ABSTRACT
OBJECTIVE: Effective doctor-patient communication, including a shared understanding, is associated with treatment adherence across medicine. However, communication is affected by a diagnosis of schizophrenia and reaching a shared understanding can be challenging. During conversation, people detect and deal with possible misunderstanding using a conversational process called repair. This study tested the hypothesis that more frequent repair in psychiatrist-patient communication is associated with better treatment adherence in schizophrenia. METHODS: Routine psychiatric consultations involving patients with (DSM-IV) schizophrenia or schizoaffective disorder were audio-visually recorded. Consultations were coded for repair and patients' symptoms and insight assessed. Adherence was assessed six months later. A principal components analysis reduced the repair data for further analysis. Random effects models examined the association between repair and adherence, adjusting for symptoms, consultation length and the amount patients spoke. RESULTS: 138 consultations were recorded, 118 were followed up. Patients requesting clarification of the psychiatrist's talk and the clarification provided by the psychiatrist was associated with adherence six months later (OR 5.82, 95% CI 1.31-25.82, p=0.02). CONCLUSION: The quality of doctor-patient communication also appears to influence adherence in schizophrenia. PRACTICE IMPLICATIONS: Future research should investigate how patient clarification can be encouraged among patients and facilitated by psychiatrists' communication.
Subject(s)
Antipsychotic Agents/therapeutic use , Communication , Patient Compliance , Physician-Patient Relations , Psychotherapy , Schizophrenia/therapy , Adult , Cluster Analysis , Comprehension , Female , Humans , Male , Middle Aged , Principal Component Analysis , Psychotic Disorders/psychology , Psychotic Disorders/therapy , Regression Analysis , Schizophrenia/diagnosis , Socioeconomic Factors , Time Factors , Video RecordingABSTRACT
Macrae and Lewis (2002) showed that repeated reporting of the global dimension of Navon stimuli improved performance in a subsequent face identification task, whilst reporting the features of the Navon stimuli impaired performance. Using a face composite task, which is assumed to require featural processing, Weston and Perfect (2005) showed the complementary pattern: Featural responding to Navon letters speeded performance. However, both studies used Navon stimuli with global precedence, in which the overall configuration is easier to report than the features. Here we replicate the two studies above, whilst manipulating the precedence (global or featural) of the letter stimuli in the orientation task. Both studies replicated the previously reported findings with global precedence stimuli, but showed the reverse pattern with local precedence stimuli. These data raise important questions as to what is transferred between the Navon orientation task and the face-processing tasks that follow.
Subject(s)
Attention , Face , Field Dependence-Independence , Orientation , Pattern Recognition, Visual , Practice, Psychological , Transfer, Psychology , Adolescent , Choice Behavior , Discrimination Learning , Female , Humans , Male , Size Perception , Young AdultABSTRACT
Recent work has demonstrated that performance on a simultaneous target-present photographic line-up can be enhanced by prior global processing orientation, and hindered by prior local processing orientation induced by processing Navon letter stimuli. A series of studies explore the generality of this processing bias effect using either videotaped scenarios or live interactions. Five experiments demonstrate that these effects are seen across a range of test stimuli, test formats, and test instructions. These data inform the processes engaged in by witnesses when making line-up identifications and indicate that it may be possible to improve the accuracy of witnesses making such judgements.
