Do we agree about when patients are psychotic

Objective:  To investigate into the use of the term ‘psychotic’ as defined by ICD-10 or by the concept of impaired reality testing, among psychiatric staff members. Method:  Questionnaire investigation using 11 short case vignettes. Results:  Responses were received from 266 psychiatric staff members: psychiatrists, nursing staff and psychologists. When using ICD-10, patients were identified as psychotic with a sensitivity ranging from 90% to 55%. Specificity ranged from 60% to 75%. According to the concept of impaired reality testing, all three groups showed a sensitivity of about 60%, whereas specificity ranged from 65% to 50%. The combined use of the terms correlated significantly with responses regarding indication for legal detention for psychiatrists and nursing staff. Conclusion:  In identifying a patient as ‘psychotic’ a broad concept of impaired reality testing was widely used particularly in cases with legal issues. Psychotic symptoms, however, were identified with high sensitivity and specificity.