Accuracy rates of recognition of psychiatric disorders by nonpsychiatry specialists in a consultation-liaison service of a university hospital [Bir üniversite hastanesi konsültasyon liyezon servisinde psikiyatrik hastaliklarin psikiyatri dişi hekimlerce dogru taninma oranlari]

Objective: Psychiatric comorbidity has been found to be associated with increased length of hospital stay, increased morbidity and mortality. For example cognitive disorders were found to be associated with increased length of hospital stay, increased morbidity, and mortality for adult patients of all ages. Although psychiatric comorbidity is high in medical illnesses, it is not recognized and treated sufficiently. In this study we aimed to investigate the accuracy of all psychiatric referrals and agreement between primary medical providers and consulting psychiatrists in terms of initial and final psychiatric diagnosis. Method: A retrospective review of all consultation requests from January 1, to June 30, 2003 was evaluated. The accuracy rate between the initial psychiatric diagnoses determined by primary medical providers and the final psychiatric diagnoses determined by consultant psychiatrists was calculated and measure of agreement in terms of psychiatric diagnoses between two doctors was evaluated. Results: A total of 580 psychiatric referrals (277 men, 47.8%; 303 women, 52.2%) were retrospectively reviewed. Mean age of the sample was 46.36 (SD=19.83) years. Psychiatric referrals were requested 40% from surgery departments (general surgery, plastic and reconstructive surgery, obstetrics and gynecology, chest heart blood vessel surgery, neurosurgery, orthopedics, and urology), 25.3% from emergency service, 10.5% from internal medicine departments, and 24.7 % from other inpatient clinics of the center. Final psychiatric diagnoses of 580 patients were classified as depressive disorders (33.8%), anxiety disorders (4%), adjustment disorders (13.3%), psychotic disorders (6.6%), cognitive disorders (14.3%), bipolar disorder (1.4%), alcohol and substance use disorders (4.8%), personality disorders (1.7%), no active psychopathology (14%) and other (6.1%). In this study primary medical providers requested psychiatric referrals for five different psychiatric disorder categories. They were; depressive disorders, cognitive disorders, substance use disorders, anxiety disorders, and somatoform disorders. There were no psychiatric referrals for psychosis, adjustment disorder or bipolar disorder. Therefore in this study accuracy rates of five psychiatric disorder categories and agreement between two doctors were assessed. The accuracy rates of depressive and cognitive disorders were similar (57% and 52.3% respectively) hence substance use disorders were assigned 79.2% accurately. The accuracy rates for anxiety disorders and somatoform disorders were 26.5% and 41.2% respectively. The degree of agreement between two doctors for substance use disorders was high (kappa value=0.718), but for the rest four diagnostic categories (depressive disorders, cognitive disorders, anxiety disorders, somatoform disorders) it was moderate or low. Conclusions: This study showed that substance use disorders were recognized well, whereas, depression and anxiety disorders which are seen more frequently than other psychiatric disorders among inpatients were recognised poorly by primary medical care providers.