Dress and address in hospital psychiatry: an issue?

Background and aims: To assess the preferences of Dutch psychiatric patients in three general hospital psychiatric settings for the dress of psychiatrists and patients preference to be addressed by psychiatrists. To assess the associations concerning different clothing styles and the attributes of the patient-doctor relationship.Methods: One hundred and seventy-three adults, in and outpatients (aged 18-89 years) attending the psychiatry departments of three general hospitals, were included during the period June 2015 to May 2016. In these hospitals, the psychiatrist staff has different clothing policies. Data were analyzed with SPSS21.Results: Divided over the three hospitals, 173 patients were included, 96 inpatients and 77 outpatients. The patients' opinions on the psychiatrists' dress differed significantly between the hospitals in line with the local hospital clothing policy (p = 0.002 for the male psychiatrists, p = 0.000 for the female psychiatrists). The patients' ethnicity significantly influenced their preferences for dress and address, as a majority of the patients with a non-Dutch ethnic background expressed a preference for white coats, and address by surname (RR = 2.0, p = 0.003 for male and RR = 2.1 p = 0.002 for female psychiatrists). A significant difference in preference for being addressed by their first names by the psychiatrist was found between Dutch and non-native Dutch patients (RR = 2.6, p = 0.005). According to patients, the male psychiatrist in trousers and a long sleeve shirt and female psychiatrist in casual clothing were most often associated as being the friendliest, a white coat as being the most competent, and wearing smart attire as being the most accessible.Conclusion: Patients' preferences are in line with current local clothing habits. Ethnicity, setting and country influence a patient's preferences. Casual clothing for psychiatrists is assessed as being the friendliest but as the least competent, and white coats are assessed as being the most competent but as being less friendly and less accessible.

[Bizarre somatic complaints as a manifestation of schizophrenia]. / Bizarre lichamelijke klachten als uiting van een schizofrene stoornis.

Three patients, men aged 50 and 32 and a woman aged 30 years, presented with bizarre somatic symptoms, i.e. that are anatomically and physiologically impossible. The first patient, for instance, thought that he could only walk while holding his forehead back with his hand; the woman thought that the skin of her neck and back was disconnected from the underlying tissues. The patients were preoccupied with their complaints and could not be convinced that there was no organic substrate for their symptoms. The presented patients had coenesthetic symptoms of schizophrenia: disturbances in the awareness of their bodily integrity. These symptoms occur frequently in patients with schizophrenia, but have not received much attention in medical literature. The patient's visit to a somatic or general physician is a good opportunity to refer him or her for adequate psychiatric treatment.

The non-palpable, radiographically suspicious breast lesion: an analysis of 101 cases.

Analysis of 94 patients with 101 non-palpable, radiographically suspicious, breast lesions revealed 46 malignancies (46%). Comparison of the malignant lesions with 225 palpable carcinomas (221 patients) removed surgically during the same period, showed a higher incidence of carcinoma in situ. Contrary, lymph-node metastases and distant metastases were, at the time of operation, distinctly less than in the patients with non-palpable malignant lesions. A breast-conserving therapy was more often feasible in patients with nonpalpable malignant lesions.