Daigneault Andrée, Duclos Catherine, Saury Sybille, Paquet Jean, Dumont Daniel, Beaulieu Serge
Hôpital du Sacré-Cœur de Montréal, Montréal, Québec, Canada; Douglas Mental Health University Institute, Montréal, Québec, Canada; Université de Montréal, Montréal, Québec, Canada; McGill University, Montréal, Québec, Canada.
Hôpital du Sacré-Cœur de Montréal, Montréal, Québec, Canada; Douglas Mental Health University Institute, Montréal, Québec, Canada; Université de Montréal, Montréal, Québec, Canada.
J Affect Disord. 2015 Mar 15;174:225-32. doi: 10.1016/j.jad.2014.10.057. Epub 2014 Nov 8.
Studies suggest that misdiagnosis of bipolar disorders (BD) is frequent in primary care. This study aimed to evaluate agreement between referral for BD by general practitioners (GP) and BD diagnosis by secondary care psychiatrists, and to evaluate the impact of age, gender, and BD type on agreement.
The study was conducted at Hôpital du Sacré-Coeur de Montréal׳s "Module Evaluation/Liaison" (MEL), which establishes/clarifies psychiatric diagnoses requested mainly from GPs and directs patients to appropriate treatment and care. Socio-demographic variables, reason for referral, and psychiatric diagnosis were compiled for patients assessed from 1998 to 2010. GP-psychiatrist agreement was established for BD type, gender, and age group (18-25, 26-35, 36-45, >45) using Cohen׳s Kappa coefficient (Κ).
From 1998 to 2010, MEL psychiatrists received 18,111 requests and carried out 10,492 (58%) assessments. There were 583 referrals for BD suspicion, while 640 assessments (6.1%) received a BD diagnosis (40.3% type I, 40.5% type II). The overall K was 0.35 (95% CI [0.31, 0.38]), and was significantly higher for type I than type II (I=0.35, 95% CI [0.30, 0.39]; II=0.25, 95% CI [0.21, 0.30]), though age group and gender had no impact.
Reasons for referral were converted into keywords and categories to facilitate agreement analyses. Only the main psychiatric diagnosis was available.
Our study suggests diagnosing BD remains strenuous, regardless of age and gender, though BD type I seems better understood by primary care GPs. The true measure of BD diagnosis remains a critical issue in clinical practice.
研究表明，双相情感障碍（BD）在初级保健中误诊情况频发。本研究旨在评估全科医生（GP）转诊的BD病例与二级保健精神科医生做出的BD诊断之间的一致性，并评估年龄、性别和BD类型对一致性的影响。
该研究在蒙特利尔圣心医院的“评估/联络模块”（MEL）进行，该模块主要根据全科医生的请求确立/明确精神科诊断，并指导患者接受适当的治疗和护理。收集了1998年至2010年接受评估患者的社会人口统计学变量、转诊原因和精神科诊断。使用科恩卡方系数（Κ）确定全科医生与精神科医生在BD类型、性别和年龄组（18 - 25岁、26 - 35岁、36 - 45岁、>45岁）方面的一致性。
1998年至2010年，MEL精神科医生收到18111份请求，进行了10492次（58%）评估。有583例疑似BD转诊病例，而640例评估（6.1%）被诊断为BD（I型占40.3%，II型占40.5%）。总体Κ值为0.35（95%置信区间[0.31, 0.38]），I型的Κ值显著高于II型（I型 = 0.35，95%置信区间[0.30, 0. ;II型 = 0.25，95%置信区间[0.21, 0.30]），不过年龄组和性别对此无影响。
转诊原因被转换为关键词和类别以方便一致性分析。仅提供了主要精神科诊断。
我们的研究表明，无论年龄和性别，BD的诊断仍然困难，尽管初级保健全科医生似乎对I型BD的理解更好。BD诊断的准确衡量在临床实践中仍然是一个关键问题。
