GPs ‘misdiagnosing’ kids with behavioural problems
In 244 cases, GPs misdiagnosed 154 children and prescribed antipsychotics and antidepressants to 45 children that were discontinued by hospital experts
Matthew Vella
Maltese psychiatrists studying the diagnosis by GPs of children and teens with behavioural problems, found that the prescription of antipsychotic drugs often took place without consultation with professionals, leading to a substantial misdiagnosis of these children.
Of a total of 244 children referred to St Luke’s Hospital’s child guidance clinic between 2005 and 2006, a sheer 154 (63%) were “misdiagnosed by the referring doctor” compared to the final diagnosis of specialists at St Luke’s.
The study, appearing in the Malta Medical Journal, was carried out by Nigel Camilleri from the South Tyneside General Hospital in Newcastle, and Abigail Cassar Parnis and Joseph Cassar from Mount Carmel Hospital.
The psychiatrists carried out a review of the case notes for the 244 children, aged two to 16, referred by “non-psychiatric specialists” to St Luke’s.
Of these patients, 187 were referred by general practitioners (GPs), 48 by paediatricians, and nine by consultant psychiatrists. But it’s the figures of misdiagnosis from these referrals that makes for interesting reading, with doctors misdiagnosing the actual disorder, or prescribing ‘unnecessary’ antipsychotic medication.
According to the study, 154 children were misdiagnosed by the referring doctors. In the 55 cases of neurosis and stress-related disorders, 81% had been misdiagnosed in the first place; in 46 cases of conduct disorder, 70% were initially misdiagnosed; and 44 attention deficit and hyperactivity cases were misdiagnosed in 48% of the cases by the doctors.
A total of 66 children (27%) were even prescribed various types of psychiatric treatment, prior to referral to the St Luke’s clinic. “The main reason for being referred to the clinic in these cases was failure to respond to the previously prescribed medication,” the psychiatrists note.
Indeed, a number of children were tried on more than one type of medication – usually sulpiride, an anti-psychotic drug used in the treatment of schizophrenia and depression – before being referred to the clinic.
But the St Luke’s specialists actually discontinued their treatment. Of the 30 children on sulpiride – the antipsychotic mainly prescribed by GPs – 25 had the treatment discontinued after six months; and 13 of the 15 kids who were prescribed antidepressants had the treatment discontinued.
Indeed, the psychiatrists conclude that a high percentage of children were “misdiagnosed, and if correctly diagnosed were started on antipsychotic medicine for the wrong indications.”
They said that in many cases sulpiride – an antipsychotic and antidepressant – was started for the wrong reason in most cases and therefore the children “made little or no clinical improvement… The misuse of sulpiride by primary level doctors is of concern considering that this is an antipsychotic with a number of long- and short-term side effects. Sulpiride is not indicated in children under 14.”
The psychiatrists warned that antipsychotics “should not be resorted to as a first line treatment but only in resistant cases.”
Indeed, the four patients left on sulpiride by the St Luke’s experts was because they were not responsive to other oral medication or psychotherapy. “Sulpiride was prescribed as these patients were of danger to themselves or others.”
The psychiatrists note that GPs are usually the initial contact point for families and children. However, avoiding misdiagnosis would improve if GPs could ask for advice from consultants from the children’s clinic: “by providing advice over the phone in urgent cases, and with GPs, a one-off assessment by the psychiatrist could result in feedback to the GP for regular monitoring.”
In fact the psychiatrists recommended that GPs undertake continued medical education courses to improve their standard for community care for kids and teens.
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