Clarity of request for consultation: its relationship to psychiatric diagnosis

Psychiatric consultants’ ratings of the clarity of requests for 203 psychiatric consultations by medical and surgical services were studied prospectively during a three-month period. The subsequent psychiatric diagnoses were grouped depending on whether or not a major mental illness (MMI), mainly in the form of dementia, delirium, affective disorders, and schizophrenic disorders, was present according to DSM-III criteria. An MMI was diagnosed in 61% of cases in which the reason for the consultation request was considered unclear, but in only 32% of cases in which the reason was considered clear. These findings support earlier speculations that patients with serious psychiatric disturbances tend to affect the clarity of communications among members of the treatment team.