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Second Opinions for Diagnoses of Psychotic Disorders: Delivering Stage-Specific Recommendations
Carol Lim1, Abigail L Donovan1, Sophie Freudenreich1
1Department of Psychiatry, Massachusetts General Hospital, Boston (all authors); Harvard Medical School, Boston (Lim, Donovan, Cather, O. Freudenreich); Tufts University, Medford, Massachusetts (S. Freudenreich); North Suffolk Community Services, Boston (Maclaurin).
Objective:
The impact of obtaining second-opinion consultations on diagnoses of schizophrenia spectrum disorders was evaluated.
Methods:
A retrospective chart review was conducted for 177 patients referred to a psychosis consultation service at an academic medical center from January 1, 2017, to October 1, 2023; these consultations aimed to clarify a diagnosis of psychosis. Diagnoses made before and after consultations were compared, and treatment recommendations resulting from the consultation visit were summarized.
Results:
Among patients without a preconsultation diagnosis of schizophrenia, 28% (N=28 of 100) received a postconsultation diagnosis of schizophrenia. Among 62 patients with a postconsultation diagnosis of treatment-resistant schizophrenia (TRS), 56% (N=35) received this diagnosis only after consultation. Nearly all of these patients were advised to begin taking clozapine, and electroconvulsive therapy was less commonly recommended.
Conclusions:
Expert consultation facilitates timely identification and optimal treatment of schizophrenia and its more severe subtype, TRS.
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