Second Opinions for Diagnoses of Psychotic Disorders: Delivering Stage-Specific Recommendations
Abstract
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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