Non-verbal communication in meetings of psychiatrists and patients with schizophrenia.

OBJECTIVE: Recent evidence found that patients with schizophrenia display non-verbal behaviour designed to avoid social engagement during the opening moments of their meetings with psychiatrists. This study aimed to replicate, and build on, this finding, assessing the non-verbal behaviour of patients and psychiatrists during meetings, exploring changes over time and its association with patients' symptoms and the quality of the therapeutic relationship. METHOD: 40-videotaped routine out-patient consultations, involving patients with schizophrenia, were analysed. Non-verbal behaviour of patients and psychiatrists was assessed during three fixed, 2-min intervals using a modified Ethological Coding System for Interviews. Symptoms, satisfaction with communication and the quality of the therapeutic relationship were also measured. RESULTS: Over time, patients' non-verbal behaviour remained stable, whilst psychiatrists' flight behaviour decreased. Patients formed two groups based on their non-verbal profiles, one group (n = 25) displaying pro-social behaviour, inviting interaction and a second (n = 15) displaying flight behaviour, avoiding interaction. Psychiatrists interacting with pro-social patients displayed more pro-social behaviours (P < 0.001). Patients' pro-social profile was associated reduced symptom severity (P < 0.05), greater satisfaction with communication (P < 0.001) and positive therapeutic relationships (P < 0.05). CONCLUSION: Patients' non-verbal behaviour during routine psychiatric consultations remains unchanged, and is linked to both their psychiatrist's non-verbal behaviour and the quality of the therapeutic relationship.

Good communication in psychiatry--a conceptual review.

BACKGROUND: The communication between clinician and patient is the basis of psychiatric treatment. However, there has been little practical attention to training in it, and no specific theory of what constitutes good communication in psychiatry has been developed. This review aims to identify principles that guide good communication. METHODS: A conceptual review of guiding principles for how clinicians should communicate with patients to achieve clinical objectives in psychiatry. RESULTS: Five guiding principles for clinicians were identified: a focus on the patient's concerns; positive regard and personal respect; appropriate involvement of patients in decision making; genuineness with a personal touch; and the use of a psychological treatment model. CONCLUSIONS: The principles are mostly generic, but their implementation can be particularly challenging in psychiatry. They may guide further empirical research on effective communication in psychiatry and be utilised using different personal skills of clinicians.

[Psychiatric disorders in emigrants. II. Follow-up over six months and attitudes of the patients]. / Psychische Störungen bei Ubersiedlern. II. Verlauf über sechs Monate und Sichtweisen der Patienten.

In the first part of this study we investigated people who had left East Germany and sought psychiatric help within six weeks after their move. 94 patients were re-examined approximately six month later. Meanwhile 40% had found an adequate job and 44% satisfactory accommodation. 65% stated that some of their original hopes had remained unfulfilled in the west. However, in general patients viewed significantly fewer problems associated with integration in the West, than in the first interview. Symptoms were clearly improved according to clinical and self-ratings. Only three patients reported an overall deterioration. Sociodemographic and clinical variables as assessed in the first interview--including diagnostic classification according to ICD-9 and DSM-III-R-, allowed only a limited prediction of different outcome criteria.

[Psychiatric disorders in emigrants. III. Follow-up after two and a half years]. / Psychische Störungen bei Ubersiedlern. III. Nachuntersuchung nach zweieinhalb Jahren.

In the first and the second part of this study we reported about first examination and a six month follow-up in patients who had left East-Germany in 1989. In this third and last part, findings of a two and a half year follow-up in 52 patients are shown. 92% of the patients reported further improvement, 87% stated to have an adequate job, and also 87% to have satisfactory accommodation. Frequency of complaints and level of psychopathological symptoms were clearly reduced. This positive change was not due to psychiatric treatment.

[Psychiatric disorders in immigrants. I. History, symptoms and diagnostic classification]. / Psychische Störungen bei Ubersiedlern. I. Vorgeschichte, Symptomatik und diagnostische Einordnung.

155 people who had left East-Germany and sought psychiatric help within six weeks after their arrival in West Berlin, were examined. History, living situation and psychopathological symptoms were studied. The disorders were diagnosed according to ICD-9 and DSM-III-R. 85% of the patients reported that they had already suffered from similar complaints in East Germany. 50% stated they have had symptoms before they had made the decision to leave. On average, that decision had been taken 22 months before the actual leaving. Most often patients complained about sleep disturbance, nervousness, and headaches. According to ICD-9, 55% of the disorders were classified as reactive and 39% as neurotic or personality disorders. The most frequent diagnoses according to DSM-III-R were adjustment disorders (41%), major depression (21%), anxiety disorders (16%), and dysthymia (14%). Regardless of diagnosis most patients were found to have symptoms of anxiety and depression associated with vegetative complaints. There were no clear relationships between psychopathological symptoms and data of history or present living situation.

Expressed emotion and auditory evoked potentials.

The expressed emotion (EE) of key relatives has been shown to predict the course of illness in psychiatric patients. In this study, we examined whether there might be physiological correlates to the EE index in nonbiological key relatives of patients with affective psychoses. High-EE and low-EE relatives were compared concerning their slopes of the amplitude/stimulus intensity function (auditory evoked N1/P2-component). We found that the slopes were clearly steeper in the case of low-EE relatives. In comparing the slopes of all key relatives with those of an age-matched control group without psychiatrically ill partners, we could find no differences. Therefore, the slope differences between high-EE and low-EE relatives do not seem to reflect differences in the illness of partners. We speculated whether a steep slope as well as low EE could be associated with an action-oriented, impulsive communication style, which would prevent the development of an affectively tense communication pattern.

Lithium prophylaxis and expressed emotion.

Expressed emotion (EE) in key relatives of 21 patients with bipolar affective or schizoaffective psychoses was assessed by the CFI. All patients had been on prophylactic lithium for at least three years and were without psychotic symptoms at interview. The relationship between relatives' EE status and patients' course of illness was studied both retrospectively and prospectively. Two critical remarks designated high EE. The relatives' EE status was not related to number of hospital admissions or to severity and length of recurrences if the entire period of lithium treatment is considered as a whole. However, patients living with high-EE relatives showed a significantly poorer response during the three years before interview, and an even poorer response in the nine-month follow-up.