Psikiyatri Pratiğinde Zor Hasta: Bir Vaka-Kontrol Çalışması

Yıl 2018, Cilt: 4 Sayı: 3, 1064 - 1073, 15.12.2018

Murat Eren Ozen Mehmet Hamdi Orum Aysun Kalenderoglu

https://doi.org/10.30569/adiyamansaglik.458680

Cited By: 5

Öz

Amaç: Bazı hasta-hekim karşılaşmaları
ilgili hekimler tarafından "zor" olarak kabul edilir. Somatik
belirtiler, madde kötüye kullanımı, saldırganlık, düşmanlık ve işbirliği
eksikliği, zor hastalarla ilgili en sık görülen özelliklerdir. Yani, psikiyatri
pratiğinde zor hastalarla karşılaşma riski yüksektir. Zor ilişki hastaya olduğu
kadar hekime de bağlı olabilir. Biz bu çalışmada hasta ile ilgili zor hasta
özelliklerini araştırmayı amaçladık.

Gereç ve Yöntem: Zor ilişki “psikiyatrist-hasta
ilişkisinin sorunlu olarak algılandığı durumlar” olarak tanımlanmaktadır. Olgular,
çalışmakta olan psikiyatristlerin en az iki tanesi tarafından zor ilişki olarak
tanımlandı. Kontroller bu hekimlere göre zor ilişkileri olmayan hastalardan
oluşuyordu. Çalışmaya 45 olgu ve 90 kontrol dahil edildi.

Bulgular: İki grup arasında yaş, cinsiyet,
medeni durum, eğitim durumu ve çalışma durumu açısından anlamlı bir fark yoktu.
Olgu grubunda hastaneye yatış sayısı, kullanılan ilaçlar, psikoterapi ve sosyal
müdahale, kontrol grubuna göre daha yüksekti. Olgu grubunda kişilik
bozuklukları anlamlı olarak yüksek bulundu.

Sonuçlar: Daha fazla ilaç kullanımı, daha
fazla sosyal müdahale, daha fazla hastane yatışı zor olarak nitelendirilen bu
hastaların memnuniyetsizliğinden kaynaklanabilmektedir. İlerletilmiş iyi bir
terapötik ilişki, bu zor hastalarda daha az semptom ve daha az girişimi-yatışı
sağlar. Hem etiyolojisini hem de çözümünü daha iyi anlayabilmek için
hasta-hekim ilişkisine ilişkin daha fazla sistematik araştırma yapılmalıdır.

Anahtar Kelimeler

Vaka-Kontrol Çalışması, Zor Hasta, Hekim-Hasta İlişkisi, İlişki

Difficult Patient in Psychiatry Practice: A Case-Control Study

Öz

Aim: Some of the patient-physician
encounters are considered "difficult" by the relevant physicians. Somatic
symptoms, substance abuse, aggression, hostility, and lack of co-operation are
the most common features related to difficult patients. That is, the risk of
encountering difficult patients in psychiatric practice is high. The difficult
relationship may be related to the patient as well as to the physician. We
aimed to investigate the difficult patient characteristics associated with the
patient in this study.

Material and Methods: Difficult relationship is defined
as "situations in which the psychiatrist-patient relationship is perceived
as problematic”. The cases were defined as difficult relationship with at least
two of the psychiatrists who were studying. Controls consisted of patients
without difficult relationships. 45 cases and 90 controls were included in the
study.

Results: There was no
significant difference in terms of age, sex, marital status, education status,
and working status between the two groups. The number of hospitalization, drugs
used, psychotherapy, and social intervention was higher in the case group than
in the control group. Personality disorders was significantly higher in the
case group.

Conclusion: The
use of more medicines, more social interventions, more hospital admissions have
been attributed to the dissatisfaction of these patients.
The improved good
therapeutic relationship can lead to less symptoms and fewer applications in
these difficult patients. Further systematic research should be conducted with
respect to patient-physician relationship to provide a greater understanding of
both its etiology and solution.

Anahtar Kelimeler

Case-Control Study, Difficult Patient, Physician-Patient Relation, Relationship

Kaynakça

• 1. Grooves JE. Taking Care of the Hateful Patient. N Engl J Med 1978;298(16):883-7.
• 2. Varan LR. The clinical interview using DSM-IV, Volume 2: The difficult patient. J Psychiatry Neurosci 1996;21(1):58-9.
• 3. Koekkoek B, Van Meijel B, Hutschemaeckers G. "Difficult Patients" in Mental Health Care: A Review. Psychiatr Serv 2006;57:795-802.
• 4. O’Dowd TC. Five years of heartsink patients in general practice. BMJ 1988;297(6647):528-30.
• 5. Klein D, Najman J, Kohrman AF, Munro C. Patient characteristics that elicit negative responses from family physicians. J Am Pract 1982;14(5):881-8.
• 6. Steinmetz D, Tabenkin H. The 'difficult patient' as perceived by family physicians. Fam Pract 2001;18(5):495-500.
• 7. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.
• 8. Colson DB. Difficult patients in extended psychiatric hospitalization: a research perspective on the patient, staff and team. Psychiatry 1990;53:369-82.
• 9. Gallop R, Wynn F. The difficult inpatient: identification and response by staff. Can J Psychiatry 1987;32:211-5.
• 10. Neill JR. The difficult patient: identification and response. J Clin Psychiatry 1979;40:209-12.
• 11. Modestin J, Greub E, Brenner HD. Problem patients in a psychiatric inpatient setting: an explorative study. Eur Arch Psychiatry Neurol Sci 1986;235:309-14.
• 12. Robbins JM, Beck PR, Mueller DP, Mizener DA. Therapists’ perceptions of difficult psychiatric patients. Journal of Nervous and Mental Disease 1988;176:490-7.
• 13. Mc Gaghie WC, Whitenack DC. A Scale for Measurement of the Problem Patient Labeling Process. J Nerv Ment Dis 1982;170(10):598-604.
• 14. Lewis G, Appleby L. Personality Disorder: The Patients Psychiatrists Dislike. Br J Psychiatry 1988;153:44-9.
• 15. Najavits L. Helping "Difficult" Patients. Psychotherapy Research 2001;11 (2):131-52.
• 16. Staley JC. Physicians and the difficult patient. Social Work 1991; 36:74-9.
• 17. Kendell RE. The distinction between personality disorder and mental illness. Br J Psychiatry 2002;180:110-5.
• 18. Dewan MJ, Pies RW. The Difficult-to-Treat Psychiatric Patient. Washington, DC; American Psychiatric Press; 2001.
• 19. Nathan, R: Scientific attitude to “difficult” patients. Br J Psychiatry 1999;175:87-8.
• 20. Hinshelwood RD. The difficult patient: the role of “scientific psychiatry” in understanding patients with chronic schizophrenia or severe personality disorder. Br J Psychiatry 1999;174:187-90.