The psychiatric translation of the Neurovegetative Dystonia diagnosis used by general physicians

Abstract

Objective: Neurovegetative Dystonia (ND) is a common diagnosis used by general physicians. This diagnosis has been used in a broad sense including patients with different and imprecise psychological and physical symptoms, frequently with a pejorative meaning. The aim of this study was to investigate the psychiatric translation of what has been called as ND in general practice. Design: ND cases were matched for sex and age (+ or 2) with ND negatives and were referred for a blind psychiatric assessment. Setting: Patients were selected from the walk-in out-tertiary patient clinic of the Hospital Sao Paula, Escola Paulista de Medicina, Federal University of Sao Paula. Participants: A researcher located in the out-patient clinic randomly selected cases diagnosed as ND by the general physicians. Cases were matched with controls and after attendance by the general physician were invited for a blind psychiatric interview. Interventions: All subjects received a psychiatric assessment which was conducted by means of a Portuguese version of the Clinical Interview Schedule, a semi-structured interview developed for identifying psychiatric disorders in primary care. The interview comprised additional questions so as to elucidate the presence of a DSMIII diagnosis. Results: 40 ND patients were matched with 40 non-ND cases. 37 (92.5%) ND cases and 15 (37.5%) non-cases received a psychiatric diagnosis. The ND cases were diagnosed as follows: Anxiety disorders (32.5%), Hypochondriasis/Somatoform disorders (22.5%), Adjustment disorders (15%) and Conversion disorders (10%). Th us, cases showed a Relative Risk 5.5 (95% CL, 1.83-21,99, p < 0.001) greater than non-cases of showing a psychiatric disturbance. Conclusions: The results suggest that oatients diagnosed as ND by general physicians do present a high probability of presenhng a formal psyihiatric disorder. General physicians had therefore a fair perception of psychopathological characteristics in this group of patients but they failed to identify the underlying psychiatric condition.