Diagnostic Consultation to a State Hospital

As part of a program to assess the needs of patients in a state hospital scheduled to be closed, a psychiatrist provided consultation for 101 chronically ill patients, including formulation of a principal diagnosis by DSM-III-R criteria. Compared with earlier diagnoses made by the hospital, the consultant diagnosed fewer cases of schizophrenia and more cases of organic mental disorders, affective syndromes, and mental retardation and pervasive developmental disorders. The largest numbers of patients no longer diagnosed as schizophrenic received diagnoses of psychosis not otherwise specified, with further assessment recommended, or organic mental disorder. The author believes consultation programs like this one can help state hospital staff take a fresh look at long-term patients and can provide useful experience for psychiatric residents who assist with such consultations.