The primary focus of many patients attending a psychiatric consultation for mood instability is to obtain an explanation for their symptoms, report researchers.
“This view was expressed irrespective of the subsequent diagnosis they received,” say researcher Jonathan Price (University of Oxford, UK) and team.
However, actually being given a diagnosis had an unpredictable effect, with some patients viewing the diagnosis as part of the explanation they sought, but others regarding it as a dismissive reaction that did not address their problems. A few patients reacted badly to receiving a diagnosis because of the perceived stigma attached to, for example, a diagnosis of bipolar disorder.
“Clinicians should pay greater attention to patient expectations in the context of psychiatric assessment rather than assume that diagnosis is the primary outcome being sought,” the team writes in the British Journal of Psychiatry.
The researchers interviewed 28 patients with mood instability about their experiences, finding that their responses fell into five main categories: wanting an explanation and help for their symptoms; wanting consistent and continuous care; difficulties communicating with their clinicians; wanting to feel involved and informed; and wanting to be acknowledged.
Patients received diagnoses including bipolar II disorder (18%), borderline personality disorder (11%), and depression/anxiety (29%), but a quarter received no firm diagnosis. Some of those given a diagnosis felt relieved because it helped them to see themselves as unwell, and “thereby provided relief from guilt about past behaviours.”
Eleven patients agreed to follow-up interviews 6 months later. Continuity and consistency of care was a large issue among these patients, with some expressing frustration at rarely seeing the same doctor and therefore having to repeat information, especially where this involved painful or personal life experiences.
Patients reported difficulty accurately communicating their mood states to clinicians, and recalling relevant information when asked. Notably, patients given a bipolar disorder diagnosis said that they only sought help during depressive bouts, so previous consultations that focused solely on current symptoms left their hypomanic episodes unrecognized.
The patients also wanted to feel involved in discussions and informed about their condition, rather than just being handed a diagnosis, but often did not. Likewise, they sought acknowledgement, but often felt dismissed. In this case, a diagnosis could even be perceived as dismissive, with this “linked to a perceived lack of support, information and explanation, which led participants to question the utility of diagnosis.”
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