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Problems in psychiatric care of ‘difficult patients’: a Delphi-study*

  • Bauke Koekkoek (a1) (a2), Berno Van Meijel (a3), Aart Schene (a4) and Giel Hutschemaekers (a5) (a6)


Aims – ‘difficult patients’ may evoke strong feelings in health professionals. The ambivalent attitude of, especially, non-psychotic chronic patients towards psychiatric care may be frustrating and burdensome to professionals. Many of these patients are cared for in non-specialized services, where professionals are often more used to working with psychotic patients. Specific problems with ‘difficult’ non-psychotic patients may occur, and hamper the quality of care offered. The aim of this research is to determine precisely what problems psychiatric professionals perceive in contact with non-psychotic chronic patients in order to identify starting points for alternative or improved care in non-specialized services. Methods – a modified five-phase Delphi study with three groups of eight participants from was used to identify and prioritize experts' judgments. Results – 46 problems were identified of which some were relevant to one or two subgroups and some were relevant to the entire group. Conclusions – a program that combines a coherent view at services level, with support and increased communication at the interprofessional level (e.g. through regular supervision, sharing of case-loads) may be highly beneficial to non-specialized services.

Declaration of Interest: None for any author. Funding for this study was provided by ZonMW ‘Geestkracht’ (Grant 100–002–031), Altrecht Mental Health Care and Gelderse Roos Mental Health Care.


Corresponding author

Address fo correspondence: Mr. B. Koekkoek, Oude Arnhemseweg 260 3705 BK Zeist (The Netherlands). Fax: +31-306965466 E-mail:


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Contributions: BK designed the study, recruited participants, col-lected and analysed data and drafted the manuscript. BvM designed the study, collected and analysed data and co-drafted the manuscript. AS and GH designed the study, analysed data an co-drafted the manuscript.



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