title: Communication about psychotic symptoms in long-term psychiatric illness.
abstract: BACKGROUND
  Communicating about psychotic symptoms can be challenging. This study aimed to identify (1) how psychiatrists and patients communicate about psychotic symptoms from a research and clinical perspective and (2) whether communication patterns depend on patients' symptom levels.
  
  
  METHODS
  Consultations between 27 psychiatrists and 100 patients with long-term schizophrenia/schizoaffective disorder in outpatient clinics were video-recorded, transcribed and coded. Symptoms were assessed on the Positive and Negative Syndrome Scale. Avoidance or engagement with psychotic symptoms was coded separately by researchers and three clinical psychiatrists.
  
  
  RESULTS
  Psychotic symptoms were not mentioned in 27% of consultations. Patients reported their absence in 34% of consultations and avoided talking about symptoms in 6%. Researchers rated psychiatrists as engaged in talking about psychotic symptoms in 15% of consultations and avoiding talking about them in 18% of consultations. Psychiatrists identified somewhat less avoidance (10%) and more engagement (23%). Psychiatrist avoidance was seen when the patient raised the topic and the psychiatrist gave brief responses and/or changed the topic. When psychiatrists engaged, they asked specific questions about symptoms, responded to patient concerns and provided explanations about symptoms. Psychotic symptoms were more often discussed with patients with more negative and general symptoms.
  
  
  CONCLUSIONS
  There is considerable variation in whether psychotic symptoms are discussed or not in outpatient consultations. Whether psychiatrists discuss psychotic symptoms is influenced by patients' symptoms; however, not by their psychotic symptoms but rather by the presence of negative and general symptoms. Psychiatrists' ratings of communication identify broadly similar patterns as detailed research analyses.
authors.affiliation: Neurosciences, Mental Health and Sensory Functions Department, Sapienza University, 2nd Medical School, Sant'Andrea Hospital, Rome, Italy.
authors.forename: M T
authors.initials: MT
authors.lastname: Federico
authors.forename: S
authors.initials: S
authors.lastname: Priebe
authors.forename: C
authors.initials: C
authors.lastname: Fusco
authors.forename: N
authors.initials: N
authors.lastname: Strapelli
authors.forename: R
authors.initials: R
authors.lastname: Singh
authors.forename: R
authors.initials: R
authors.lastname: McCabe
mesh_terms: D000328:Adult; D003142:Communication; D005260:Female; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000523:psychology; D008875:Middle Aged; D010045:Outpatients; D011570:Psychiatry; D011618:Psychotic Disorders / Q000523:psychology*; D012017:Referral and Consultation