ABSTRACT
OBJECTIVE: This study aimed to examine the stability of psychiatric emergency diagnoses and factors influencing diagnostic concordance. METHODS: The concordance between psychiatric emergency and inpatient diagnoses was calculated using kappa coefficient. The groups with and without psychiatric diagnostic stability were compared to determine factors influencing diagnostic stability. RESULTS: Agreement between psychiatric emergency and inpatient diagnoses was fair (range of kappa=.48-.56) for bipolar, schizophrenia, schizoaffective and depressive disorders. Results indicated that patients with stable diagnoses between psychiatric emergency and inpatient settings are likely to arrive on legal holds and that patients without concurring diagnoses are likely to have a higher medical burden. CONCLUSION: Further studies exploring ways to improve diagnostic stability in psychiatric emergency setting are warranted.
Subject(s)
Emergency Services, Psychiatric , Mental Disorders/diagnosis , Patient Admission , Academic Medical Centers , Adult , Bipolar Disorder/diagnosis , Bipolar Disorder/epidemiology , California , Dangerous Behavior , Depressive Disorder/diagnosis , Depressive Disorder/epidemiology , Diagnosis, Differential , Diagnostic and Statistical Manual of Mental Disorders , Female , Humans , Length of Stay/statistics & numerical data , Male , Mental Disorders/epidemiology , Middle Aged , Patient Readmission/statistics & numerical data , Psychotic Disorders/diagnosis , Psychotic Disorders/epidemiology , Referral and Consultation/statistics & numerical data , Reproducibility of Results , Schizophrenia/diagnosis , Schizophrenia/epidemiology , Statistics as TopicABSTRACT
BACKGROUND: The objective of the current study was to examine possible clinical predictors of positive response to lamotrigine or gabapentin monotherapy in treatment-refractory affectively ill patients. METHODS: Forty-five patients with treatment refractory bipolar (n = 35) or unipolar (n = 10) affective disorder participated in a clinical study evaluating six weeks of treatment with lamotrigine, gabapentin, or placebo monotherapy given in a double-blind, randomized fashion with two subsequent cross-overs to the other agents. Patients received daily mood ratings and weekly cross-sectional scales. Much or very much improved on the Clinical Global Impression scale modified for bipolar illness was considered a positive response. Degree of response was correlated with a number of baseline demographic and course of illness variables in a univariate analysis and then by linear regression. RESULTS: Response rates to lamotrigine (51%) exceeded those to gabapentin (28%) and placebo (21%). A positive response to lamotrigine monotherapy was associated with a bipolar diagnosis; fewer hospitalizations; fewer prior medication trials; and male gender (of which the latter two variables survived logistic regression). For gabapentin, degree of response correlated with shorter duration of illness; younger age; and lower baseline weight (with the latter two surviving linear regression). CONCLUSIONS: In this highly treatment-refractory population, lamotrigine appeared most effective for male patients with fewer prior medication trials. Gabapentin monotherapy, although not better than placebo, appeared most effective in those with younger age and lower baseline weight. These preliminary data in a treatment refractory subgroup may help in the further definition of the range of clinical utility of these widely used anticonvulsants.
