Mental health researchers discovered that at least half of people diagnosed with schizophrenia at a Baltimore clinic had been misdiagnosed and were suffering only from anxiety. A misdiagnosis can have far reaching implications for a person who could simply undergo the correct treatment for anxiety.
What this new study conducted by experts from the John Hopkins University suggests is that overdiagnosis of a serious mental illness may be a national problem that could be causing inappropriate and delayed treatment.
Central to the study was the method used by general health practitioners to make their diagnoses. According to the Schizophrenia and Related Disorders Alliance of America, there are five common symptoms that need to be present before a person can be diagnosed with schizophrenia. This includes delusions, hallucinations, disorganized speech, disorganized or "catatonic" behavior, and negative symptoms.
However, while many general practitioners were making their diagnoses according to this list, they were not necessarily seeking a second opinion from a psychiatry specialist or clinic. At issue is that, although auditory hallucinations are considered to be one of the symptoms of schizophrenia, symptoms of anxiety and hearing voices were also the most common reasons for misdiagnosis.
"Hearing voices is a symptom of many different conditions, and sometimes it is just a fleeting phenomenon with little significance," explained Russell L. Margolis, who was involved in the study.
"At other times when someone reports 'hearing voices,' it may be a general statement of distress rather than the literal experience of hearing a voice. The key point is that hearing voices on its own doesn’t mean a diagnosis of schizophrenia."
To arrive at these findings, the research team looked at the patients referred to the Johns Hopkins Early Psychosis Intervention Clinic with schizophrenia diagnoses. They analyzed data from 78 cases referred by non-specialty physicians for consultation between February 2011 and July 2017.
The clinic conducted extensive interviews with the patients as well as their families, performed physical exams then had patients fill in questionnaires before looking at their medical and psychosocial histories.
What the team found was that, of the 54 people who came in with a predetermined diagnosis of schizophrenia, only 26 received a confirmed diagnosis. Fifty-one% of the 54 cases were diagnosed as having anxiety or mood disorders. Anxiety symptoms were prominent in 14 of those misdiagnosed patients.
"The big take-home message from our study is that careful consultative services by experts are important and likely underutilized in psychiatry," said Margolis.
"Just as a primary care clinician would refer a patient with possible cancer to an oncologist or a patient with possible heart disease to a cardiologist, it’s important for general mental health practitioners to get a second opinion from a psychiatry specialty clinic like ours for patients with confusing, complicated, or severe conditions. This may minimize the possibility that a symptom will be missed or overinterpreted," he added.
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