Second Opinions for Diagnoses of Psychotic Disorders: Delivering Stage-Specific Recommendations.

IF 3.3 3区医学 Q1 HEALTH POLICY & SERVICES

Psychiatric services Pub Date : 2024-10-01 Epub Date: 2024-06-28 DOI:10.1176/appi.ps.20230623

Carol Lim, Abigail L Donovan, Sophie Freudenreich, Corinne Cather, Sarah Maclaurin, Oliver Freudenreich

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引用次数: 0

Abstract

Objective: The impact of obtaining second-opinion consultations on diagnoses of schizophrenia spectrum disorders was evaluated.

Methods: A retrospective chart review was conducted for 177 patients referred to a psychosis consultation service at an academic medical center from January 1, 2017, to October 1, 2023; these consultations aimed to clarify a diagnosis of psychosis. Diagnoses made before and after consultations were compared, and treatment recommendations resulting from the consultation visit were summarized.

Results: Among patients without a preconsultation diagnosis of schizophrenia, 28% (N=28 of 100) received a postconsultation diagnosis of schizophrenia. Among 62 patients with a postconsultation diagnosis of treatment-resistant schizophrenia (TRS), 56% (N=35) received this diagnosis only after consultation. Nearly all of these patients were advised to begin taking clozapine, and electroconvulsive therapy was less commonly recommended.

Conclusions: Expert consultation facilitates timely identification and optimal treatment of schizophrenia and its more severe subtype, TRS.

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精神病诊断的第二意见：提供针对特定阶段的建议。

目的：评估第二意见咨询对精神分裂症谱系障碍诊断的影响：评估获得第二意见咨询对精神分裂症谱系障碍诊断的影响：对2017年1月1日至2023年10月1日期间转诊至某学术医疗中心精神病咨询服务的177名患者进行了回顾性病历审查；这些会诊旨在明确精神病的诊断。对会诊前后的诊断结果进行了比较，并总结了会诊后提出的治疗建议：在会诊前未确诊为精神分裂症的患者中，28%（100 人中有 28 人）在会诊后确诊为精神分裂症。在 62 名会诊后确诊为耐药精神分裂症（TRS）的患者中，56%（35 人）是在会诊后才确诊的。几乎所有这些患者都被建议开始服用氯氮平，而电休克疗法则较少被推荐：专家会诊有助于及时发现精神分裂症及其更严重的亚型 TRS，并对其进行最佳治疗。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Psychiatric services 医学-公共卫生、环境卫生与职业卫生

CiteScore

5.80

自引率

7.90%

发文量

295

审稿时长

3-8 weeks

期刊介绍： Psychiatric Services, established in 1950, is published monthly by the American Psychiatric Association. The peer-reviewed journal features research reports on issues related to the delivery of mental health services, especially for people with serious mental illness in community-based treatment programs. Long known as an interdisciplinary journal, Psychiatric Services recognizes that provision of high-quality care involves collaboration among a variety of professionals, frequently working as a team. Authors of research reports published in the journal include psychiatrists, psychologists, pharmacists, nurses, social workers, drug and alcohol treatment counselors, economists, policy analysts, and professionals in related systems such as criminal justice and welfare systems. In the mental health field, the current focus on patient-centered, recovery-oriented care and on dissemination of evidence-based practices is transforming service delivery systems at all levels. Research published in Psychiatric Services contributes to this transformation.