Mental health clinicians have previously been reported to express reservations regarding the utility and accuracy of the psychiatric classification systems. In this study we aimed to examine clinicians’ experiences with instances of perceived inaccuracy of a schizophrenia diagnosis.
Mental health clinicians (N = 175) participated in an online survey assessing prevalence and perceived reasons for inaccuracies of a schizophrenia diagnosis. Respondents included psychiatric ward directors (13.1%), senior psychiatrists and psychologists (40.5%), and psychiatry and clinical psychology residents (36%).
Fifty-three percent of respondents reported encountering instances where a schizophrenia diagnosis was assigned even though clinical presentation did not match diagnostic criteria. Seventy-three percent of senior psychiatrists in a position to determine a diagnosis declared assigning schizophrenia even when controversial among clinical staff, and 15% of them declared doing so frequently. The likelihood of frequently assigning a schizophrenia diagnosis even when clearly controversial was predicted by the perception that an inaccurate diagnosis is assigned due to the presence of negative symptoms (OR 2.20, 95% CI 1.04–4.66, p = 0.039) and due to patient-related factors, such as the need to facilitate rehabilitation (OR 1.77, 95% CI 1.07–2.90, p = 0.024).
Although a schizophrenia diagnosis is considered relatively stable and clear, our study indicates that, in clinical practice, the assignment of this diagnosis is frequently controversial. These controversies are associated with the perception that an inaccurate diagnosis is assigned due to diagnostic considerations, or due to the possibility that patients might benefit from such a diagnosis. Implications and limitations for psychiatric practice and discourse are discussed.
Reed GM, Mendonça Correia J, Esparza P, Saxena S, Maj M. The WPA-WHO global survey of psychiatrists’ attitudes towards mental disorders classification. World Psychiatry. 2011;10:118–31. CrossRef
Evans SC, Reed GM, Roberts MC, Esparza P, Watts AD, Correia JM, et al. Psychologists’ perspectives on the diagnostic classification of mental disorders: results from the WHO-IUPsyS Global Survey. Int J Psychol [Internet]. 2013;48:177–93. Available from: http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=3725658&tool=pmcentrez&rendertype=abstract.
Raskin JD, Gayle MC. DSM-5: do psychologists really want an alternative? J Humanist Psychol. 2016;56:439–56 SAGE Publications Sage CA: Los Angeles, CA. CrossRef
Sullivan G, Mittal D, Reaves CM, Haynes TF, Han X, Mukherjee S, et al. Influence of schizophrenia diagnosis on providers’ practice decisions. J Clin Psychiatry. 2015;76:1068–74. CrossRef
Link BG, Struening EL, Neese-Todd S, Asmussen S, Phelan JC. Stigma as a barrier to recovery: the consequences of stigma for the self-esteem of people with mental illnesses. Psychiatr Serv. 2001;52:1621–6. CrossRef
Link BG, Struening EL, Rahav M, Phelan JC, Nuttbrock L. On stigma and its consequences: evidence from a longitudinal study of men with dual diagnoses of mental illness and substance abuse. J Health Soc Behav. 1997;38:177–90. CrossRef
Rosenfield S. Labeling mental illness: the effects of received services and perceived stigma on life satisfaction. Am Sociol Rev. 1997;62:660–72. CrossRef
Rössler W, Joachim Salize H, Van Os J, Riecher-Rössler A. Size of burden of schizophrenia and psychotic disorders. Eur Neuropsychopharmacol. 2005:399–409. CrossRef
Sirey JA, Bruce ML, Alexopoulos GS, Perlick DA, Friedman SJ, Meyers BS. Stigma as a barrier to recovery: perceived stigma and patient-rated severity of illness as predictors of antidepressant drug adherence. Psychiatr Serv. 2001;52:1615–20. CrossRef
Świtaj P, Wciórka J, Smolarska-Świtaj J, Grygiel P. Extent and predictors of stigma experienced by patients with schizophrenia. Eur Psychiatry. 2009;24:513–20. CrossRef
Sartorius N, Schulze H. Reducing the stigma of mental illness: a report from a global Programme of the world psychiatric association. Reducing stigma Ment. Illn. A Rep. From a Glob. Program. World Psychiatr. Assoc. 2005.
Kingdon D, Sharma T, Hart D. What attitudes do psychiatrists hold towards people with mental illness? Psychiatr Bull. 2004;28:401–6. CrossRef
Gunderson JG, Singer MT. Defining borderline patients: an overview. Am J Psychiatry. 1975:1–10.
Horgan D. Change of diagnosis to manic-depressive illness. Psychol Med. 1981;11:517–23. CrossRef
Yee L, Korner AJ, McSwiggan S, Meares RA, Stevenson J. Persistent hallucinosis in borderline personality disorder. Compr Psychiatry. 2005;46:147–54. CrossRef
Joyce PR. Age of onset in bipolar affective disorder and misdiagnosis as schizophrenia. Psychol Med. 1984;14:145–9. CrossRef
Pope HG, Jonas JM, Hudson JI, Cohen BM, Tohen M. An empirical study of psychosis in borderline personality disorder. Am J Psychiatry. 1985;142:1285–90. CrossRef
Gonzalez-Pinto A, Gutierrez M, Mosquera F, Ballesteros J, Lopez P, Ezcurra J, et al. First episode in bipolar disorder: misdiagnosis and psychotic symptoms. J Affect Disord. 1998;50:41–4. CrossRef
Haasen C, Yagdiran O, Mass R, Krausz M. Potential for misdiagnosis among Turkish migrants with psychotic disorders: a clinical controlled study in Germany. Acta Psychiatr Scand. 2000;101:125–9. CrossRef
Jones BE, Gray BA. Problems in diagnosing schizophrenia and affective disorders among blacks. Hosp Community Psychiatry. 1986;37:61–5. PubMed
Bell CC, Mehta H. The misdiagnosis of black patients with manic depressive illness. J Natl Med Assoc [Internet]. 1980;72:141–145. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2552475/
Bell CC, Mehta H. Misdiagnosis of black patients with manic depressive illness: second in a series. J Natl Med Assoc [Internet]. 1981;73:101–107. Available from: http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=2552632&tool=pmcentrez&rendertype=abstract
Bromet EJ, Naz B, Fochtmann LJ, Carlson GA, Tanenberg-Karant M. Long-term diagnostic stability and outcome in recent first-episode cohort studies of schizophrenia. Schizophr. Bull. 2005;31:639–49. CrossRef
Paris J. Is hospitalization useful for suicidal patients with borderline personality disorder? J Pers Disord [Internet]. 2004;18:240–7. Available from: https://guilfordjournals.com/doi/10.1521/pedi.220.127.116.11443. https://doi.org/10.1521/pedi.18.104.22.168443. CrossRef
Bury JE, Bostwick JM. Iatrogenic delusional parasitosis: a case of physician-patient folie a deux. Gen Hosp Psychiatry. 2010;32:210–2. CrossRef
Pope HG, Jonas JM, Jones B. Factitious psychosis: phenomenology, family history, and long-term outcome of nine patients. Am J Psychiatry. 1982;139:1480–3. CrossRef
Mead MA, Hohenshil TH, Singh K. How the DSM system is used by clinical counselors: A national study. J Ment Heal Couns [Internet]. 1997;19:383. Available from: http://search.ebscohost.com/login.aspx?direct=true&db=a9h&AN=226909&site=ehost-live&scope=site.
Bartlett MS. A note on the multiplying factors for various X2 approximations. J R Stat Soc. 1954.
Kaiser HF. A second generation little jiffy. Psychometrika. 1970.
Kaiser HF. An index of factorial simplicity. Psychometrika. 1974.
Tsuang MT, Woolson RF, Winokur G, Crowe RR. Stability of psychiatric diagnosis. Schizophrenia and affective disorders followed up over a 30- to 40-year period. Arch Gen Psychiatry [Internet]. 1981;38:535–9. Available from: http://archpsyc.jamanetwork.com/data/Journals/PSYCH/12341/archpsyc_38_5_005.pdf CrossRef
Hollis C. Adult outcomes of child- and adolescent-onset schizophrenia: diagnostic stability and predictive validity. Am J Psychiatry. 2000;157:1652–9. CrossRef
Frances A. The new crisis of confidence in psychiatric diagnosis. Ann Intern Med. 2013:720. CrossRef
Kendler KS. The phenomenology of major depression and the representativeness and nature of DSM criteria. Am J Psychiatry. 2016:771–80. CrossRef
Andreasen NC. DSM and the death of phenomenology in America: an example of unintended consequences. Schizophr Bull. 2007;33:108–12. CrossRef
Hyman SE. The diagnosis of mental disorders: the problem of reification. Annu Rev Clin Psychol Annual Reviews. 2010;6:155–79. CrossRef
Kendler KS. DSM issues: incorporation of biological tests, avoidance of reification, and an approach to the “box canyon problem”. Am J Psychiatry. 2014;171:1248–50. CrossRef
Kendell R, Jablensky A. Distinguishing between the validity and utility of psychiatric diagnoses. Am J Psychiatry. 2003.
Jablensky A. Psychiatric classifications: validity and utility. World Psychiatry. 2016.
Whooley O. Diagnostic ambivalence: psychiatric workarounds and the diagnostic and statistical manual of mental disorders. Sociol Heal Illn. 2010;32:452–69. CrossRef
American Psychiatric Association. Highlights of Changes from DSM-IV-TR to DSM-5. Am Psychiatr Assoc Washington, … [Internet]. 2013;19. Available from: https://dsm.psychiatryonline.org/doi/abs/10.1176/appi.books.9780890425596.changes.
Dobransky K. The good, the bad, and the severely mentally ill: official and informal labels as organizational resources in community mental health services. Soc Sci Med. 2009;69:722–8. CrossRef
Wakefield JC. DSM-5 and clinical social work: mental disorder and psychological justice as goals of clinical intervention. Clin Soc Work J. 2013;41:131–8. CrossRef
Probst B. “Walking the tightrope:” clinical social workers’ use of diagnostic and environmental perspectives. Clin Soc Work J. 2013;41:184–91. CrossRef
Rost K, Smith R, Matthews DB, Guise B. The deliberate misdiagnosis of major depression in primary care. Arch Fam Med. 1994;3:333–7. CrossRef
Roe D, Gross R, Kravetz S, Baloush-Kleinman V, Rudnick A. Assessing psychiatric rehabilitation service (PRS) outcomes in Israel: conceptual, professional and social issues. Isr J Psychiatry Relat Sci. 2009;46(2):103–10. PubMed
- Attitudes of mental health clinicians toward perceived inaccuracy of a schizophrenia diagnosis in routine clinical practice
Dana Tzur Bitan
Ariella Grossman Giron
- BioMed Central
Neu im Fachgebiet Psychiatrie
Meistgelesene Bücher aus dem Fachgebiet
Mail Icon II