Autoavaliação de pacientes e médicos em relação à estabilidade clínica em transtornos mentais graves: um estudo transversal

Iraneide Castro De Oliveira,Vanessa Andrade Martins Pinto,José Carlos Appolinario,Isabella Nascimento,Maria Tavares Cavalcanti,Helio G Rocha Neto

doi:10.1590/0047-2085000000344

Iraneide Castro De Oliveira, Vanessa Andrade Martins Pinto + Show 4 more

Open Access

https://doi.org/10.1590/0047-2085000000344

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Abstract

ABSTRACT Objective This study explores the relationship between patients’ self-assessment and physicians’ evaluation regarding clinical stability. Methods This cross-sectional study was carried out at the general outpatient clinic of the Instituto de Psiquiatria da Universidade Federal do Rio de Janeiro (IPUB-UFRJ) in a large sample (1,447) of outpatients, of which 67.9% were patients with severe mental disorders (SMD). We collected information using a structured questionnaire developed for this purpose, filled in by the patient’s physician. Clinical stability was assessed by means of five psychiatric instability criteria and by the physician’s global clinical impression over the six previous months. The patients’ self-assessment was based on a question about how they evaluated their health status: stable/better, worse, does not know. For the analyses, patients’ self-evaluation was considered as our standard. Results The sample was composed of 824 (57%) women with an average age of 49 years. The most prevalent diagnoses within the SMD category corresponded to 937 patients, of whom 846 (90.3%) assessed themselves as stable/better. The physicians’ evaluations agreed more with patients with bipolar disorders and less with schizophrenics regarding stability. As for patients with depressive disorder, physicians agreed more with them regarding instability. Conclusion The data analysis confirms our hypothesis that the self-assessment made by patients with SMD was accurate regarding their health condition, and that the self-assessment made by patients who considered themselves stable agree with the physicians’ evaluation.

Highlights

Accurate and reliable assessments are the cornerstone of research worldwide in any field of knowledge
In Psychiatry, the outpatient clinic assists around 1,300 patients per month, most of them referred from Primary Care
To the best of our knowledge, this is the first study that assesses the clinical stability of patients with severe mental disorder (SMD) assisted at a psychiatry outpatient clinic of a university

Summary

Introduction

Accurate and reliable assessments are the cornerstone of research worldwide in any field of knowledge. The interest in patients’ self-assessment has been growing since the beginning of the 1980s, leading to the development of specific measures for certain disorders, generic measures[18], and measures of the patient’s subjective health status[19]. This has allowed to compare patients’ self-assessment with other evaluations: patients versus non-patients[13,15,17,20], patients versus clinicians[5,16,18,19,20,21], patients versus caregivers[20,21], and patients versus their family and friends[20,21]. Patients with SMD provide inaccurate self-assessment reports compared with other information, including informant reports, due to different degrees of impairment of the investigated area[3,4,9,11,12,13,14,16]

Methods

Discussion

Conclusion