The Experts below are selected from a list of 360 Experts worldwide ranked by ideXlab platform
David T Armitage - One of the best experts on this subject based on the ideXlab platform.
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the forensic role of the child Psychiatrist in child abuse and neglect cases
Child and Adolescent Psychiatric Clinics of North America, 2002Co-Authors: Willis T Leavitt, David T ArmitageAbstract:Child Psychiatrists play important roles in the legal system. By training and experience, they have unique insight into the emotional life of the child, the dynamics of the family system, and the relationship between child and parent. They help provide objective information to the judge and jury for making difficult legal decisions in child abuse and neglect-related cases. Functioning in various roles, child Psychiatrists must reach a clear understanding with the hiring party as to the reason for the consultation, what materials and interviews are necessary for a comprehensive evaluation, the charges involved, and ethical principles to be followed. They must recognize and negotiate the challenges for objectivity in these forensic evaluations. Finally, they should understand that the role of the child Psychiatrist in forensic issues is a dynamic one that is shaped by the ever-evolving response of society, law, and the medical profession to the phenomena of child abuse and neglect. Language: en
Stephen Bremner - One of the best experts on this subject based on the ideXlab platform.
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training to enhance Psychiatrist communication with patients with psychosis tempo cluster randomised controlled trial
British Journal of Psychiatry, 2016Co-Authors: Rose Mccabe, Patrick G T Healey, Paula John, Jemima Dooley, Annie Cushing, David Kingdon, Stephen Bremner, Stefan PriebeAbstract:Background A better therapeutic relationship predicts better outcomes. However, there is no trial-based evidence on how to improve therapeutic relationships in psychosis. Aims To test the effectiveness of communication training for Psychiatrists on improving shared understanding and the therapeutic relationship (trial registration: [ISRCTN94846422][1]). Method In a cluster randomised controlled trial in the UK, 21 Psychiatrists were randomised. Ninety-seven (51% of those approached) out-patients with schizophrenia/schizoaffective disorder were recruited, and 64 (66% of the sample recruited at baseline) were followed up after 5 months. The intervention group received four group and one individualised session. The primary outcome, rated blind, was Psychiatrist effort in establishing shared understanding (self-repair). Secondary outcome was the therapeutic relationship. Results Psychiatrists receiving the intervention used 44% more self-repair than the control group (adjusted difference in means 6.4, 95% CI 1.46–11.33, P <0.011, a large effect) adjusting for baseline self-repair. Psychiatrists rated the therapeutic relationship more positively (adjusted difference in means 0.20, 95% CI 0.03–0.37, P = 0.022, a medium effect), as did patients (adjusted difference in means 0.21, 95% CI 0.01–0.41, P = 0.043, a medium effect). Conclusions Shared understanding can be successfully targeted in training and improves relationships in treating psychosis. [1]: /external-ref?link_type=ISRCTN&access_num=ISRCTN94846422
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shared understanding in Psychiatrist patient communication association with treatment adherence in schizophrenia
Patient Education and Counseling, 2013Co-Authors: Rosemarie Mccabe, Patrick G T Healey, Stefan Priebe, Mary Lavelle, David Dodwell, Richard Laugharne, Amelia Snell, Stephen BremnerAbstract:Abstract Objective Effective doctor–patient communication, including a shared understanding, is associated with treatment adherence across medicine. However, communication is affected by a diagnosis of schizophrenia and reaching a shared understanding can be challenging. During conversation, people detect and deal with possible misunderstanding using a conversational process called repair. This study tested the hypothesis that more frequent repair in Psychiatrist–patient communication is associated with better treatment adherence in schizophrenia. Methods Routine psychiatric consultations involving patients with (DSM-IV) schizophrenia or schizoaffective disorder were audio-visually recorded. Consultations were coded for repair and patients’ symptoms and insight assessed. Adherence was assessed six months later. A principal components analysis reduced the repair data for further analysis. Random effects models examined the association between repair and adherence, adjusting for symptoms, consultation length and the amount patients spoke. Results 138 consultations were recorded, 118 were followed up. Patients requesting clarification of the Psychiatrist's talk and the clarification provided by the Psychiatrist was associated with adherence six months later (OR 5.82, 95% CI 1.31–25.82, p = 0.02). Conclusion The quality of doctor–patient communication also appears to influence adherence in schizophrenia. Practice implications Future research should investigate how patient clarification can be encouraged among patients and facilitated by Psychiatrists’ communication.
Patrick G T Healey - One of the best experts on this subject based on the ideXlab platform.
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miscommunication in doctor patient communication
Topics in Cognitive Science, 2018Co-Authors: Rosemarie Mccabe, Patrick G T HealeyAbstract:The effectiveness of medical treatment depends on the quality of the patient–clinician relationship. It has been proposed that this depends on the extent to which the patient and clinician build a shared understanding of illness and treatment. Here, we use the tools of conversation analysis (CA) to explore this idea in the context of psychiatric consultations. The CA “repair” framework provides an analysis of the processes people use to deal with problems in speaking, hearing, and understanding. These problems are especially critical in the treatment of psychosis where patients and health care professionals need to communicate about the disputed meaning of hallucinations and delusion. Patients do not feel understood, they are frequently non‐adherent with treatment, and many have poor outcomes. We present an overview of two studies focusing on the role of repair as a mechanism for producing and clarifying meaning in Psychiatrist–patient communication and its association with treatment outcomes. The first study shows patient clarification or repair of Psychiatrists’ talk is associated with better patient adherence to treatment. The second study shows that training which emphasizes the importance of building an understanding of patients’ psychotic experiences increases Psychiatrists’ self‐repair. We propose that Psychiatrists are working harder to make their talk understandable and acceptable to the patient by taking the patient's perspective into account. We conclude that these findings provide evidence that repair is an important mechanism for building shared understanding in doctor–patient communication and contributes to better therapeutic relationships and treatment adherence. The conversation analytic account of repair is currently the most sophisticated empirical model for analyzing how people construct shared meaning and understanding. Repair appears to reflect greater commitment to and engagement in communication and improve both the quality and outcomes of communication. Reducing potential miscommunication between Psychiatrists and their patients with psychosis is a low‐cost means of enhancing treatment from both the Psychiatrist and patient perspective. Given that misunderstanding and miscommunication are particularly problematic in psychosis, this is critical for improving the longer term outcomes of treatment for these patients who often have poor relationships with Psychiatrists and health care services more widely.
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training to enhance Psychiatrist communication with patients with psychosis tempo cluster randomised controlled trial
British Journal of Psychiatry, 2016Co-Authors: Rose Mccabe, Patrick G T Healey, Paula John, Jemima Dooley, Annie Cushing, David Kingdon, Stephen Bremner, Stefan PriebeAbstract:Background A better therapeutic relationship predicts better outcomes. However, there is no trial-based evidence on how to improve therapeutic relationships in psychosis. Aims To test the effectiveness of communication training for Psychiatrists on improving shared understanding and the therapeutic relationship (trial registration: [ISRCTN94846422][1]). Method In a cluster randomised controlled trial in the UK, 21 Psychiatrists were randomised. Ninety-seven (51% of those approached) out-patients with schizophrenia/schizoaffective disorder were recruited, and 64 (66% of the sample recruited at baseline) were followed up after 5 months. The intervention group received four group and one individualised session. The primary outcome, rated blind, was Psychiatrist effort in establishing shared understanding (self-repair). Secondary outcome was the therapeutic relationship. Results Psychiatrists receiving the intervention used 44% more self-repair than the control group (adjusted difference in means 6.4, 95% CI 1.46–11.33, P <0.011, a large effect) adjusting for baseline self-repair. Psychiatrists rated the therapeutic relationship more positively (adjusted difference in means 0.20, 95% CI 0.03–0.37, P = 0.022, a medium effect), as did patients (adjusted difference in means 0.21, 95% CI 0.01–0.41, P = 0.043, a medium effect). Conclusions Shared understanding can be successfully targeted in training and improves relationships in treating psychosis. [1]: /external-ref?link_type=ISRCTN&access_num=ISRCTN94846422
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shared understanding in Psychiatrist patient communication association with treatment adherence in schizophrenia
Patient Education and Counseling, 2013Co-Authors: Rosemarie Mccabe, Patrick G T Healey, Stefan Priebe, Mary Lavelle, David Dodwell, Richard Laugharne, Amelia Snell, Stephen BremnerAbstract:Abstract Objective Effective doctor–patient communication, including a shared understanding, is associated with treatment adherence across medicine. However, communication is affected by a diagnosis of schizophrenia and reaching a shared understanding can be challenging. During conversation, people detect and deal with possible misunderstanding using a conversational process called repair. This study tested the hypothesis that more frequent repair in Psychiatrist–patient communication is associated with better treatment adherence in schizophrenia. Methods Routine psychiatric consultations involving patients with (DSM-IV) schizophrenia or schizoaffective disorder were audio-visually recorded. Consultations were coded for repair and patients’ symptoms and insight assessed. Adherence was assessed six months later. A principal components analysis reduced the repair data for further analysis. Random effects models examined the association between repair and adherence, adjusting for symptoms, consultation length and the amount patients spoke. Results 138 consultations were recorded, 118 were followed up. Patients requesting clarification of the Psychiatrist's talk and the clarification provided by the Psychiatrist was associated with adherence six months later (OR 5.82, 95% CI 1.31–25.82, p = 0.02). Conclusion The quality of doctor–patient communication also appears to influence adherence in schizophrenia. Practice implications Future research should investigate how patient clarification can be encouraged among patients and facilitated by Psychiatrists’ communication.
Rosemarie Mccabe - One of the best experts on this subject based on the ideXlab platform.
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miscommunication in doctor patient communication
Topics in Cognitive Science, 2018Co-Authors: Rosemarie Mccabe, Patrick G T HealeyAbstract:The effectiveness of medical treatment depends on the quality of the patient–clinician relationship. It has been proposed that this depends on the extent to which the patient and clinician build a shared understanding of illness and treatment. Here, we use the tools of conversation analysis (CA) to explore this idea in the context of psychiatric consultations. The CA “repair” framework provides an analysis of the processes people use to deal with problems in speaking, hearing, and understanding. These problems are especially critical in the treatment of psychosis where patients and health care professionals need to communicate about the disputed meaning of hallucinations and delusion. Patients do not feel understood, they are frequently non‐adherent with treatment, and many have poor outcomes. We present an overview of two studies focusing on the role of repair as a mechanism for producing and clarifying meaning in Psychiatrist–patient communication and its association with treatment outcomes. The first study shows patient clarification or repair of Psychiatrists’ talk is associated with better patient adherence to treatment. The second study shows that training which emphasizes the importance of building an understanding of patients’ psychotic experiences increases Psychiatrists’ self‐repair. We propose that Psychiatrists are working harder to make their talk understandable and acceptable to the patient by taking the patient's perspective into account. We conclude that these findings provide evidence that repair is an important mechanism for building shared understanding in doctor–patient communication and contributes to better therapeutic relationships and treatment adherence. The conversation analytic account of repair is currently the most sophisticated empirical model for analyzing how people construct shared meaning and understanding. Repair appears to reflect greater commitment to and engagement in communication and improve both the quality and outcomes of communication. Reducing potential miscommunication between Psychiatrists and their patients with psychosis is a low‐cost means of enhancing treatment from both the Psychiatrist and patient perspective. Given that misunderstanding and miscommunication are particularly problematic in psychosis, this is critical for improving the longer term outcomes of treatment for these patients who often have poor relationships with Psychiatrists and health care services more widely.
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shared understanding in Psychiatrist patient communication association with treatment adherence in schizophrenia
Patient Education and Counseling, 2013Co-Authors: Rosemarie Mccabe, Patrick G T Healey, Stefan Priebe, Mary Lavelle, David Dodwell, Richard Laugharne, Amelia Snell, Stephen BremnerAbstract:Abstract Objective Effective doctor–patient communication, including a shared understanding, is associated with treatment adherence across medicine. However, communication is affected by a diagnosis of schizophrenia and reaching a shared understanding can be challenging. During conversation, people detect and deal with possible misunderstanding using a conversational process called repair. This study tested the hypothesis that more frequent repair in Psychiatrist–patient communication is associated with better treatment adherence in schizophrenia. Methods Routine psychiatric consultations involving patients with (DSM-IV) schizophrenia or schizoaffective disorder were audio-visually recorded. Consultations were coded for repair and patients’ symptoms and insight assessed. Adherence was assessed six months later. A principal components analysis reduced the repair data for further analysis. Random effects models examined the association between repair and adherence, adjusting for symptoms, consultation length and the amount patients spoke. Results 138 consultations were recorded, 118 were followed up. Patients requesting clarification of the Psychiatrist's talk and the clarification provided by the Psychiatrist was associated with adherence six months later (OR 5.82, 95% CI 1.31–25.82, p = 0.02). Conclusion The quality of doctor–patient communication also appears to influence adherence in schizophrenia. Practice implications Future research should investigate how patient clarification can be encouraged among patients and facilitated by Psychiatrists’ communication.
Ross J Baldessarini - One of the best experts on this subject based on the ideXlab platform.
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perinatal use of anticonvulsants differences in attitudes and recommendations among neurologists and Psychiatrists
Archives of Womens Mental Health, 2010Co-Authors: Adele C Viguera, Lee S Cohen, Theodore H Whitfield, Alison M Reminick, Edward B Bromfield, Ross J BaldessariniAbstract:We surveyed opinions and recommendations about perinatal anticonvulsant (AC) treatment among 166 neurologists (n = 88) and Psychiatrists (n = 78) practicing in Massachusetts. They were similar in the recommendation of routinely informing patients of potential teratogenic risks of ACs and avoiding valproate during pregnancy. Neurologists were more likely to encourage pregnancy and nursing during AC-use than Psychiatrists, and Psychiatrist were more cautious regarding perinatal safety, citing potential neurobehavioral risks and complications of breastfeeding. These observations indicate substantial differences in opinions between Psychiatrists and neurologists regarding AC use during pregnancy.
