Nonpsychiatrist House Staff Frequently Misdiagnose Psychiatric Disorders in General Hospital Inpatients

Nonpsychiatric house staff referring inpatients for psychiatric consultation were asked to make a psychiatric diagnosis before their patients were evaluated by the consultants. The psychiatrists confirmed this diagnosis in only 22% of patients age 50 years and older, but in 68% of patients under age 50. Referring physicians identified 27 cases of major depression; the psychiatric consultants agreed with this diagnosis in only 6 (22%) of these patients. In the remaining 21 patients, the psychiatrists identified 10 cases of delirium, 7 cases of adjustment disorder, and 4 cases of various other conditions. These results suggest that nonpsychiatric house staff frequently misidentify other psychiatric conditions as major depression and that the psychiatric diagnosis of older patients by nonpsychiatrist house staff is far more problematic than the diagnosis of younger patients.