When it comes to psychiatric diagnoses, criteria for one disorder may spill over into another. One may share symptoms with others, making it difficult at times for doctors to pinpoint what exactly a patient’s dealing with.

When doctors misdiagnose, however, they may hurt their patients’ chances of seeking appropriate treatment. In these circumstances, clinicians can rely on the patient-centered care approach to effectively address patients’ needs while encouraging accurate diagnostic and treatment protocols.

 

Accuracy of psychiatric diagnoses by non-psychiatrists

Before a patient gets referred to a psychiatrist, they may first see a non-psychiatric doctor about their symptoms. At this juncture, it’s not uncommon for these doctors to inaccurately diagnose a patient.

A study published by Medicine looked at 875 patients enrolled in an inpatient program at McGill University Health Center (MUHC).

AlSalem M, AlHarbi MA, Badeghiesh A, et al. Accuracy of initial psychiatric diagnoses given by nonpsychiatric physicians. Medicine. 2020;99(51):e23708.

The initial diagnosis given to 379 (44.8%) of these patients by a previous non-psychiatric doctor was inconsistent with the diagnoses provided by the MUHC consultation-liaison psychiatry service.

 

They didn’t show the same precision, however, when it came to patients with mood disorders such as depression or bipolar disorder, personality disorders, and psychotic disorders.

Another study published by Shanghai Archives of Psychiatry, which looked at rates of misdiagnosis of bipolar disorder in outpatient settings, found that some doctors often diagnosed patients with major depression when bipolar was the more accurate diagnosis.

Shen H, Zhang L, Xu C, et al. Analysis of misdiagnosis of bipolar disorder in an outpatient setting. Shanghai Arch Psychiatry. 30(2):93–101.

 

This is likely because some patients initially met their doctors during a depressive episode. The authors of the study elaborated on the effects of this dynamic, writing, “[T]hese patients apparently lacked insight into their own mania and hypomania symptoms, resulting in difficulties in early diagnosis, longer time needed to confirm the diagnosis, higher rate of hospitalization, and greater number of hospitalizations.”

 

Delirium or catatonia?

Another instance in which doctors may inaccurately diagnose patients is when older adults exhibit symptoms consistent with both delirium and late-onset catatonia.

A case series published by The American Journal of Geriatric Psychiatry stated that late-onset catatonia may be misdiagnosed as delirium due to comparable symptoms such as stupor, agitation, and decreased psychomotor activity among patients.

Ratnakaran B, Neupane B, White JB. A case series on late-onset catatonia misdiagnosed as delirium. The American Journal of Geriatric Psychiatry. 2020;28(4):S105–S106.

 

Electroconvulsive shock therapy can be another effective mode of treatment for patients with this condition.

When clinicians inaccurately diagnose older adult patients with delirium instead of catatonia, they miss the opportunity to help them effectively manage their illness, which may lead to a neglect of high-risk complications associated with the appropriate diagnoses. Although delirium and catatonia share symptoms, they require different treatment protocols.

 

Lean on patient-centered care

If you find yourself struggling to treat a patient who’s been misdiagnosed in the past, or you’re having a hard time diagnosing someone yourself, focusing on maintaining patient-centered care is key.

According to the AMA Journal of Ethics, if diagnostic discrepancies come up, rest assured that no one patient is defined by a singular diagnosis.

Aultman JM. Psychiatric diagnostic uncertainty: challenges to patient-centered care. AMA Journal of Ethics. 2016;18(6):579–586.

Patients are similar to diagnoses in the sense that they aren’t always going to fit perfectly within the boundaries of a given label.

 

Remain sensitive to your patient's concerns and keep their experiences at the center of your decision-making. Ultimately, if the patient’s in your care, it’s up to you to use your clinical knowledge and expertise to determine the most effective course of action in diagnosing and treating the patient.

In some cases, the best course of action may be to refer the patient to a psychiatric provider to establish the appropriate diagnoses more effectively.