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Published Online: 28 June 2024

Second Opinions for Diagnoses of Psychotic Disorders: Delivering Stage-Specific Recommendations

Carol Lim, M.D., M.P.H. [email protected], Abigail L. Donovan, M.D., Sophie Freudenreich, Corinne Cather, Ph.D., Sarah Maclaurin, P.M.H.N.P., and Oliver Freudenreich, M.D., F.A.C.L.P.Authors Info & Affiliations
Publication: Psychiatric Services
Preprint
https://doi.org/10.1176/appi.ps.20230623
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Abstract

Objective:

The impact of obtaining second-opinion consultations on diagnoses of schizophrenia spectrum disorders was evaluated.

Methods:

A retrospective chart review was conducted for 177 patients referred to a psychosis consultation service at an academic medical center from January 1, 2017, to October 1, 2023; these consultations aimed to clarify a diagnosis of psychosis. Diagnoses made before and after consultations were compared, and treatment recommendations resulting from the consultation visit were summarized.

Results:

Among patients without a preconsultation diagnosis of schizophrenia, 28% (N=28 of 100) received a postconsultation diagnosis of schizophrenia. Among 62 patients with a postconsultation diagnosis of treatment-resistant schizophrenia (TRS), 56% (N=35) received this diagnosis only after consultation. Nearly all of these patients were advised to begin taking clozapine, and electroconvulsive therapy was less commonly recommended.

Conclusions:

Expert consultation facilitates timely identification and optimal treatment of schizophrenia and its more severe subtype, TRS.

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Information & Authors

Information

Published In

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Psychiatric Services
Preprint

History

Received: 14 December 2023
Revision received: 29 February 2024
Accepted: 15 April 2024
Published online: 28 June 2024

Keywords

  1. second-opinion consultation
  2. psychotic disorders
  3. schizophrenia spectrum disorder
  4. treatment-resistant schizophrenia
  5. clozapine

Authors

Details

Carol Lim, M.D., M.P.H. [email protected]
Department of Psychiatry, Massachusetts General Hospital, Boston (all authors); Harvard Medical School, Boston (Lim, Donovan, Cather, O. Freudenreich); Tufts University, Medford, Massachusetts (S. Freudenreich); North Suffolk Community Services, Boston (Maclaurin).
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Abigail L. Donovan, M.D.
Department of Psychiatry, Massachusetts General Hospital, Boston (all authors); Harvard Medical School, Boston (Lim, Donovan, Cather, O. Freudenreich); Tufts University, Medford, Massachusetts (S. Freudenreich); North Suffolk Community Services, Boston (Maclaurin).
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Sophie Freudenreich
Department of Psychiatry, Massachusetts General Hospital, Boston (all authors); Harvard Medical School, Boston (Lim, Donovan, Cather, O. Freudenreich); Tufts University, Medford, Massachusetts (S. Freudenreich); North Suffolk Community Services, Boston (Maclaurin).
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Corinne Cather, Ph.D.
Department of Psychiatry, Massachusetts General Hospital, Boston (all authors); Harvard Medical School, Boston (Lim, Donovan, Cather, O. Freudenreich); Tufts University, Medford, Massachusetts (S. Freudenreich); North Suffolk Community Services, Boston (Maclaurin).
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Sarah Maclaurin, P.M.H.N.P.
Department of Psychiatry, Massachusetts General Hospital, Boston (all authors); Harvard Medical School, Boston (Lim, Donovan, Cather, O. Freudenreich); Tufts University, Medford, Massachusetts (S. Freudenreich); North Suffolk Community Services, Boston (Maclaurin).
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Oliver Freudenreich, M.D., F.A.C.L.P.
Department of Psychiatry, Massachusetts General Hospital, Boston (all authors); Harvard Medical School, Boston (Lim, Donovan, Cather, O. Freudenreich); Tufts University, Medford, Massachusetts (S. Freudenreich); North Suffolk Community Services, Boston (Maclaurin).
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Notes

Send correspondence to Dr. Lim ([email protected]).

Competing Interests

Dr. Lim reports receiving research grants from Karuna, Merck, and Neurocrine Biosciences; consultant honoraria from Karuna; and medical honoraria from MDedge and Hatherleigh. Dr. Donovan reports that her spouse owns equity in Mirah and is a board member of Artisan Industries Corporation, in which she owns equity. Dr. Cather reports receiving consulting income from Navigate Consultants. Ms. Maclaurin reports receiving research grants from Alkermes and Janssen and consultant honoraria from Alkermes and the American Psychiatric Association. Dr. O. Freudenreich reports receiving research grants from Alkermes, Janssen, and Otsuka; consultant honoraria from the American Psychiatric Association, Integral, and Janssen; medical honoraria from Elsevier and Medscape; and royalties from UpToDate. Ms. S. Freudenreich reports no financial relationships with commercial interests.

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