Cited by 299Clinical Reasoning and Diagnostic SkillsEmergency and Acute Care StudiesPsychosomatic Disorders and Their Treatments

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Diagnostic Overshadowing and Other Challenges Involved in the Diagnostic Process of Patients with Mental Illness Who Present in Emergency Departments with Physical Symptoms – A Qualitative Study

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Shefer, Guy, Henderson, Claire, Howard, Louise M., Murray, Joanna, Thornicroft, Graham·2014·PLoS ONE

DOI 10.1371/journal.pone.0111682PMC PMC4219761

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Abstract

We conducted a qualitative study in the Emergency Departments (EDs) of four hospitals in order to investigate the perceived scope and causes of 'diagnostic overshadowing'--the misattribution of physical symptoms to mental illness--and other challenges involved in the diagnostic process of people with mental illness who present in EDs with physical symptoms. Eighteen doctors and twenty-one nurses working in EDs and psychiatric liaisons teams in four general hospitals in the UK were interviewed. Interviewees were asked about cases in which mental illness interfered with diagnosis of physical problems and about other aspects of the diagnostic process. Interviews were transcribed and analysed thematically. Interviewees reported various scenarios in which mental illness or factors related to it led to misdiagnosis or delayed treatment with various degrees of seriousness. Direct factors which may lead to misattribution in this regard are complex presentations or aspects related to poor communication or challenging behaviour of the patient. Background factors are the crowded nature of the ED environment, time pressures and targets and stigmatising attitudes held by a minority of staff. The existence of psychiatric liaison team covering the ED twenty-four hours a day, seven days a week, can help reduce the risk of misdiagnosis of people with mental illness who present with physical symptoms. However, procedures used by emergency and psychiatric liaison staff require fuller operationalization to reduce disagreement over where responsibilities lie.

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Ruhl, K. (2003) · Choice Reviews Online · doi:10.5860/choice.41-1319 · Cited by 10,514
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Harris, C., & Barraclough, B. (1998) · British Journal of Psychiatry · doi:10.1192/bjp.173.1.11 · Cited by 1,881 · cited 1×
“People with mental illness suffer higher rates of physical illness and are more likely to die prematurely as a result of physical illness than members of the general population [1–4].”
Background
Excess early mortality in schizophrenia.
Laursen, T. M., Nordentoft, M., & Mortensen, P. B. (2014) · Annual Review of Clinical Psychology · doi:10.1146/annurev-clinpsy-032813-153657 · Cited by 913 · cited 1×
“More specifically, these explanations include side effects of medication, failure to seek early treatment or to seek it at all, difficulties in managing medication and complying with treatment more generally, unhealthy life-style and poor economic conditions affecting access to healthcare services [2], [6], [9].”
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“health of people with mental illness and the rest of the population [13–14].”
BackgroundSelf-citation
Physical illness and schizophrenia: a review of the literature
Leucht, S., Burkard, T., Henderson, J., Maj, M., & Sartorius, N. (2007) · Acta Psychiatrica Scandinavica · doi:10.1111/j.1600-0447.2007.01095.x · Cited by 633 · cited 2×
“More specifically, these explanations include side effects of medication, failure to seek early treatment or to seek it at all, difficulties in managing medication and complying with treatment more generally, unhealthy life-style and poor economic conditions affecting access to healthcare services [2], [6], [9].”
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Druss, B. G. (2000) · JAMA · doi:10.1001/jama.283.4.506 · Cited by 541 · cited 1×
“Such possible contributions can be indicated from service users’ complaints [15] and from evidence of disparities in treatment – for example, in hospitalisation and pathology tests for diabetes [5], [16–17], coronary re-vascularisation procedures and in basic health assessments such as blood pressure monitoring [18–19…”
Background
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Jones, S., Howard, L., & Thornicroft, G. (2008) · Acta Psychiatrica Scandinavica · doi:10.1111/j.1600-0447.2008.01211.x · Cited by 475 · cited 3×
“This finding is consistent with the prediction of researchers that ‘diagnostic overshadowing’ is unlikely to be simply the result of bias or of discriminatory attitudes and that a range of other factors related to the communication between doctor and patient may also be relevant [14].”
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“Such possible contributions can be indicated from service users’ complaints [15] and from evidence of disparities in treatment – for example, in hospitalisation and pathology tests for diabetes [5], [16–17], coronary re-vascularisation procedures and in basic health assessments such as blood pressure monitoring [18–19…”
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Additional file 2 of Does medical disparity exist while treating severe mental illness patients with acute appendicitis in emergency departments? A real-world database study
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Additional file 2 of The lived experience of severe mental illness and long-term conditions: a qualitative exploration of service user, carer, and healthcare professional perspectives on self-managing co-existing mental and physical conditions
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“Qualitative studies consistently report that patients with mental health disorders often perceive a lack of trust in their accounts, with physical symptoms being attributed to psychiatric conditions and diagnostic or therapeutic interventions being delayed or withheld [9,16].”
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Authors: Shefer, G., Henderson, C., Howard, L. M., Murray, J., & Thornicroft, G.
Affiliations: King's College London (GB)
Corresponding author: Shefer, Guy
ORCID: Shefer, Guy
Henderson, Claire
Howard, Louise M.
Murray, Joanna
Thornicroft, Graham
Venue: PLoS ONE
Publisher: Public Library of Science (PLoS)
Published: 2014-11-04
Volume: 9
Issue: 11
Pages: e111682
ISSN: 1932-6203 (ISSN-L)
DOI: 10.1371/journal.pone.0111682
PMC: PMC4219761
OpenAlex: W1988019453
Cited by: 299
References: 25
Citations by year: 2026: 45 · 2025: 33 · 2024: 29 · 2023: 30 · 2022: 54 · 2021: 22 · 2020: 26 · 2019: 24 · 2018: 12 · 2017: 12 · 2016: 10 · 2015: 2
FWCI: 8.26
Type: journal article
Language: en
Open access: gold
doi.org
Licence: cc-by
creativecommons.org/licenses/by/4.0/ (unspecified)
Locations: PLoS ONE (publishedVersion, cc-by)
Europe PMC (PubMed Central) (publishedVersion, cc-by)
PubMed Central (publishedVersion, cc-by)
PubMed (publishedVersion)
RePEc: Research Papers in Economics (submittedVersion)
DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
Research Portal (King's College London) (submittedVersion)
Funders: South London and Maudsley NHS Foundation Trust
Maudsley Charity
National Institute for Health and Care Research (RP-PG-0606-1053, NF-SI-0611-10053, NIHR-RP-R3-12-011)
King's College London
Topics: Health Sciences › Medicine › Family Practice › Clinical Reasoning and Diagnostic Skills
Health Sciences › Medicine › Emergency Medicine › Emergency and Acute Care Studies
Health Sciences › Medicine › Psychiatry and Mental health › Psychosomatic Disorders and Their Treatments
Keywords: diagnostic overshadowing, mental illness, somatic symptoms, emergency department, misdiagnosis, delayed diagnosis, employee attitudes, stigma, patient communication, behavioral problems, time pressure, diagnostic process
MeSH terms: Attitude of Health Personnel, Mental Disorders, Diagnostic Errors, Emergency Service, Hospital, Female, Humans, Male, Surveys and Questionnaires, Stereotyping

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Diagnostic Overshadowing and Other Challenges Involved in the Diagnostic Process of Patients with Mental Illness Who Present in Emergency Departments with Physical Symptoms – A Qualitative Study

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