NEUROVEGETATIVE DYSTONIA - PSYCHIATRIC EVALUATION OF 40 PATIENTS DIAGNOSED BY GENERAL PHYSICIANS IN BRAZIL

The diagnosis of neurovegetative dystonia (NVD) is commonly made by ge neral physicians in Brazil, but its precise meaning is unclear. Anecdo tal evidence suggests that it is used to describe patients with a wide range of psychological and physical symptoms and is often used pejora tively, in a similar way to ''crocks'' in the USA. Forty patients who had been diagnosed as having NVD by general physicians working in a tr iage department of a general public hospital were compared with 40 non -NVD patients, matched for age and gender, from the same department. P atients were evaluated by a psychiatrist who was blind to the diagnosi s that had been made. The assessment included a structured sociodemogr aphic questionnaire, the Clinical Interview Schedule (CIS), and a rout ine psychiatric interview using DSM-III-R criteria. Using the CIS, the ''reported symptoms'' that most distinguished NVD patients from contr ols were somatic and anxiety, whereas for ''manifest abnormality'' NVD patients displayed more anxiety, histrionic behavior, hypochondriasis , and depressive thoughts. A total of 92.5% of NVD patients received d iagnoses using DSM-III-R criteria compared to 37.5% of controls. The r elative risk of NVD patients subsequently receiving a psychiatric diso rder was 8.3 (95% CI = 2.5-43.1, p < 0.001). Although general physicia ns correctly identify most patients with psychiatric disorder they mis s many others. Furthermore, they use an obsolete diagnostic category w hich has no psychiatric currency. Medical students and residents need better psychiatric training so that they can correctly identify patien ts in general medical settings who are suffering from mental disorders and make a diagnosis using accepted psychiatric terminology. (C) 1997 Elsevier Science Inc.