Getinet Ayano1,2, Sileshi Demelash3, Zegeye Yohannes4, Kibrom Haile4, Mikiyas Tulu4, Dawit Assefa4, Abel Tesfaye4,5, Kelemua Haile4, Melat Solomon4, Asrat Chaka4, Light Tsegay6. 1. Research and Training Department, Amanuel Mental Specialized Hospital, Addis Ababa, Ethiopia. babiget2015@gmail.com. 2. School of Public Health, Curtin University, Perth, WA, Australia. babiget2015@gmail.com. 3. Ethiopian Public Health Institute, Addis Ababa, Ethiopia. 4. Research and Training Department, Amanuel Mental Specialized Hospital, Addis Ababa, Ethiopia. 5. Department of Medicine, Hawassa University, Hawassa, Ethiopia. 6. Department of Psychiatry, Axum University, Axum, Ethiopia.
Abstract
BACKGROUND: There are limited studies on the prevalence of misdiagnosis as well as detection rates of severe psychiatric disorders in specialized and non-specialized healthcare settings. To the best of our knowledge, this is the first study to determine the prevalence of misdiagnosis and detection rates of severe psychiatric disorders including schizophrenia, schizoaffective, bipolar, and depressive disorders in a specialized psychiatric setting. METHOD: In this cross-sectional study, a random sample of 309 patients with severe psychiatric disorders was selected by systematic sampling technique. Severe psychiatric disorders were assessed using the Structured Clinical Interview for DSM-IV (SCID). The potential determinates of misdiagnosis were explored using univariable and multivariable logistic regression models, adjusting for the potential confounding factors. RESULT: This study revealed that more than a third of patients with severe psychiatric disorders were misdiagnosed (39.16%). The commonly misdiagnosed disorder was found to be a schizoaffective disorder (75%) followed by major depressive disorder (54.72%), schizophrenia (23.71%), and bipolar disorder (17.78%). Among the patients detected with the interview by SCID criteria, the highest level of the correct diagnosis was recorded in the medical record for schizophrenia (76.29%) followed by bipolar (72.22%), depressive (42.40%), and schizoaffective (25%) disorders with detection rate (sensitivity) of 0.76 (95% CI 0.69-0.84), 0.42 (95% CI 0.32-0.53), 0.72 (95% CI 0.60-0.84), and 0.25 (95% CI 0.09-0.41), respectively for schizophrenia, depressive, bipolar, and schizoaffective disorders. Patients with bipolar disorder were more likely to be misdiagnosed as having schizophrenia (60%), whereas schizophrenic patients were more likely to be misdiagnosed as having bipolar disorder (56.25%) and patients with depressive disorders were more likely to be misdiagnosed as having schizophrenia (54.72%). Having a diagnosis of schizoaffective and depressive disorders, as well as suicidal ideation, was found to be significant predictors of misdiagnosis. CONCLUSION: This study showed that roughly four out of ten patients with severe psychiatric disorders had been misdiagnosed in a specialized psychiatric setting in Ethiopia. The highest rate of misdiagnosis was observed for schizoaffective disorder (3 out of 4), followed by major depressive disorder (1 out of 2), schizophrenia (1 out of 4), and bipolar disorders (1 in 5). The detection rates were highest for schizophrenia, followed by bipolar, depressive, and schizoaffective disorders. Having a diagnosis of schizoaffective and depressive disorders as well as suicidal ideation was found to be significant predictors of misdiagnosis.
BACKGROUND: There are limited studies on the prevalence of misdiagnosis as well as detection rates of severe psychiatric disorders in specialized and non-specialized healthcare settings. To the best of our knowledge, this is the first study to determine the prevalence of misdiagnosis and detection rates of severe psychiatric disorders including schizophrenia, schizoaffective, bipolar, and depressive disorders in a specialized psychiatric setting. METHOD: In this cross-sectional study, a random sample of 309 patients with severe psychiatric disorders was selected by systematic sampling technique. Severe psychiatric disorders were assessed using the Structured Clinical Interview for DSM-IV (SCID). The potential determinates of misdiagnosis were explored using univariable and multivariable logistic regression models, adjusting for the potential confounding factors. RESULT: This study revealed that more than a third of patients with severe psychiatric disorders were misdiagnosed (39.16%). The commonly misdiagnosed disorder was found to be a schizoaffective disorder (75%) followed by major depressive disorder (54.72%), schizophrenia (23.71%), and bipolar disorder (17.78%). Among the patients detected with the interview by SCID criteria, the highest level of the correct diagnosis was recorded in the medical record for schizophrenia (76.29%) followed by bipolar (72.22%), depressive (42.40%), and schizoaffective (25%) disorders with detection rate (sensitivity) of 0.76 (95% CI 0.69-0.84), 0.42 (95% CI 0.32-0.53), 0.72 (95% CI 0.60-0.84), and 0.25 (95% CI 0.09-0.41), respectively for schizophrenia, depressive, bipolar, and schizoaffective disorders. Patients with bipolar disorder were more likely to be misdiagnosed as having schizophrenia (60%), whereas schizophrenicpatients were more likely to be misdiagnosed as having bipolar disorder (56.25%) and patients with depressive disorders were more likely to be misdiagnosed as having schizophrenia (54.72%). Having a diagnosis of schizoaffective and depressive disorders, as well as suicidal ideation, was found to be significant predictors of misdiagnosis. CONCLUSION: This study showed that roughly four out of ten patients with severe psychiatric disorders had been misdiagnosed in a specialized psychiatric setting in Ethiopia. The highest rate of misdiagnosis was observed for schizoaffective disorder (3 out of 4), followed by major depressive disorder (1 out of 2), schizophrenia (1 out of 4), and bipolar disorders (1 in 5). The detection rates were highest for schizophrenia, followed by bipolar, depressive, and schizoaffective disorders. Having a diagnosis of schizoaffective and depressive disorders as well as suicidal ideation was found to be significant predictors of misdiagnosis.
Authors: M M Weissman; R C Bland; G J Canino; C Faravelli; S Greenwald; H G Hwu; P R Joyce; E G Karam; C K Lee; J Lellouch; J P Lépine; S C Newman; M Rubio-Stipec; J E Wells; P J Wickramaratne; H Wittchen; E K Yeh Journal: JAMA Date: 1996 Jul 24-31 Impact factor: 56.272
Authors: S Zisook; L A McAdams; J Kuck; M J Harris; A Bailey; T L Patterson; L L Judd; D V Jeste Journal: Am J Psychiatry Date: 1999-11 Impact factor: 18.112
Authors: A J Ferrari; A J Somerville; A J Baxter; R Norman; S B Patten; T Vos; H A Whiteford Journal: Psychol Med Date: 2012-07-25 Impact factor: 7.723
Authors: Nityanand Jain; Sakshi Prasad; Zsófia Csenge Czárth; Swarali Yatin Chodnekar; Srinithi Mohan; Elena Savchenko; Deepkanwar Singh Panag; Andrei Tanasov; Marta Maria Betka; Emilia Platos; Dorota Świątek; Aleksandra Małgorzata Krygowska; Sofia Rozani; Mahek Srivastava; Kyriacos Evangelou; Kitija Lucija Gristina; Alina Bordeniuc; Amir Reza Akbari; Shivani Jain; Andrejs Kostiks; Aigars Reinis Journal: J Prim Care Community Health Date: 2022 Jan-Dec
Authors: Grace Png; Andrei Barysenka; Linda Repetto; Pau Navarro; Xia Shen; Maik Pietzner; Eleanor Wheeler; Nicholas J Wareham; Claudia Langenberg; Emmanouil Tsafantakis; Maria Karaleftheri; George Dedoussis; Anders Mälarstig; James F Wilson; Arthur Gilly; Eleftheria Zeggini Journal: Nat Commun Date: 2021-12-02 Impact factor: 14.919