title: Problems in psychiatric care of 'difficult patients': a Delphi-study.
abstract: OBJECTIVE
  'difficult patients' may evoke strong feelings in health professionals. The ambivalent attitude of, especially, non-psychotic chronic patients towards psychiatric care may be frustrating and burdensome to professionals. Many of these patients are cared for in non-specialized services, where professionals are often more used to working with psychotic patients. Specific problems with 'difficult' non-psychotic patients may occur, and hamper the quality of care offered. The aim of this research is to determine precisely what problems psychiatric professionals perceive in contact with non-psychotic chronic patients in order to identify starting points for alternative or improved care in non-specialized services.
  
  
  METHODS
  a modified five-phase Delphi study with three groups of eight participants from was used to identify and prioritize experts' judgments.
  
  
  RESULTS
  46 problems were identified of which some were relevant to one or two subgroups and some were relevant to the entire group.
  
  
  CONCLUSIONS
  a program that combines a coherent view at services level, with support and increased communication at the interprofessional level (e.g. through regular supervision, sharing of case-loads) may be highly beneficial to non-specialized services.
authors.affiliation: Altrecht Mental Health Care, Department of Outpatient Community Care, Zeist, The Netherlands. b.koekkoek@altrecht.nl
authors.forename: Bauke
authors.initials: B
authors.lastname: Koekkoek
authors.forename: Berno
authors.initials: B
authors.lastname: van Meijel
authors.forename: Aart
authors.initials: A
authors.lastname: Schene
authors.forename: Giel
authors.initials: G
authors.lastname: Hutschemaekers
mesh_terms: D000328:Adult; D003697:Delphi Technique; D005260:Female; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000628:therapy; D008875:Middle Aged; D011369:Professional-Patient Relations