
Hallak
Jaime Eduardo Cecílio
JE
Sponholz
Alcion
A
Marques
João Mazzoncini de Azevedo
JM
Labate
Cybelli Morelo
CM
Contel
José Onildo Betioli
JO
Zuardi
Antonio Waldo
AW
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