Do we agree about when patients are psychotic?
OBJECTIVE
To investigate into the use of the term 'psychotic' as defined by ICD-10 or by the concept of impaired reality testing, among psychiatric staff members.


METHODS
Questionnaire investigation using 11 short case vignettes.


RESULTS
Responses were received from 266 psychiatric staff members: psychiatrists, nursing staff and psychologists. When using ICD-10, patients were identified as psychotic with a sensitivity ranging from 90% to 55%. Specificity ranged from 60% to 75%. According to the concept of impaired reality testing, all three groups showed a sensitivity of about 60%, whereas specificity ranged from 65% to 50%. The combined use of the terms correlated significantly with responses regarding indication for legal detention for psychiatrists and nursing staff.


CONCLUSIONS
In identifying a patient as 'psychotic' a broad concept of impaired reality testing was widely used particularly in cases with legal issues. Psychotic symptoms, however, were identified with high sensitivity and specificity.
Nielsen
J
J
Unit for Psychiatric Research, Aalborg Psychiatric Hospital, Aalborg, Denmark. jin@rn.dk
Mogensen
B
B
Martiny
K
K
Stage
K B
KB
Larsen
J K
JK
Lindhardt
A
A
Bertelsen
A
A