Internal medical residents' ability to diagnose and characterize major depression

Citation
Ma. Medow et al., Internal medical residents' ability to diagnose and characterize major depression, WEST J MED, 170(1), 1999, pp. 35-40
Citations number
27
Categorie Soggetti
General & Internal Medicine
Journal title
WESTERN JOURNAL OF MEDICINE
ISSN journal
00930415 → ACNP
Volume
170
Issue
1
Year of publication
1999
Pages
35 - 40
Database
ISI
SICI code
0093-0415(199901)170:1<35:IMRATD>2.0.ZU;2-O
Abstract
The purpose of this study was to assess medical residents' knowledge of sym ptom criteria and subtypes of major depressive episode and their accuracy i n diagnosing major depressive disorders and classifying episode severity an d subtype according to criteria of the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. Thirty-five third-year internal medicine residents completed a self-administered, written instrument containing 2 o pen-ended questions and 21 hypothetical scenarios. The sensitivity for reco gnizing major depressive disorder was 64%, and the specificity was 69%. The sensitivity for classifying severity was 86% for mild, 66% for moderate, 7 1% for severe, and 66% for severe with psychosis. Misclassification of seve rity was most commonly to a less severe class. For scenarios with a diagnos able subtype of a major depressive disorder, the sensitivity for classifica tion was 34% for atypical, 51% for catatonic, 74% for melancholic, 100% for postpartum, and 94% for seasonal depression. When asked to enumerate the c riteria symptoms for depression, 80% or more of the residents listed sad mo od, loss of interest, weight change, and sleep disturbances; 14 to 21 (40%- 60%) listed thoughts of death and worthlessness; other criteria were listed by 7 to 11 (20%-31%). When asked to list the episode subtypes, none was li sted by more than 3 (9%) residents, although 13 (37%) residents volunteered psychotic as a subtype. Residents frequently failed to recognize the prese nce or absence of major depressive disorder and often misclassified episode severity and subtype on scenarios. Few could spontaneously list the episod e subtypes. Methods must be developed to improve the recognition and classi fication of major depressive episodes to better direct treatment.