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Tijdschrift voor Psychiatrie 45 (2003) 1, 5 - 14

New research

Difficult psychiatric patients

C. Sonneborn, J.B. Dijkstra

background  Difficult psychiatric patients tend to become involved in prolonged treatment impasses. These situations extract a considerable toll on the treaters' capacity for perseverance, professional competence, and sense of well being, as well as on the total reserve of treatment resources within an institutional setting.
aim  The current article describes a 'clinic for intensive treatment', an inpatient setting specialized in the treatment of difficult psychiatric patients.
method  By using a retrospective case note design the demographic characteristics of 128 patients, admitted between 1993 and 1998, are described, as well as the details of their psychiatric history, the reason for referral, the therapeutic progress and the manner/destination of discharge. Using a follow-up design the long-term treatment results and satisfaction of patients and referrers were examined.
results  The patients included in the study had a mean length of previous psychiatric history of thirteen years, were mostly suffering from severe personality disorder and/or a psychotic disorder. Half of the patients remained dependent on intensive in-patient care. Most patients and referrers were satisfied with the service provided.
conclusion  It seems possible to curtail treatment impasses which results in a minority of cases in resocialisation to independent living.



keywords context, difficult patients, personality disorder, psychosis, treatment