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David E. Ness, MD

Arch Intern Med. 2002;162:2037-2044.

	Since this article does not have an abstract, we have provided the first 150 words of the full text and any section headings.

INTRODUCTION

Discussing medical treatment options and risks becomes a more complicated task when patients have psychiatric problems. Such patients may perceive risk and judge options differently from usual, they may raise special issues about informed consent and competency, and they may present special needs and stresses in the physician-patient relationship. This article addresses how to approach such treatment discussions within the framework of 3 content areas of the medical interview (medical decision making, informed consent, and the physician-patient relationship) and 2 formal techniques of the interview (exploration and assertion). Clinical research regarding how psychiatric problems may affect each of these areas of concern is reviewed. Ultimately, the goal of understanding such variations—and of possessing methods to address them in discussing treatment options and risks—is to help the patient be as free as possible from the burden of biases or distortions in making his or her decisions and . . . [Full Text of this Article]

PSYCHIATRIC PROBLEMS AND MEDICAL DECISION MAKING

Effect of Psychopathologic Conditions on Judgment

Depression

Emotional and Neuropsychiatric Factors

Psychosis

Implications for Discussing Treatment

Case 1

PSYCHIATRIC PROBLEMS AND INFORMED CONSENT

Legal Implications of Psychiatric Status

Disclosure

Voluntariness

Competence

Age and Dementia

Affective Disorders

Emotional and Neuropsychological Factors

Schizophrenia

Implications for Discussing Treatment

Case 2

Psychiatric Problems and the Physician-Patient Relationship

Depression

Schizophrenia

Personality Disorder

Implications for Discussing Treatment

Case 3

CONCLUSIONS

From Mercy Hospital of Pittsburgh, Pittsburgh, Pa. Dr Ness is now affiliated with Western Psychiatric Institute and Clinic, Pittsburgh.

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ABSTRACT | FULL TEXT