BALTIMORE — A significant number of people declared schizophrenic by their doctors may be misdiagnosed. New research concluded from a small study of schizophrenia patients referred to the Johns Hopkins Early Psychosis Intervention Clinic (EPIC) found that about half didn’t have the disease at all.

Schizophrenia is a severe, chronic mental disorder typically characterized by disordered thinking, emotions, and behavior. The study showed that most misdiagnoses of these referrals were of patients battling anxiety or other mental conditions, with many wrongly classified for reporting that they heard voices.

Hopkins researchers say the results call for second opinions at specialized schizophrenia clinics after the initial diagnosis. This could reduce the risk of misdiagnoses and ensure fast and appropriate patient treatment.

“Because we’ve shined a spotlight in recent years on emerging and early signs of psychosis, diagnosis of schizophrenia is like a new fad, and it’s a problem especially for those who are not schizophrenia specialists because symptoms can be complex and misleading,” says Krista Baker, manager of adult outpatient schizophrenia services at Johns Hopkins Medicine, in a statement. “Diagnostic errors can be devastating for people, particularly the wrong diagnosis of a mental disorder.”

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For the study, researchers examined patient data from 78 cases referred to the clinic for consultation between February 2011 and July 2017. The patients were 19 years old on average, and about seven in 10 were men (more men than women suffer from schizophrenia overall). Additionally, 74% of the participants were white, 12% African-American, and 14% were another ethnicity. Patients were referred to EPIC by general psychiatrists, primary care physicians, nurse practitioners, outpatient psychiatric centers, neurologists, or psychologists.

Patients and their family were subject to elaborate interviews and testing, including physical examinations and deep dives into their medical and mental health histories.

Though 54 of the patients reviewed had been diagnosed with a form of schizophrenia spectrum disorder, the researchers confirmed just 26 were found to be actually suffering from the condition. The remaining patients were determined to have anxiety or a mood disorder.

Experts say that when people report hearing voices, doctors may be quick to slap on the schizophrenia diagnosis. But it needs to be investigated further as it may be a less serious symptom than first thought.

“Hearing voices is a symptom of many different conditions, and sometimes it is just a fleeting phenomenon with little significance,” says Dr. Russell L. Margolis, a professor of psychiatry and behavioral sciences and the clinical director of the Johns Hopkins Schizophrenia Center. “At other times when someone reports ‘hearing voices’ it may be a general statement of distress rather than the literal experience of hearing a voice. The key point is that hearing voices on its own doesn’t mean a diagnosis of schizophrenia.”

Margolis blames “checklist psychiatry” — or doctors using computer programs to reach diagnoses when certain criteria are met via pulldown menus — for the frequent mistakes. Moving forward, the authors believe that doctors should refer patients to specialists for second opinions when making schizophrenia diagnoses.

“The big take-home message from our study is that careful consultative services by experts are important and likely underutilized in psychiatry,” says Margolis. “Just as a primary care clinician would refer a patient with possible cancer to an oncologist or a patient with possible heart disease to a cardiologist, it’s important for general mental health practitioners to get a second opinion from a psychiatry specialty clinic like ours for patients with confusing, complicated or severe conditions. This may minimize the possibility that a symptom will be missed or overinterpreted.”

The study was published in the Journal of Psychiatric Practice.

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