Perceptions of schizophrenic patients and their therapists: application of the semantic differential technique to evaluate the treatment relationship

How do patients and families evaluate attitude of psychiatrists in Japan?: quantitative content analysis of open-ended items of patient responses from a large-scale questionnaire survey

BACKGROUND

Patient and Public Involvement (PPI) has been widely advocated in psychiatric fields. In Japan, however, PPI has not been implemented in clinical practice. In order to improve quality of psychiatric service in Japan, it is essential to understand psychiatrists' attitudes from the patients' perspective as a first step in practicing PPI. This study aimed to investigate the patients' evaluation of psychiatrists' attitudes by illustrating themes appeared in the questionnaire survey.

METHODS

This study used the data obtained from the questionnaire survey responded by 2,683 patients with family members who belong to the family associations for psychiatric patients in Japan. Three open-ended question items in this survey, "criteria for selecting a psychiatrist (784 patient responses, response rate 29.2%)," "attitude of the psychiatrist in charge (929 patient responses, response rate 34.6%)," and "communication skills of the psychiatrist in charge (739 patient responses, response rate 27.5%)" were analyzed by co-occurrence network using KH Coder software.

RESULTS

The common theme observed in all three items was whether psychiatrist took sufficient consultation time. The criteria for selecting a psychiatrist were summarized whether psychiatrist provided appropriate advices for patients' problems, whether psychiatrist cared about patients' demands and whether psychiatrist informed to patients about diseases and medications. The attitudes of the psychiatrists in charge that patients had most wanted their psychiatrists to improve were: psychiatrists only watch the computer, make diagnosis according to the patients' individual condition, and try to build a relationship of trust with the patient. The patients' demands regarding communication skills of the psychiatrist in charge included: whether the psychiatrist communicated in a way that improves the patient's psychological state, whether the psychiatrist was attentive to the patients' family, and whether the psychiatrist could control his/her own mood during the consultation.

CONCLUSION

The results reflected the patients' demands that do not appear in closed-ended items. It was suggested that patients'open-ended responses to questionnaires and their involvement in the psychiatric research (PPI) may provide more insight into improving pshchiaric care in Japan.

The therapeutic relationship in secondary mental health care: a conceptual review of measures

OBJECTIVE

The study aimed to determine the conceptual basis of measures of the patient-professional relationship used in routine mental health services research by reviewing their face, content and construct validity.

METHOD

A comprehensive literature search identified measures of the relationship used in mental health services research. The conceptual basis of each identified measure was identified by a review of measures' authors assessments of face, content and construct validity plus item analysis of the measures themselves.

RESULTS

The search identified 15 measures. The seven developed in psychotherapy were likely to be better validated conceptually; most were based on therapeutic alliance models. Measures developed specifically for mental health services were based on a wider range of models including global assessments of the relationship.

CONCLUSION

Most of the better validated measures originate in psychotherapy, but there is limited evidence for their validity in general mental health services. Four measures are recommended.

Schizophrenic outpatient perceptions of psychiatric treatment and psychotic symptomatology: an investigation using structural equation modeling

Schizophrenic patient perceptions of treatment have clinical value and deserve detailed psychiatric investigation. The present study sought a model indicating statistically estimated cause-effect relationships of perceptions and psychotic symptomatology of outpatients with schizophrenia by applying a method of structural equation modeling. The perceptions included in this model were patient satisfaction with treatment, perceptions of their treating psychiatrists, and patient-role perception. Scores of Positive and Negative Syndrome Scale and poor insight measures were added to the model as possible influential factors. The constructed model revealed that the poor insight exerted a major influence on the patient-role perception that had small effects on the reliable therapist perception and the satisfaction. It was also shown that satisfaction was chiefly determined by the reliable therapist perception that was formed in the treatment relationship, rather independently of the other construct. These findings were valuable in terms of their implications for understanding the makeup of the perceptions and the strategy for interventions to improve them.