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Do we agree about when patients are psychotic?
J Nielsen1, B Mogensen, K Martiny
1Unit for Psychiatric Research, Aalborg Psychiatric Hospital, Aalborg, Denmark. jin@rn.dk
Acta Psychiatrica Scandinavica
|September 2, 2008
Summary
Psychiatric staff widely use impaired reality testing to define psychosis, especially in legal contexts. However, psychotic symptoms are accurately identified using both ICD-10 criteria and reality testing concepts.
Area of Science:
- Psychiatry
- Psychology
- Mental Health
Background:
- The definition and application of 'psychotic' vary among mental health professionals.
- Understanding how psychiatric staff interpret and use diagnostic criteria is crucial for consistent patient care.
Purpose of the Study:
- To examine the usage of the term 'psychotic' based on the International Classification of Diseases, 10th Revision (ICD-10) and the concept of impaired reality testing.
- To compare these interpretations among psychiatrists, nursing staff, and psychologists.
Main Methods:
- A questionnaire-based study was conducted.
- Eleven short case vignettes were presented to 266 psychiatric staff members.
Main Results:
- When using ICD-10 criteria, sensitivity for identifying psychosis ranged from 55% to 90%, with specificity between 60% and 75%.
- Using impaired reality testing, sensitivity was approximately 60% across all groups, while specificity ranged from 50% to 65%.
- A combined approach correlated significantly with legal detention indications for psychiatrists and nursing staff.
Conclusions:
- Psychiatric staff frequently employ a broad concept of impaired reality testing, particularly in cases involving legal considerations.
- Despite variations in definition, psychotic symptoms themselves were identified with high sensitivity and specificity.
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