title: How do psychiatrists address delusions in first meetings in acute care? A qualitative study.
abstract: BACKGROUND
  Communicating about delusions can be challenging, particularly when a therapeutic relationship needs to be established in acute care. So far, no systematic research has explored how psychiatrists address patients' delusional beliefs in first meetings in acute care. The aim of this study was to describe how psychiatrists address patients' delusional experiences in acute in-patient care.
  
  
  METHODS
  First meetings between five psychiatrists and 14 patients in acute care were audio-recorded and analysed using thematic content analysis.
  
  
  RESULTS
  296 psychiatrist statements about delusions were identified and coded. Three commonly used approaches (with a total of 6 subthemes) were identified. The most common approaches were eliciting the content (1 subtheme: eliciting content and evidence) and understanding the impact (3 subthemes: identifying emotions, exploring links with dysfunctional behaviour and discussing reasons for hospital admission) while questioning the validity of the beliefs (2 subthemes: challenging content and exploring alternative explanations) was less common. The last approach sometimes put patients in a defensive position.
  
  
  CONCLUSIONS
  Psychiatrists commonly use three approaches to address patients' delusions in the first meeting in acute in-patient care. Questioning the patients' beliefs can lead to disagreement which might hinder establishing a positive therapeutic relationship. Future research should explore the impact of such an approach on outcomes and specify to what extent questioning the validity of delusional beliefs is appropriate in the first meeting.
authors.forename: Alessia
authors.initials: A
authors.lastname: Zangrilli
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Ducci
authors.forename: Pier Luca
authors.initials: PL
authors.lastname: Bandinelli
authors.forename: Jemima
authors.initials: J
authors.lastname: Dooley
authors.forename: Rosemarie
authors.initials: R
authors.lastname: McCabe
authors.affiliation: Unit for Social and Community Psychiatry, WHO Collaborating Centre for Mental Health Services Development, Queen Mary University of London, London E13 8SP, UK. s.priebe@qmul.ac.uk.
authors.forename: Stefan
authors.initials: S
authors.lastname: Priebe
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D003422:Critical Care; D003702:Delusions / Q000175:diagnosis*; D004644:Emotions; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010343:Patient Admission; D010817:Physician-Patient Relations; D011570:Psychiatry; D036301:Qualitative Research; D000078329:Workforce