Study: Most psychiatric cases involve multiple issues

PROVIDENCE – A study by researchers at Rhode Island Hospital, published in the February edition of the journal Psychological Medicine, has found that most outpatient psychiatric patients have more than one diagnosis. Multiple diagnoses are especially common in patients with bipolar disorder or post-traumatic stress disorder, the researchers found.

Their study – based on data from 2,300 psychiatric outpatients – found an average of 1.9 current diagnoses per patient. More than one-third of patients having at least three disorders, the report says.

Lead author Dr. Mark Zimmerman, director of outpatient psychiatry at Rhode Island Hospital and associate professor of psychiatry and human behavior at Brown University’s Alpert Medical School, said the study indicates that clinicians “should assume that, in outpatients presenting for the treatment of mood or anxiety problems, the patients have more than one diagnosis.”

The study also looked at which disorders were the most common reasons for seeking treatment.

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It found major depression was No. 1 – present in nearly half the patients, and generally the main reason for seeking treatment. Social phobia was the second most common diagnosis, present in about 25 percent of the patients – but of those, 95 percent came in seeking treatment for something else.

Zimmerman and fellow researchers Joseph B. McGlinchey, Iwona Chelminski and Diane Young noted that the study results highlight the importance of doing treatment research on patients with multiple disorders, because such patients are the norm in actual clinical practice. Most treatment studies exclude patients with multiple disorders.

“We hope that by documenting the high frequency of co-morbidity in clinical practice, this will provide the impetus for modifying how treatment studies are conducted to allow patients with multiple disorders to be included and to determine the outcome of co-morbid disorders as well as the primary disorder that is being treated,” they wrote.

The report is from the Rhode Island Hospital Methods to Improve Diagnostic Assessment and Services (MIDAS) Project, for which Zimmerman is the principal investigator.

Rhode Island Hospital, a private nonprofit institution founded in 1863, is a founding member of the Lifespan health system. Additional information is available at www.rhodeislandhospital.org .

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