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Topics in Cognitive Science Apr 2018The effectiveness of medical treatment depends on the quality of the patient-clinician relationship. It has been proposed that this depends on the extent to which the...
The effectiveness of medical treatment depends on the quality of the patient-clinician relationship. It has been proposed that this depends on the extent to which the patient and clinician build a shared understanding of illness and treatment. Here, we use the tools of conversation analysis (CA) to explore this idea in the context of psychiatric consultations. The CA "repair" framework provides an analysis of the processes people use to deal with problems in speaking, hearing, and understanding. These problems are especially critical in the treatment of psychosis where patients and health care professionals need to communicate about the disputed meaning of hallucinations and delusion. Patients do not feel understood, they are frequently non-adherent with treatment, and many have poor outcomes. We present an overview of two studies focusing on the role of repair as a mechanism for producing and clarifying meaning in psychiatrist-patient communication and its association with treatment outcomes. The first study shows patient clarification or repair of psychiatrists' talk is associated with better patient adherence to treatment. The second study shows that training which emphasizes the importance of building an understanding of patients' psychotic experiences increases psychiatrists' self-repair. We propose that psychiatrists are working harder to make their talk understandable and acceptable to the patient by taking the patient's perspective into account. We conclude that these findings provide evidence that repair is an important mechanism for building shared understanding in doctor-patient communication and contributes to better therapeutic relationships and treatment adherence. The conversation analytic account of repair is currently the most sophisticated empirical model for analyzing how people construct shared meaning and understanding. Repair appears to reflect greater commitment to and engagement in communication and improve both the quality and outcomes of communication. Reducing potential miscommunication between psychiatrists and their patients with psychosis is a low-cost means of enhancing treatment from both the psychiatrist and patient perspective. Given that misunderstanding and miscommunication are particularly problematic in psychosis, this is critical for improving the longer term outcomes of treatment for these patients who often have poor relationships with psychiatrists and health care services more widely.
Topics: Communication; Comprehension; Humans; Physician-Patient Relations; Psychiatry; Psychotic Disorders
PubMed: 29749042
DOI: 10.1111/tops.12337 -
Dialogues in Clinical Neuroscience Mar 2003On November 3, 1906, a clinical psychiatrist and neuroanatomist, Alois Alzheimer, reported "A peculiar severe disease process of the cerebral cortex" to the 37th Meeting...
On November 3, 1906, a clinical psychiatrist and neuroanatomist, Alois Alzheimer, reported "A peculiar severe disease process of the cerebral cortex" to the 37th Meeting of South-West German Psychiatrists in Tubingen, He described a 50-year-old woman whom he had followed from her admission for paranoia, progressive sleep and memory disturbance, aggression, and confusion, until her death 5 years later. His report noted distinctive plaques and neurofibrillary tangles in the brain histology. It excited little interest despite an enthusiastic response from Kraepelin, who promptly included "Alzheimer's disease" in the 8th edition of his text Psychiatrie in 1910. Alzheimer published three further cases in 1909 and a "plaque-only" variant in 1911, which reexamination of the original specimens in 1993 showed to be a different stage of the same process, Alzheimer died in 1915, aged 51, soon after gaining the chair of psychiatry in Breslau, and long before his name became a household word.
PubMed: 22034141
DOI: 10.31887/DCNS.2003.5.1/hhippius -
BJPsych Bulletin Oct 2019Research into patient suicide indicates that it has an impact on the psychiatrists involved, but leaves a number of unanswered questions about which elements of the...
Research into patient suicide indicates that it has an impact on the psychiatrists involved, but leaves a number of unanswered questions about which elements of the experience are most likely to cause problems, who is most at risk, what is the clinical or professional significance of any effect on the psychiatrist and how other professionals are affected. Despite these uncertainties, it is clear that a response is needed, with three bodies responsible in different ways for coordinating one: the relevant mental health trust, as employer; the Royal College of Psychiatrists, as the professional representative body; and the National Confidential Inquiry into Suicide and Safety in Mental Health, as mediator of social and professional impact.
PubMed: 31663495
DOI: 10.1192/bjb.2019.53 -
Tijdschrift Voor Psychiatrie 2023Clear and unambiguous description of psychiatric symptoms is a prerequisite for a personalized and reliable mental state examination.
BACKGROUND
Clear and unambiguous description of psychiatric symptoms is a prerequisite for a personalized and reliable mental state examination.
AIM
To draw attention to the correct use of psychiatric language.
METHOD
Description of persistent linguistic errors and relevant but too little used terms, and a new Dutch translation for some psychopathological terms.
RESULTS
The following linguistic errors are presented: ‘concentration’ as if it means the sustaining of attention; ‘compulsive behaviour’ that is not really compulsive; ‘no diagnosis’ while no disorder is diagnosed; ‘no psychopathology’ as if the patient has no science of psychopathology; ‘to impress as’ for characteristic that are not impressive; ‘mild’ while psychiatric disorders are never mild; ‘inhibition’ as if we can observe that subjective phenomenon; ‘signs’ for symptoms that do not appear to us at all; ‘weather and climate’ for affect and mood, while the mood generally changes somewhat faster than he climate. Attention is drawn for the terms chronognosia, overvalued idea, sensory hyporeactivity and disorders of self-awareness. New Dutch translations for dysmorphic disorder, délire de négation, and paranoic are explained.
CONCLUSION
Psychiatrists, watch your language!
Topics: Male; Humans; Mental Disorders; Language; Psychiatry
PubMed: 36951767
DOI: No ID Found -
BJPsych Bulletin Oct 2021
PubMed: 34556199
DOI: 10.1192/bjb.2021.79 -
The Israel Journal of Psychiatry and... 2014A series of studies reveals that patient suicide is experienced by most psychiatrists, particularly adult psychiatrists in the public sector. Psychiatrists respond to...
A series of studies reveals that patient suicide is experienced by most psychiatrists, particularly adult psychiatrists in the public sector. Psychiatrists respond to patient suicide with symptoms of grief, with an intensity in 25-50% of cases similar to those who have lost a parent and sought help, although the duration is more brief. Patient suicide usually results in psychiatrists becoming more defensive in their practice: extra careful to ask about suicidal ideation, more likely to suggest hospitalization and compulsory care, and seek colleagues' consultation. The frequency of patient suicide and its emotional and professional impact have lead to recommendations that the psychiatrist is supported during the early phase of shock and grief, and receives ongoing support for a period after the suicide. Most families of suicide patients would wish to have contact with the psychiatrist after the event. While distress and fear of litigation may influence the psychiatrist's actions, meeting with the family should be seen as part of care, and the psychiatrist should receive guidance and support in this process.
Topics: Humans; Physicians; Psychiatry; Suicide
PubMed: 25618283
DOI: No ID Found -
Psychopathology 2022In the present article, we aimed at describing the diagnostic process in Psychiatry through a phenomenological perspective. We have identified 4 core concepts which may... (Review)
Review
In the present article, we aimed at describing the diagnostic process in Psychiatry through a phenomenological perspective. We have identified 4 core concepts which may represent the joints of a phenomenologically oriented diagnosis. The "tightrope walking" attitude refers to the psychiatrist's ability to swing between 2 different and sometimes contrasting tendencies (e.g., engagement and disengagement). The "holistic experience" includes all those intuitive, nonverbal, and pre-thematic elements that emerge in the early stages of the clinical encounter as an emanation of the atmospheric quality of the intersubjective space. The "co-construction of symptoms" regards the hermeneutic process behind psychiatric symptoms, involving both the patient as a self-interpreting agent and the clinician as a translator of his/her experience. Finally, by the "evolving typification" we mean that the closer the relationship becomes with the patient, the more specific and nuanced becomes the typification behind psychiatric diagnosis. Each of these concepts will be accompanied by an extract from a clinical case deriving from one of the authors' most recent clinical experiences.
Topics: Female; Humans; Male; Mental Disorders
PubMed: 34965532
DOI: 10.1159/000520334 -
Journal of Family Medicine and Primary... Mar 2022The under-or misdiagnosis, and symptomatic treatment of the panic disorder (PD), despite high prevalent medical illness, is common among non-psychiatric physicians. The... (Review)
Review
The under-or misdiagnosis, and symptomatic treatment of the panic disorder (PD), despite high prevalent medical illness, is common among non-psychiatric physicians. The non-psychiatrist physician's role is vital in the care of PD as most patients initially approach general medical settings for medical help, including primary care. However, a significant proportion is undiagnosed and undergoes either unnecessary investigation, misdiagnosed, or mismanaged even among post-Coronary Artery Bypass Grafting patients, which profoundly affects the patients functioning and quality of life. This article aims to provide overviews of relevant epidemiological aspects, presenting features across medical specialties with respective diagnostic dilemmas, assessment, and management of the PD in their general medical settings, including emergency visits. Apart from psychiatrists, this will also assist non-psychiatrist physicians across all medical specialties, including general practitioners, to understand, identify, and provide the first line evidence-based pharmacotherapy and address the unmet need of patients with PD in their day-to-day busy clinical practice. This paper also provides a referral guide for non-psychiatrist physicians to refer to psychiatrists for further management after their first-line management.
PubMed: 35495823
DOI: 10.4103/jfmpc.jfmpc_888_21 -
BJPsych Bulletin Oct 2021
PubMed: 34556201
DOI: 10.1192/bjb.2021.78