Misidentification of mental health symptoms in presence of organic diseases and delirium during psychiatric liaison consulting.
OBJECTIVE
To identify predictors of misidentification of organic mental disorders and delirium in patients undergoing psychiatric liaison consultation.


METHODS
Data were collected at Santa Casa de São Paulo between July of 2009 and March of 2013. We included in our analysis all inpatients for whom the requesting service judged that a psychiatric consultation was required for a possible mental health condition. Outcomes of interest were the instances of misidentification where a condition was initially deemed to be of a psychiatric nature, whereas the final diagnosis by the liaison psychiatric team was of an organic disease or delirium. Our predictors were the clinical specialty of the requesting service, requester and patient characteristics. A series of generalised linear models were used to evaluate misidentification risks.


RESULTS
A total of 947 subjects met our inclusion criteria, 14.6% having a final liaison diagnosis of organic mental disorder and 8.1% of delirium. Older patients were significantly associated with increased risk of misidentification for both organic conditions (OR 3.01 - 95% CI 2.01, 4.5) and delirium (OR 3.92 - 2.4, 6.39).


CONCLUSIONS
Educational interventions in general hospitals focused on preventing psychiatric misdiagnosis should target in-hospital services where patients tend to be older.
a Department of Mental Health , Santa Casa Medical School , São Paulo , Brazil.
Victor Henrique Oyamada
VHO
Otani
a Department of Mental Health , Santa Casa Medical School , São Paulo , Brazil.
Thaís Zélia Dos Santos
TZDS
Otani
a Department of Mental Health , Santa Casa Medical School , São Paulo , Brazil.
Andrea
A
Freirias
a Department of Mental Health , Santa Casa Medical School , São Paulo , Brazil.
Elie Leal de Barros
ELB
Calfat
a Department of Mental Health , Santa Casa Medical School , São Paulo , Brazil.
Patricia Satiko
PS
Aoki
a Department of Mental Health , Santa Casa Medical School , São Paulo , Brazil.
Quirino
Q
Cordeiro
b Chair of Psychiatry, Austin Health , University of Melbourne , Melbourne , Australia.
Richard A A
RAA
Kanaan
c Maudsley Simulation, South London & Maudsley Foundation NHS Trust , Lambeth Hospital , London , UK.
Sean
S
Cross
d School of Nursing, Faculty of Science, Medicine and Health University of Wollongong , Wollongong , Australia.
Susan
S
Liersch-Sumskis
a Department of Mental Health , Santa Casa Medical School , São Paulo , Brazil.
Ricardo Riyoiti
RR
Uchida
D000328:Adult; D003693:Delirium / Q000175:diagnosis*; D003951:Diagnostic Errors / Q000706:statistics & numerical data*; D005260:Female; D006748:Hospital Departments / Q000706:statistics & numerical data; D006801:Humans; D016014:Linear Models; D008297:Male; D001523:Mental Disorders / Q000175:diagnosis*; D008875:Middle Aged; D019965:Neurocognitive Disorders / Q000175:diagnosis*; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D055815:Young Adult
Diagnostic errors; delirium; psychiatry; referral and consultation