MIDAS Project
Publication Abstracts
Zimmerman, M., Mattia, J.I. Psychiatric diagnosis in clinical practice:
Is comorbidity being missed? Comprehensive Psychiatry, 1999, 40,
182-191.
The recognition of comorbidity has important clinical significance.
Comorbidity predicts poorer outcome for patients with depressive and
anxiety disorders, and the presence of multiple psychiatric disorders is
associated with greater levels of psychosocial impairment. In routine
clinical settings, an unstructured interview is typically used to assess
patients. Unstructured interviews, however, may result in missed
diagnoses, with potential negative clinical consequences. The goal of the
present study was to examine whether diagnostic comorbidity is less
frequently identified during a routine clinical evaluation than a
semistructured diagnostic interview. Axis I diagnoses derived from
structured and unstructured clinical interviews were compared in two
groups of psychiatric outpatients seen in the same practice setting. Five
hundred individuals presenting for an intake appointment to a general
adult psychiatric practice underwent a routine unstructured clinical
interview. Subsequent to the completion of the first study the method of
conducting diagnostic evaluations was changed and 500 individuals were
interview with the Structural Clinical Interview for DSM-IV disorders (SCID).
The two groups had similar demographic characteristics and scored
similarly on symptom questionnaires. Individuals interviewed with the SCID
were assigned significantly more Axis I diagnose than individuals who were
assessed with an unstructured interview. More than one-third of patients
interviewed with SCID received 3 or more disorders in contrast to fewer
than 10% of the patients assessed with an unstructured interview. Fifteen
disorders were more frequently diagnosed in the SCID sample, and these
differences cut across mood, anxiety, eating, somatoform, and impulse
control disorder categories. The results suggest that in routine clinical
practice clinicians underrecognized diagnostic comorbidity. The anxiety,
somatoform, and not otherwise specified (NOS) disorders were the most
frequently underdetected disorders. The implications of underdiagnosis for
treatment outcome are discussed.
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