Consensus judgments of discharge readiness based on paranoid behavior: to what are clinical staff responding?

Background Salinas et al. (J Consult Clin Psychol 4:1029–1039, 2002) found that, contrary to widely held beliefs, paranoid behavior was a positive prognostic indicator for psychiatric inpatients only due to artifactual restrictions on overall level of functioning that result from traditional classif...

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Bibliographic Details
Published in:Social Psychiatry and Psychiatric Epidemiology 2008-05, Vol.43 (5), p.380-386
Main Authors: Salinas, Julian A., Paul, Gordon L., Springer, Justin R.
Format: Article
Language:English
Subjects:
Adult
Attitude of Health Personnel
Behavior
Biological and medical sciences
Consensus
Decision Making
Disability Evaluation
Epidemiology
Hallucinations
Health staff related problems. Vocational training
Hostility
Humans
Judgment
Medical sciences
Medicine
Medicine & Public Health
Nosology. Terminology. Diagnostic criteria
Original Paper
Patient Discharge
Patients
Psychiatry
Psychology. Psychoanalysis. Psychiatry
Psychopathology. Psychiatry
Schizophrenia, Paranoid - diagnosis
Schizophrenia, Paranoid - epidemiology
Schizophrenia, Paranoid - psychology
Social psychiatry. Ethnopsychiatry
Surveys and Questionnaires
Techniques and methods
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Summary:Background Salinas et al. (J Consult Clin Psychol 4:1029–1039, 2002) found that, contrary to widely held beliefs, paranoid behavior was a positive prognostic indicator for psychiatric inpatients only due to artifactual restrictions on overall level of functioning that result from traditional classification procedures. Paranoid functioning, in fact, negatively impacted consensus staff discharge-readiness judgments. This discrepancy between clinical lore and empirical findings raises a question about the aspects of paranoid functioning to which staff responds. Method Those aspects of paranoid functioning are examined in this study, using the same sample of 469 inpatients from 19 treatment units reported in the Salinas et al. investigation. Results Both dimensionally measured paranoid functioning and overall level of disability were independently associated with negative discharge-readiness decisions. However, rather than delusions or hallucinations, hostility entirely accounted for the contribution of paranoid functioning to these prognostic judgments. Conclusion We discuss implications of an alternative approach to classifying patients’ problem behavior for clinical research and practice.
ISSN:0933-7954
1433-9285
DOI:10.1007/s00127-008-0319-z