ABSTRACT
Informed consent allows patients to make treatment decisions based on the best possible information. The current study examines the long-term impact of the informed consent process on schizophrenic patients. Patients were administered a baseline questionnaire and were given an information form, which was read aloud to them by the investigator. Patients were re-administered the questionnaire at 4 weeks and were randomly assigned to no review (single-session group) or a review of the information (educational review group). All patients were administered the questionnaire at 2-year follow-up. Both the single session and the educational review process significantly increase the schizophrenic patient's knowledge about the benefits and risks of neuroleptic medication. No previous study has examined the impact of informed consent for antipsychotic medication at 2-year follow-up.
Subject(s)
Antipsychotic Agents/therapeutic use , Dyskinesia, Drug-Induced , Informed Consent , Patient Education as Topic/methods , Schizophrenia/drug therapy , Antipsychotic Agents/adverse effects , Attitude to Health , Dyskinesia, Drug-Induced/etiology , Follow-Up Studies , Humans , Patient Participation , Risk Assessment , Surveys and QuestionnairesSubject(s)
Antipsychotic Agents/adverse effects , Informed Consent/legislation & jurisprudence , Patient Education as Topic/methods , Schizophrenia/drug therapy , Schizophrenic Psychology , Adult , Antipsychotic Agents/therapeutic use , Dyskinesia, Drug-Induced/etiology , Follow-Up Studies , Humans , Mental Recall , Patient ParticipationABSTRACT
A psychiatric clerkship which emphasizes a clinical exposure to the conduct of outpatient psychodynamic psychotherapy is described and evaluated. Compared to more traditional inpatient based clerkships, an outpatient psychotherapy-oriented clerkship attracts significantly greater numbers of students. In addition, medical students taking such a rotation rate its educational value on its completion significantly more positively compared to other clerkship sites. Finally, students taking the psychotherapy oriented clerkship opt for psychiatry as a specialty significantly more frequently than students taking the more traditional clerkships. The impact of such a learning experience on interpersonal skills with non-psychiatric, medical patients is also discussed.
Subject(s)
Clinical Clerkship , Education, Medical, Undergraduate , Outpatient Clinics, Hospital , Psychiatry/education , Psychotherapy/education , Attitude of Health Personnel , Career Choice , Humans , Teaching/methodsABSTRACT
We have described a psychiatric clerkship which is highlighted by a clinical exposure for the students to the practice of psychodynamic psychotherapy on relatively well-functioning outpatients. Students assigned this rotation are shown to opt for psychiatry significantly more often and rate the educational experience as significantly more positive when compared to psychiatry clerks other teaching hospitals which do not emphasize this clinical experience in outpatient psychotherapy. In addition, students undergoing this type of clerkship are shown to significantly improve in their ability to the histories and interact with medically ill patients, suggesting a further beneficial effect of the experience in conducting psychotherapy during the clerkship.
Subject(s)
Ambulatory Care Facilities , Clinical Clerkship , Education, Medical, Undergraduate , Psychiatry/education , Psychotherapy/education , Attitude , Career Choice , Interviews as Topic , Physician-Patient Relations , Students, MedicalABSTRACT
The use of psychotherapy and pharmacotherapy in combination remains a neglected area of study. In spite of evidence validating the combined treatment psychiatrists often avoid this approach. When combined treatment is employed insufficient attention may be devoted to the important interactive effects. Patients may react to the prescription of medication with a variety of transference feelings such as acceptance, rejection, manipulation and narcissistic injury. Discussion of interpersonal issues precipitated by the use of medication can improve not only the doctor-patient alliance but also the patient's symptomatic experience. The initiation or discontinuation of medications must be carried out with sufficient attention to the patient's realistic concerns and transference distortions. The neglect of a negative transference reaction aroused by the prescription of a medication can result in a resistance to treatment. Case examples and discussion in the article illustrate such phenomena. Psychiatrists need to be aware that their decision to prescribe medication may be influenced by their own unconscious conflicts surrounding the use of medication. They may prescribe or fail to prescribe motivated by their latent fantasies. Attention to the interactive effects of combined therapy is viewed as essential in order to aid patients in the dual goals of symptom alleviation and enrichment of interpersonal experience.
