![]() ![]() Each admission diagnosis was made by either a psychiatric resident or a board-certified psychiatrist. This physician also obtained all medical history, including history of seizures. The neurological examinations were performed by a staff or resident psychiatrist within 24 hours of admission. Patients were included in the study if they were evaluated for a psychotic illness, had no previous evaluations for a psychosis, and received a CT scan of the head.Įach case was categorized by the independent variables of age (18 to 30 years, 31 to 40 years, and 41 years and older), sex, diagnosis (schizophreniform disorder and schizophrenia, bipolar disorder, major depression, schizoaffective disorder, and other diagnoses), neurological examination (normal or abnormal), and a history of seizure (present or absent). Charts were reviewed for all patients admitted to or discharged from the inpatient psychiatry service from January 1, 1992, through September 30, 1994, with a DSM-III-R diagnosis on admission of psychotic disorder not otherwise specified, schizophreniform disorder, schizophrenia, brief reactive psychosis, schizoaffective disorder, delusional disorder, bipolar disorder, or major depression. The psychiatry ward's log book of admissions and discharges was used to identify potential subjects. Currently, most of these patients receive a head CT scan as a standard part of their diagnostic work-up if they are admitted with a new psychotic illness. On average, the daily inpatient psychiatry census is 48 ( 8). ![]() The Naval Medical Center in San Diego is a tertiary care center with 393 inpatient beds ( 8), which provides care to persons on active military duty, retirees, and their dependents. If investigators can define subpopulations of newly psychotic patients in which the benefits of CT scanning outweigh the costs and in subpopulations in which CT scanning is unwarranted, health care dollars could be more carefully spent. CT scans cost money failing to detect a brain lesion by not scanning has potentially greater costs. In this era of cost control in health care, each dollar spent must be justified. This study is valuable because it looked at a relatively homogeneous group without such confounding variables as advanced age and comorbid conditions. ![]() A working hypothesis was that psychotic illness alone is not sufficient to warrant a CT scan. To help advance this debate, this study examined a specific group of new-onset psychotic patients-those who are young and in good general health. A prospective study examining CT scans and organic versus functional psychosis found that CT scan abnormalities did not correlate with diagnoses of organic brain syndrome, casting further doubt on the value of routine CT scanning in this group ( 7). Rather than scanning all first-break psychotic patients, some investigators propose using neurologic abnormalities ( 4- 6), a history of seizure ( 4, 5), a history of head injury ( 5), or age above 40 years ( 5) as reasons to order a CT scan. The other had an arteriovenous malformation that was small and not easily accessible and was managed conservatively. One of the patients had a colloid cyst that was judged to be symptomatic and was removed. However, only two of 168 patients (1.19 percent) had abnormalities that had actual implications for patient management. In a study by Gewirtz and colleagues ( 1) of patients with new psychotic illness, the incidence of CT findings other than atrophy was 6.6 percent. Some clinicians have argued that all patients presenting with a first onset of psychotic illness should receive a computed tomography (CT) scan of the head to rule out such causes as tumors, abscesses, Huntington's disease, encephalitis, Wilson's disease, and trauma (1-3). ![]()
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