Challenges Diagnosing Psychotic Disorders in Emergency Departments
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Joy Cutler
May 1, 2013, 1:40:02 PM5/1/13
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Please consider this free-reprint article written by:
Joy Cutler
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Article Title: Challenges Diagnosing Psychotic Disorders in Emergency Departments
Author: Joy Cutler
Word Count: 670
Article URL: http://www.isnare.com/?aid=1836645&ca=Medical+Business
Format: 64cpl
Contact The Author: http://www.isnare.com/eta.php?aid=1836645
Easy Publish Tool: http://www.isnare.com/html.php?aid=1836645
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Emergency physicians are tasked with treating patients suffering from physical complaints as well as those with psychiatric problems. Often, however, it can be difficult to determine whether drug or alcohol use is the primary cause for psychosis, or whether the use of illicit substances is simply a side effect of the underlying psychiatric problem. Emergency physicians must often make this determination in the course of treating patients and deciding how to best recommend follow-up care for them. Surprisingly, as many as half of the patients who present at psychiatric emergency departments seeking care use either drugs or alcohol, and often patients will show up to the emergency room while intoxicated. The issue of separating out the two different diseases is an important one because of the implications it will have for the patient as well as the healthcare system at large. For instance, if the patient has a psychiatric disorder but is not treated appropriately, this will impair the healing process. At the same time, if the patient is suffering the effects of substance abuse but is inaccurately diagnosed with a psychiatric condition, this can lead to overtreatment with inappropriate anti-psychotic medications as well as lead the clinician and patient away from substance abuse treatment options.
To test the rates at which these types of misdiagnoses can occur, researchers conducted a study on the behaviors of emergency room physicians at psychiatric emergency departments. The goals of the research were to determine the accuracy of emergency department diagnoses of primary and substance-induced psychosis, and to determine the long-term implications of the diagnoses and their effects on subsequent inpatient hospital admission, use of antipsychotic medication use, and outpatient follow-up treatment. To carry out the study, researchers selected patients who had been diagnosed with early-phase psychosis in psychiatric hospitals in the Manhattan area. To be eligible, patients had to have suffered at least one psychotic symptom during the assessment period, and they had to have used alcohol or drugs within the past 30 days. The participants were interviewed initially, and then at six months, and then 12 months using the Psychiatric Research Interview for Substance and Mental Disorder (known as the PRISM). Researchers also used a test to measure psychotic symptoms called the Positive and Negative Syndrome Scale (PANSS). Each time the study participants were interviewed using these two methods, their urine was also screened to check for evidence of alcohol or drug use. The patients� discharge records were examined as well, along with records of medications prescribed to them (either anti-psychotic medications, psychotropic medications (such as mood stabilizers), or no medication at all).
The results of the study were quite interesting. 75% of the patients who were identified as suffering from a primary psychotic disorder at the emergency room were found to have a primary psychotic disorder when the researchers completed their interviews. For 25% of the study participants (equal to 56 patients), the diagnosis they were given in the emergency department of a primary psychotic disorder did not hold true based upon the researchers� interviews and further investigation. For those patients, the primary affliction that was noted was a substance-induced psychotic disorder and not one that was a primary underlying condition. For those patients who were diagnosed with a substance abuse problem in the emergency department, 71% were similarly identified in the researchers� follow-up studies. So while the overall accuracy rates for diagnosis were quite good for both types of diagnosis, approximately 25% were incorrectly identified. The researchers also noted that for patients with a diagnosis of a primary psychotic disorder, the hospitalization rates were much higher (93%), whereas only 66% of patients diagnosed with substance-abuse induced psychosis were hospitalized.
The authors conclude that more research is needed, and that the study points out the challenges inherent in emergency physician jobs � determining whether a patient has problems with substance abuse or psychiatric disorders can be difficult. The implications of a misdiagnosis are far-reaching and can negatively impact access to care. Future studies should examine ways to improve diagnostic accuracy and eliminate cases of misdiagnosis.
About The Author: Physicians Employment has job listings in more than 200 medical specialties. Some of the most popular include emergency physician jobs, cardiology jobs, urgent care jobs, psychiatry jobs, and many more. Visit http://www.physemp.com/physician_jobs/perma_emergency_jobs.html or call 800-267-6115.
Please use the HTML version of this article at:
http://www.isnare.com/html.php?aid=1836645
*********************** ARTICLE END ***********************
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Message delivered directly to members of the group:
publish-the...@googlegroups.com
*****************************************************************
Please consider this free-reprint article written by:
Joy Cutler
*****************************
IMPORTANT - Publication/Reprint Terms
- You have permission to publish this article electronically in free-only publications such as a website or an ezine as long as the bylines are included.
- You are not allowed to use this article for commercial purposes. The article should only be reprinted in a publicly accessible website and not in a members-only commercial site.
- You are not allowed to post/reprint this article in any sites/publications that contains or supports hate, violence, porn and warez or any indecent and illegal sites/publications.
- You are not allowed to use this article in UCE (Unsolicited Commercial Email) or SPAM. This article MUST be distributed in an opt-in email list only.
- If you distribute this article in an ezine or newsletter, we ask that you send a copy of the newsletter or ezine that contains the article to http://www.isnare.com/eta.php?aid=1836645
- If you post this article in a website/forum/blog, ALL links MUST be set to hyperlinks and we ask that you send a copy of the URL where the article is posted to http://www.isnare.com/eta.php?aid=1836645
- We request that you ask permission from the author if you want to publish this article in print.
The role of iSnare.com is only to distribute this article as part of its Article Distribution feature ( http://www.isnare.com/distribution.php ). iSnare.com does NOT own this article, please respect the author's copyright and this publication/reprint terms. If you do not agree to any of these terms, please do not reprint or publish this article.
*****************************
Article Title: Challenges Diagnosing Psychotic Disorders in Emergency Departments
Author: Joy Cutler
Word Count: 670
Article URL: http://www.isnare.com/?aid=1836645&ca=Medical+Business
Format: 64cpl
Contact The Author: http://www.isnare.com/eta.php?aid=1836645
Easy Publish Tool: http://www.isnare.com/html.php?aid=1836645
*********************** ARTICLE START ***********************
Emergency physicians are tasked with treating patients suffering from physical complaints as well as those with psychiatric problems. Often, however, it can be difficult to determine whether drug or alcohol use is the primary cause for psychosis, or whether the use of illicit substances is simply a side effect of the underlying psychiatric problem. Emergency physicians must often make this determination in the course of treating patients and deciding how to best recommend follow-up care for them. Surprisingly, as many as half of the patients who present at psychiatric emergency departments seeking care use either drugs or alcohol, and often patients will show up to the emergency room while intoxicated. The issue of separating out the two different diseases is an important one because of the implications it will have for the patient as well as the healthcare system at large. For instance, if the patient has a psychiatric disorder but is not treated appropriately, this will impair the healing process. At the same time, if the patient is suffering the effects of substance abuse but is inaccurately diagnosed with a psychiatric condition, this can lead to overtreatment with inappropriate anti-psychotic medications as well as lead the clinician and patient away from substance abuse treatment options.
To test the rates at which these types of misdiagnoses can occur, researchers conducted a study on the behaviors of emergency room physicians at psychiatric emergency departments. The goals of the research were to determine the accuracy of emergency department diagnoses of primary and substance-induced psychosis, and to determine the long-term implications of the diagnoses and their effects on subsequent inpatient hospital admission, use of antipsychotic medication use, and outpatient follow-up treatment. To carry out the study, researchers selected patients who had been diagnosed with early-phase psychosis in psychiatric hospitals in the Manhattan area. To be eligible, patients had to have suffered at least one psychotic symptom during the assessment period, and they had to have used alcohol or drugs within the past 30 days. The participants were interviewed initially, and then at six months, and then 12 months using the Psychiatric Research Interview for Substance and Mental Disorder (known as the PRISM). Researchers also used a test to measure psychotic symptoms called the Positive and Negative Syndrome Scale (PANSS). Each time the study participants were interviewed using these two methods, their urine was also screened to check for evidence of alcohol or drug use. The patients� discharge records were examined as well, along with records of medications prescribed to them (either anti-psychotic medications, psychotropic medications (such as mood stabilizers), or no medication at all).
The results of the study were quite interesting. 75% of the patients who were identified as suffering from a primary psychotic disorder at the emergency room were found to have a primary psychotic disorder when the researchers completed their interviews. For 25% of the study participants (equal to 56 patients), the diagnosis they were given in the emergency department of a primary psychotic disorder did not hold true based upon the researchers� interviews and further investigation. For those patients, the primary affliction that was noted was a substance-induced psychotic disorder and not one that was a primary underlying condition. For those patients who were diagnosed with a substance abuse problem in the emergency department, 71% were similarly identified in the researchers� follow-up studies. So while the overall accuracy rates for diagnosis were quite good for both types of diagnosis, approximately 25% were incorrectly identified. The researchers also noted that for patients with a diagnosis of a primary psychotic disorder, the hospitalization rates were much higher (93%), whereas only 66% of patients diagnosed with substance-abuse induced psychosis were hospitalized.
The authors conclude that more research is needed, and that the study points out the challenges inherent in emergency physician jobs � determining whether a patient has problems with substance abuse or psychiatric disorders can be difficult. The implications of a misdiagnosis are far-reaching and can negatively impact access to care. Future studies should examine ways to improve diagnostic accuracy and eliminate cases of misdiagnosis.
About The Author: Physicians Employment has job listings in more than 200 medical specialties. Some of the most popular include emergency physician jobs, cardiology jobs, urgent care jobs, psychiatry jobs, and many more. Visit http://www.physemp.com/physician_jobs/perma_emergency_jobs.html or call 800-267-6115.
Please use the HTML version of this article at:
http://www.isnare.com/html.php?aid=1836645
*********************** ARTICLE END ***********************
- To distribute your articles go to http://www.isnare.com/distribution.php
- For more free-reprint articles go to http://www.isnare.com
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