Intended for healthcare professionals


Engaging patients with psychosis in consultations

BMJ 2003; 326 doi: (Published 08 March 2003) Cite this as: BMJ 2003;326:549

Design of study has several problems

  1. Gomathinayagam S Rajesh, specialist registrar (general adult psychiatry) (
  1. Soho House, North Birmingham Mental Health Trust, Birmingham B23 6AL
  2. Psychiatric Hospital, GGZ Delfland, Jorisweg 2, 2311BM Delft, Netherlands
  3. The Grange, Newcastle upon Tyne NE12 9PN
  4. Unit for Social and Community Psychiatry, Barts and the London School of Medicine, Newham Centre for Mental Health, London E13 8SP

    EDITOR—McCabe et al discussed how psychiatrists engage with psychotic patients during routine consultations.1 However, the design of their study may have compromised the conclusions.

    The clients selected were already attending a psychiatric outpatient clinic and had willingly agreed to participate in the study. These clients presumably had already engaged with their respective teams, which affects the generalisability of the study to clients who do not engage.

    Videotaping the consultation introduces an element of subject and observer bias. The presence of a video camera can affect the nature of the interaction between doctor and client, which again affects the generalisability of the findings to routine clinical consultations. Given that 50% of the clients were not white British, the social interaction may have been influenced by the social, ethnic, and cultural differences between the client and doctor. In addition, clients with psychosis often present with thought disorder, negative symptoms (poverty of thought), and other abnormalities of affect, which makes the interaction qualitatively and quantitatively different from normal conversation.

    Some studies have shown that patient centred skills, particularly when giving information and counselling, are related to increased compliance with treatment, improved satisfaction, and decreased symptoms and emotional distress.2 Unfortunately these studies occurred in primary care and may not be applicable to psychiatric consultations. Clients at different stages of psychotic illness need different types of consultations, with the clinician having to judge the amount of information that would be beneficial for each person.

    This article has succeeded in highlighting the importance of the consultation between doctor and patient in engaging clients. However, psychiatric treatment is within a multidisciplinary team, with other agencies being equally capable of delivering information. …

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