بررسي ميزان توافق دستياران روانپزشكي در زمينه تشخيص گذاري محور

A Study on the Agreement Rate in Diagnosis of DSM-IV Axis III Between

Background and Objectives: Prevalence of medical disorders in psychiatric patients is significantly greater than general population and causes significant morbidity and mortality in them. This study was carried out to assess the agreement rate in the primary diagnosis of medical problem(s) in psychiatric patients among the residents of psychiatry. Materials and Methods: One hundrend seventeen psychiatric patients were interviewed in the morning reports at Razi psychiatric hospital of Tabriz University of Medical Sciences. They were evaluated individually by residents for mental status examination. Propable diagnosis in axis III was recorded in a questionnaire. CoIIected data were analysed regarding the average agreement among residents by ICC (Intraclass Correlation Coefficient). Analysis of variance was also done to estimate the effects of a group of factors, including patients personal characteristics, residents personal characteristics, as well as mental status assessments by residents upon final agreement in diagnosis. Results: According to ICC, agreement rate among residents in diagnosis of medical illness was moderate (ICC : 0.42). Second and third-degree residents agreed significantly less than the first degree ones. Azari speaking residents agreed significantly more than other residents. The rate of agreement among female residents was significantly more than male residents. Personal characteristics of the patients were not significantly important in explaining diagnostic differences. In mental status examination, only "appearance" and "attitude" were partially important. Conclusion: Diagnosis on axis III by residents of psychiatry is almost unreliable. This study shows the need for further attention of educational-directors in motivating the residents to focus on medical problems in, psychiatric patients.