The traditional diagnosis of patients with disorders of consciousness relies solely on behavioral responses. In 1996 it was estimated that 43% of patients diagnosed with unresponsive wakefulness syndrome (vegetative state) receive the wrong diagnosis. Assessing consciousness is perhaps the most crucial part of the diagnostic process. The challenging task of identifying covert consciousness in this patient group seems to be the biggest issue. In 2006 willful modulation of brain activity in response to a mental imagery task was discovered in a patient with unresponsive wakefulness syndrome. The brain activity was measured with functional magnetic resonance imaging. It was concluded that consciousness was preserved in this patient and new research investigating this novel method began to take place. The aim of this thesis was to conduct a systematic review of the literature and thereby arrive at the best current estimate of the proportion of patients who receive a diagnosis that wrongfully defines them as “unconscious” although they in fact are “covertly conscious”. In this review, 11 studies were examined. The results showed that patients with unresponsive wakefulness syndrome, who still receive the wrong diagnosis, decreased to 22-28% by the use of neuroimaging. This improvement points to the possible use of neuroimaging methods in the diagnosis of disorders of consciousness. However, this result cannot be taken without reservations. The limitations of the studies have to be taken into consideration. For example, most studies included a limited sample size and healthy controls did not always give the expected response to mental imagery tasks.

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The prevalence of medical misdiagnosis has remained high despite the adoption of diagnostic software. This ongoing controversy about the role of technology in mitigating the problem of misdiagnosis centers on the question of whether diagnostic software does reduce the incidence of misdiagnosis if properly relied upon by physicians. The purpose of this quantitative, cross-sectional study based on planned behavior theory was to measure doctors' opinions of diagnostic technology's medical utility. Recruitment e-mails were sent to 3,100 AMA-accredited physicians through their database that yielded a sample of 99 physicians for the study. One-sample t tests and, where appropriate because of non-normal data, one-sample Wilcoxon signed-rank tests were conducted on the data to address the following key research questions on whether diagnostic software decreases misdiagnosis in healthcare versus unassisted human diagnostic method, if physicians use diagnostic software frequently enough to decrease misdiagnosis in healthcare, and if liability concerns prevent physicians from using diagnostic software. It was found that in the opinion of those surveyed (a) diagnostic software was likely to result in fewer misdiagnoses in healthcare than unassisted human diagnostic methods, (b) when speaking for themselves, physicians thought they used diagnostic software frequently enough to decrease misdiagnoses, and (c) physicians agreed they were not prevented from using diagnostic software because of liability concerns. The study's social significance is the affirmation of diagnostic software's usefulness: Policy and technology stakeholders can use this finding to speed the adoption of diagnostic software, leading to a reduction in the socially costly problem of misdiagnosis.

Submitted by Luciana Ferreira (lucgeral@gmail.com) on 2014-08-21T12:48:09Z No. of bitstreams: 2 license_rdf: 23148 bytes, checksum: 9da0b6dfac957114c6a7714714b86306 (MD5) DISSERTACAO MESTRADO MOYSES PRONTA (1) (1).pdf: 679547 bytes, checksum: cf4dd53c812b868e1a8d7ceb72f62419 (MD5) / Made available in DSpace on 2014-08-21T12:48:09Z (GMT). No. of bitstreams: 2 license_rdf: 23148 bytes, checksum: 9da0b6dfac957114c6a7714714b86306 (MD5) DISSERTACAO MESTRADO MOYSES PRONTA (1) (1).pdf: 679547 bytes, checksum: cf4dd53c812b868e1a8d7ceb72f62419 (MD5) Previous issue date: 2013-09-30 / There are several studies on the differential diagnosis of Bipolar Disorder (BD), however, further investigation with an emphasis on clinical phenotypes that inaugurate the disease is needed. The aims of this study are to identify the psychiatric disorders most frequently diagnosed before the definitive diagnosis of BD, the time until the correct diagnosis and compare BD I and II for the variables studied. We studied 259 patients with current diagnosis of BD according to the DSM- IV-TR, evaluated by the same psychiatrist. Early psychiatric signs and symptoms were identified through an interview with the patient and family members and were considered suggestive of an initial diagnosis that was coded according to the same diagnostic criteria. The authors analyzed data on patients' age at prodromes suggestive of initial psychiatric diagnosis and time delay to the actual diagnosis of BD. Comparisons were made between sex, schooling and type of BD. The mean age of patients was 41.6 years, with a predominance of adults (19-60 years), women (67.6%), as well as type II BD (68.3%). Patients were on average 24.6 years of age at initial diagnosis, 41.6 years in the diagnosis of BD and the mean time delay between these was 16.9 years. The most common initial diagnoses were depressive disorders (41.3%), anxiety (12.7%), ADHD (8.1%), disorders related to substance abuse (7.7%), somatoform disorders (6 9%), and psychosis (5.4%). BD can be considered a “great imitator” in modern psychiatry, since initial phenotypes can mimic other disorders. BD diagnosis is very delayed in Brazil. / Há diversos estudos sobre o diagnóstico diferencial do Transtorno Bipolar (TB), entretanto, investigações com ênfase nos fenótipos clínicos que inauguram a doença são escassos. Os objetivos deste estudo consistem em identificar as doenças psiquiátricas mais frequentemente diagnosticadas antes do diagnóstico definitivo de TB, assim como o intervalo de tempo até o mesmo; e comparar o pacientes com TB I e II quanto aos diagnósticos iniciais, escolaridade, sexo e faixa etária. Para tanto, estudamos 259 pacientes com diagnóstico atual de TB segundo os critérios do DSM-IV-TR, realizado por um mesmo psiquiatra. Através de entrevistas com o paciente e familiares, identificou-se retrospectivamente os sinais e sintomas precoces considerados sugestivos do primeiro diagnóstico psiquiátrico, segundo os mesmos critérios. Dados relativos à idade dos pacientes no diagnóstico inicial e tempo até o diagnóstico atual de TB foram analisados e comparações foram feitas entre sexo, escolaridade, faixa etária e tipo de TB. A média de idade encontrada foi de 41,6 anos, com predominância de adultos (19-60 anos), do gênero feminino (67,6%), com TB II(68,3%). Os pacientes tinham em média 24,6 anos de idade no diagnóstico inicial, 41,6 anos no diagnóstico de TB e o tempo médio de atraso diagnóstico foi de 16,9 anos. Os diagnósticos iniciais mais frequentemente encontrados foram: transtornos depressivos (41,3%), ansiosos (12,7%), TDAH (8,1%), transtornos relacionados ao abuso de substâncias psicoativas (7,7%), transtornos somatoformes (6,9%) e psicóticos (5,4%). O T pode ser considerado um “grande imitador” moderno da Psiquiatria, posto que fenótipos iniciais podem mimetizar outros transtornos. Há um atraso significativo no diagnóstico do TBno Brasil.

According to recent studies, there is an interethnic research gap that exists regarding Portuguese-American parents' knowledge of Attention Deficit Hyperactive Disorder (ADHD). The purpose of this study was to explore Portuguese-American parents' knowledge of the symptoms and diagnosis of ADHD, how they think it impacts their children's education, learning, behaviors, and what interventions they use to address the behavioral issues and learning disabilities that result from ADHD. Guided by family systems theory, with the premise that children are an integral part of the family and cannot be understood in isolation from the family, this qualitative, phenomenological study used semi-structured interviews to gather visual and verbal data to understand Portuguese-American parents' knowledge, perception, attitude, and awareness of ADHD. Inductive analysis allowed for identification of themes and categories of transcribed data and field notes until saturation was reached. Multiple recurring themes found in this study indicated (a) lack of knowledge of ADHD, (b) lack of information provided by professionals, (c) opportunity to be educated about this neurodevelopmental mental health disorder, and (d) lack of the appropriate resources for these parents to get the necessary help needed to cope with their children's symptoms and diagnosis of ADHD. The results could bring about positive social change for this underserved ethnic minority group of people on how to deal and understand their children's learning and behaviors related to ADHD.

Vocal Cord Dysfunction (VCD) is characterized by paradoxical vocal cord movement during inspiration or expiration, and generally affects adolescents and predominantly women. Previous studies have shown a large inconsistency concerning terminology, definitions, etiology, assessment, differential diagnosis, co-morbidity and treatment. The purpose of this study was to map knowledge on and management of VCD in Sweden. The study was conducted as a written survey addressed to speech-language pathologists and physicians, and attained an answer percentage of 79 percent. The results showed that several professions were involved in the management of these patients, but no clear pattern of referral could be observed. The majority of the respondents considered intense physical exertion and psychological stress as triggering factors for VCD. Despite this, referral to a psychologist or psychiatrist seldom occurred. Asthma was the most frequent diagnosis regarding co-morbidity, and also the most frequent misdiagnosis. Respiratory exercises, relaxation and information about the diagnosis generally form the basis of VCD treatment. Physicians rated their knowledge on VCD greater compared to the speech-language pathologists. Several of the respondents stated that an increase in knowledge and awareness among nursing staff had contributed to an increase of patients with suspected or confirmed VCD. This study showed that there was no consensus regarding assessment, co-morbidity, misdiagnosis and treatment of VCD among speech-language pathologists and physicians in Sweden. / Vocal Cord Dysfunction (VCD) karakteriseras av paradoxala stämbandsrörelser vid in- eller utandning och drabbar vanligtvis ungdomar och huvudsakligen kvinnor. I tidigare studier framkom ingen konsensus kring terminologi, definition, etiologi, utredning, differentialdiagnostik, komorbiditet eller behandling. Syftet med föreliggande studie var att kartlägga kännedom om och handhavande av VCD i Sverige. Studien genomfördes i form av en enkätundersökning bland logopeder och läkare och svarsfrekvensen var 79 %. Ur resultatet framkom att flera professioner hade träffat dessa patienter men ingen tydlig remitteringsgång observerades. Majoriteten av respondenterna ansåg att intensiv fysisk ansträngning och psykologisk stress var utlösande faktorer till VCD. Däremot förekom sällan remittering till psykolog eller psykiater. Astma var den mest frekventa diagnosen gällande komorbiditet och feldiagnostisering. Andningsövningar, avspänning/avslappning samt information kring diagnosen inkluderades i behandlingen i hög grad. Läkarna skattade sin kunskapsnivå om VCD högre än logopederna. Flera av respondenterna angav att ökad kunskap och medvetenhet bland vårdpersonal hade bidragit till en ökning av diagnostisering av patienter med misstänkt eller konstaterad VCD. Föreliggande studie visade att det inte fanns någon enighet gällande utredning, komorbiditet, feldiagnostisering och behandling av VCD bland logopeder och läkare i Sverige.

The difficulty of distinguishing between genuine disorder and characteristics that can be attributed to high IQ increases the likelihood of diagnostic error by mental health practitioners. This mixed methods study explores the possibility of misdiagnosis of high IQ youth by mental health professionals. Participants were private practice mental health professionals who read case study vignettes illustrating high IQ youth exhibiting characteristics associated with their population. Participants then completed a survey and provided an assessment of the hypothetical client. In the study, 59% of participants were unable to recognize behavioral characteristics associated with high IQ youth unless suggested to them, and 95% of participants were unable to recognize emotional characteristics associated with high IQ youth unless suggested. The results of this study provide much-needed empirical exploration of the concern for misdiagnosis of high IQ youth and inform clinical practice and education.