Clinical Edge

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Avoiding Incorrect Diagnoses of Schizophrenia

J Psychiatr Pract; 2019 Mar; Coulter, Baker, et al

Making the diagnosis of a psychotic disorder, especially earlier in the course of disease, can be challenging, and an incorrect diagnosis of a psychotic disorder may also have significant consequences. This according to a recent study where researchers conducted a retroactive chart review of 78 patients referred to a specialty early psychosis consultation clinic to examine the role of specialty clinics in clarifying the diagnosis of early psychosis, especially potential schizophrenia. They found:

  • Of total patients, 43 (55%) had a primary diagnosis at referral of a schizophrenia spectrum disorder.
  • The primary diagnosis in the consultation clinic was different in 22 (51%) of these 43 cases, and 18 (42%) of these patients were not diagnosed with any form of primary psychotic disorder.
  • These patients were more likely to report anxiety and less likely to report thought disorder than patients with a consultation diagnosis of schizophrenia or schizoaffective disorder.
  • Clinicians may, therefore, overdiagnose schizophrenia, demonstrating the value of second opinions from clinics specializing in the diagnosis of recent-onset psychosis.

Coulter C, Baker KK, Margolis RL. Specialized consultation for suspected recent-onset schizophrenia: Diagnostic clarity and the distorting impact of anxiety and reported auditory hallucinations. J Psychiatr Pract. 2019;25(2):76-81. doi:10.1097/PRA.0000000000000363.