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Author Notes:

E-mail: mrapapo@emory.edu

Becky Kinkead ORCID: https://orcid.org/0000-0003-0169-6989

Conceptualization and Supervision: Clyde Partin, Mark Hyman Rapaport.

Data curation: Gabriella Waserstein, Clyde Partin, Debra Cohen.

Formal analysis: Pamela Schettler.

Investigation: Gabriella Waserstein, Clyde Partin, Debra Cohen, Mark Hyman Rapaport.

Methodology: Clyde Partin, Pamela Schettler, Mark Hyman Rapaport.

Project administration: Clyde Partin, Becky Kinkead, Mark Hyman Rapaport.

Writing – original draft: Gabriella Waserstein.

Writing – review & editing: Gabriella Waserstein, Clyde Partin, Debra Cohen, Pamela Schettler, Becky Kinkead, Mark Hyman Rapaport.


Research Funding:

The author(s) received no specific funding for this work.


  • Science & Technology
  • Multidisciplinary Sciences
  • Science & Technology - Other Topics

The prevalence and impact of psychiatric symptoms in an undiagnosed diseases clinical program

Journal Title:



Volume 14, Number 6


, Pages e0216937-e0216937

Type of Work:

Article | Final Publisher PDF


In 2008, the NIH launched an undiagnosed diseases program to investigate difficult to diagnose, and typically, multi-system diseases. The objective of this study was to evaluate the presence of psychiatric symptoms or psychiatric diagnoses in a cohort of patients seeking care at the Emory Special Diagnostic Service clinic. We hypothesized that psychiatric symptoms would be prevalent and associated with trauma exposure, and a decreased quality of life and functioning. This is a cross-sectional, retrospective analysis of 247 patients seen between February 7, 2014 and May 31, 2017. The sources for data included the Emory Health History Questionnaire (HHQ) that had the work and social adjustment and quality of life enjoyment and satisfaction questionnaire–short form (QLSQ) embedded in it; medical records, and the comprehensive standardized special diagnostic clinic forms. Primary outcomes were presence of any psychiatric symptom, based on report of the symptom on the HHQ or medical record, or presence of a confirmed preexisting psychiatric disorder. Seventy-two percent of patients had at least one psychiatric symptom while 24.3% of patients had a pre-existing psychiatric diagnosis. Patients with any psychiatric symptom had significantly diminished Q-LES-Q scores (45.27 ± 18.63) versus patients with no psychiatric symptoms (62.01 ± 21.57, t = 5.60, df = 225, p<0.0001) and they had significantly greater functional disability. Patients with a psychiatric disorder also had significantly diminished Q-LES-Q scores (45.16 ± 17.28) versus those without a psychiatric diagnosis (51.85 ± 21.54, t = 2.11, df = 225, p = 0.036) but did not have significantly increased functional impairment. Both patients with psychiatric symptoms and ones with psychiatric disorders had an increased prevalence of trauma. Psychiatric symptoms are prevalent in patients evaluated for undiagnosed disorders. The presence of any psychiatric symptom, with or without a formal psychiatric diagnosis, significantly decreases quality of life and functioning. This suggests that assessment for psychiatric symptoms should be part of the evaluation of individuals with undiagnosed disorders and may have important diagnostic and treatment implications.

Copyright information:

© 2019 Waserstein et al.

This is an Open Access work distributed under the terms of the Creative Commons Attribution 4.0 International License (https://creativecommons.org/licenses/by/4.0/).
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