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Clinical Practice and Epidemiology in Mental Health

, 4:29

First Online: 16 December 2008Received: 22 May 2008Accepted: 16 December 2008


BackgroundDetection of psychotic disorders is an important issue, since early treatment might improve prognosis. Timely diagnosis of psychotic disorders depends on recognition of psychotic symptoms and their interpretation. The aim of this study is to examine to what extent reported psychotic symptoms are accounted for in clinical diagnosis.

MethodsThe medical files of all patients who had a first contact with one of two mental health care services N = 6477 were screened for reported psychotic symptoms and subsequent clinical diagnosis. Patients who reported psychotic symptoms and who were diagnosed with a psychotic disorder were followed-up for two years to register prescription of antipsychotic treatment and continuity of care.

ResultsIn the files of 242 3.7% patients specific psychotic symptoms were recorded. 37% of these patients were diagnosed with a non-affective psychotic disorder, 7% with other psychotic disorders and 56% with non-psychotic disorders or no diagnosis at all. About 90% of the patients diagnosed with a psychotic disorder did receive any prescription of antipsychotics, and about 50% were in continuous care during the first 2 years.

ConclusionRelatively large proportions of patients presenting with psychotic symptoms were diagnosed with a non-psychotic diagnosis or not diagnosed at all. This applies also to patients reporting at least two or more psychotic symptoms. Although we did not verify the appropriateness of clinical diagnosis, these findings are an indication that psychotic disorders may be underdetected. Improving the diagnostic process in mental health care services may be the most obvious way to promote early intervention in psychosis.

List of abbreviationsAPAAmerican Psychiatric Association

DSM-IVDiagnostic and Statistical Manual of Mental Disorders

NAPDnon-affective psychotic disorder

PTSSPost Traumatic Stress Syndrome.

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Autor: Nynke Boonstra - Lex Wunderink - Sjoerd Sytema - Durk Wiersma


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