a Department of Mental Health , Santa Casa Medical School , São Paulo , Brazil.
b Chair of Psychiatry, Austin Health , University of Melbourne , Melbourne , Australia.
Int J Psychiatry Clin Pract. 2017 Sep;21(3):215-220. doi: 10.1080/13651501.2017.1301483. Epub 2017 Mar 22.
To identify predictors of misidentification of organic mental disorders and delirium in patients undergoing psychiatric liaison consultation.
Data were collected at Santa Casa de São Paulo between July of 2009 and March of 2013. We included in our analysis all inpatients for whom the requesting service judged that a psychiatric consultation was required for a possible mental health condition. Outcomes of interest were the instances of misidentification where a condition was initially deemed to be of a psychiatric nature, whereas the final diagnosis by the liaison psychiatric team was of an organic disease or delirium. Our predictors were the clinical specialty of the requesting service, requester and patient characteristics. A series of generalised linear models were used to evaluate misidentification risks.
A total of 947 subjects met our inclusion criteria, 14.6% having a final liaison diagnosis of organic mental disorder and 8.1% of delirium. Older patients were significantly associated with increased risk of misidentification for both organic conditions (OR 3.01 - 95% CI 2.01, 4.5) and delirium (OR 3.92 - 2.4, 6.39).
Educational interventions in general hospitals focused on preventing psychiatric misdiagnosis should target in-hospital services where patients tend to be older.
确定在接受精神科联络会诊的患者中，有机性精神障碍和谵妄误诊的预测因素。
数据收集于 2009 年 7 月至 2013 年 3 月期间的圣家医院。我们将所有因潜在精神健康状况而被请求服务判断需要进行精神科会诊的住院患者纳入分析。感兴趣的结局是最初被认为具有精神科性质的疾病，但联络精神科团队的最终诊断为器质性疾病或谵妄的误诊情况。我们的预测因素是请求服务的临床专科、请求者和患者的特征。使用一系列广义线性模型来评估误诊风险。
共有 947 名符合纳入标准的患者，14.6%的患者最终联络诊断为器质性精神障碍，8.1%的患者为谵妄。对于有机性疾病（OR 3.01-95%CI 2.01, 4.5）和谵妄（OR 3.92-2.4, 6.39），年龄较大的患者与误诊风险显著相关。
应针对医院内服务开展针对综合医院的教育干预措施，以预防精神病误诊，这些服务的患者往往年龄较大。
