Specialized consultation for suspected recent-onset schizophrenia: Diagnostic clarity and the distorting impact of anxiety and reported auditory hallucinations

Early detection of psychotic disorders is now recognized as vital in reducing dysfunction, morbidity, and mortality. However, making the diagnosis of a psychotic disorder, especially earlier in the course of disease, can be challenging, and an incorrect diagnosis of a psychotic disorder may also have significant consequences. We therefore, conducted a retroactive chart review of 78 patients referred to a specialty early psychosis consultation clinic to examine the role of specialty clinics in clarifying the diagnosis of early psychosis, especially potential schizophrenia. Of the 78 patients, 43 (55%) had a primary diagnosis at referral of a schizophrenia spectrum disorder. The primary diagnosis in the consultation clinic was different in 22 (51%) of these 43 cases, and 18 (42%) of these patients were not diagnosed with any form of primary psychotic disorder. These patients were more likely to report anxiety and less likely to report thought disorder than patients with a consultation diagnosis of schizophrenia or schizoaffective disorder. Clinicians may therefore overdiagnose schizophrenia, demonstrating the value of second opinions from clinics specializing in the diagnosis of recent-onset psychosis.