Diagnostic accuracy at the first episode of psychosis in Uganda.

Abstract

Background: Correct clinical diagnosis at the first episode of psychosis may be difficult due to many non-specific symptoms. We determined the factors associated with a correct diagnosis among patients with a first episode of psychosis in Uganda.; ; Methods: A cross-sectional study design was performed at the national psychiatric referral and teaching hospital in Uganda. Treatment naive participants aged 18 to 60 years with a diagnosis of a psychotic disorder were included. Patients with organic disorders like HIV/AIDS, syphilis and substance use disorders were excluded. The MINI International neuropsychiatric inventory was administered to confirm the clinical diagnosis. Concordance was based on the percentage agreement and kappa statistic between the admission chart diagnosis and the MINI diagnosis. ; ; Results: 178 participants with the first episode of psychosis were included in the final analysis. The agreement between the MINI diagnosis and clinician diagnosis was 0.385, (P < 0.001) with a concordance of 49.5%. After controlling for nationality and the household source of income, duration of untreated psychosis, p-value 0.028( 95%CI: 0.07-0.89), living with a primary family member, p-value 0.038(95%CI:0.95-2.86) and the cadre of the clinician who made the initial diagnosis[Medical officer, p-value 0.011( 95%CI: 0.18-0.80) were associated with a correct diagnosis.; ; Conclusion: There was low agreement between clinician diagnoses and MINI diagnoses at the first episode of psychosis. Improved training of staff while considering the duration of untreated psychosis and the living arrangements of the patient may improve diagnostic accuracy in this population.