Factors associated with diagnostic uncertainty in an acute psychiatric department

Background

Despite the implementation of various classification systems in psychiatric disorders, there is still a diagnostic uncertainty.

Materials and methods

We investigated the possible factors mediating this phenomenon in 141 patients consecutively hospitalized in an acute psychiatric ward of the Psychiatric Hospital of Attica. 141 patients (89 males and 52 females) with a mean age 43 years (range:19-75) were recruited. A questionnaire was completed for each patient, in which psychiatrists rated the degree of certainty associated with the diagnosis.

Results

Diagnosis with a high degree of certainty was possible for 97 patients (68.8%). Certainty in diagnosis increased when the informants were the patient's parents and either lived or had regular contact with the patient. There was a difficulty in diagnostic classification for 44 patients (31.2%). In most of these cases (40 patients, 90.9%) the uncertainty referred to DSM-IV axon I diagnoses. In 31 cases (70.5%) this was due to the difficulty in applying the diagnostic criteria for the present episode, while for 34 patients (77.3%) the reason was the inability to evaluate criteria relating to the disease history and course. Lack of information given by the patient, accounted for the diagnostic uncertainty in 36 patients (81.8%), while in 27 patients (61.4%) the relatives could not provide trustworthy information.

Conclusions

For one third of this sample of acute psychiatric inpatients, there was a difficulty in ascribing a diagnosis with a high degree of certainty. This difficulty mainly involved DSM-IV axon I diagnoses and was associated with a lack of necessary information regarding the current episode and disease course, given by both patients themselves and their relatives.