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Tijdschrift voor Psychiatrie 58 (2016) 11, 777 - 784

New research

The validity of acute assessments of psychiatric conditions made by psychiatric emergency staff

E.J.M. Penterman, F.G.L.M. Sabelis, S.P.A. Rasing, C.P.F. van der Staak, H.L.I. Nijman

background Earlier research carried out by the outreach psychiatric emergency team in the region of Uden / Veghel in the Netherlands indicated that the preliminary diagnosis of patients in crisis was associated with aggressive behaviour during the later contact between the patient and the staff of the psychiatric emergency team. An accurate diagnosis by the staff of the psychiatric emergency team is important because it should guide the patient towards the right type of treatment by the most appropriate team. The staff of the psychiatric emergency service who make the initial diagnosis are pressed for time and have only limited information.
aim To find out what differences there are between the crisis team’s initial diagnosis of the psychiatric condition of the patient in crisis and the later diagnosis made after more extensive psychiatric tests are carried out following the regular intake procedure.
method Our study was based om 129 patients who, in the period of 2009 and 2010, were not known to mental health service and had not had any previous contact with the psychiatric emergency service. The first assessment of a patient’s psychiatric condition made by a member of the psychiatric emergency service was compared with the later diagnosis made by a professional psychiatrist after the regular intake procedure. We then investigated the degree of agreement between the two diagnoses using Cohen’s kappa so that we could test the validity of the initial screening of the patient’s condition.
results We found that the staff of the psychiatric emergency team was able to achieve a result that was better than could be expected on the basis of chance. The Cohen’s kappas varied between 0.81 for psychotic disorders to 0.31 for borderline personality disorders. Borderline personality disorders, however, tended to be overestimated by the psychiatric emergency staff.
conclusion Although there was only limited agreement regarding various conditions, it is encouraging that the psychiatric emergency staff were able to assess psychotic disorders accurately on the basis of the initial information they had received. This result is important because in other studies psychotic symptoms were found to be associated with a higher likelihood of aggression during the later outreach consultation.

keywords aggression, diagnosis, emergency staff, initial diagnosis