Patients, Docs Differ on Schizophrenia Treatment

Study Suggests Psychiatrists May Not Meet Patient Expectations

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Oct. 13, 2004 (Washington) -- Patients with schizophrenia seem to be at odds with psychiatrists on many of the goals of schizophrenia treatment, prompting concerns that doctors may not understand their patients' intentions for getting better, a new survey suggests.

"We might be able to do a whole lot better job with helping people," says Ronald J. Diamond, MD, a psychiatrist with the Wisconsin Psychiatric Institute and Clinics in Madison.

Diamond and other researchers surveyed 291 psychiatrists and 199 patients with schizophrenia about their schizophrenia treatment. As expected, the team found that patients and doctors agreed on the top goals of schizophrenia treatment, namely improved overall happiness, improved mental health, reduced feelings of depression, and other benefits.

But many of the similarities ended there. The survey showed that doctors stressed reducing the need for hospitalization and improved ability to perform regular daily activities much more than patients did.

Meanwhile, patients ranked a desire to return to favorite hobbies, improved ability to think clearly, and improved physical health as significantly more important than doctors did.

Diamond stresses in an interview that the study has limitations. The patients surveyed in the study were not being treated by the doctors in the study, a fact that could cause their goals to differ. Also, the study looked at mildly ill patients who were doing relatively well at schizophrenia treatment and were not hospitalized.Could ADHD be Affecting Your Life? Take this Assessment

"This is certainly not characteristic of every psychiatrist or every patient," Diamond said at a science reporters' conference hosted by the American Medical Association. He noted that his study was funded by a manufacturer of schizophrenia drugs.

Diamond also found differences in what psychiatrists and patients thought were possible with modern schizophrenia treatments. Both groups thought that decreased symptoms, including hallucinations and delusions, could be expected with schizophrenia treatment. But doctors also thought that patients could expect to feel less suspicious of others, a notion patients scored as significantly less likely.

Diamond and his colleagues expressed concern that 30% of patients say they rarely or never discuss unmet schizophrenia treatment goals with their doctors, double the amount the doctors suspect, according to the survey.

The difference could lead to low "patient satisfaction" and low expectations for schizophrenia treatment on the part of patients, he warns.

"A substantial percentage of patents ... choose not to discuss unmet treatment goals with their physicians, owing to low expectations for their medications," the researchers write in their study.

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SOURCES: 23rd Annual Science Reporters Conference, American Medical Association, Washington, D.C., Oct. 13-14, 2004. Ronald J. Diamond, professor of psychiatry, University of Wisconsin.
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