Date of Award


Degree Type


Degree Name

Doctor of Philosophy


This research identified disagreements between patients and psychiatrists on problems, goals, and methods for treatment. Specifically, their nature, type, contributing variables, and consequences were investigated.;The study was conducted at two provincial psychiatric hospitals in Ontario. Subjects included patients (n = 135) diagnosed as depressed, manic, neurotic, or schizophrenic. The attending psychiatrist (n = 29) also participated in the study.;Two to five days after admission to hospital, patients were interviewed according to a checklist on problems, goals, and methods for treatment. At the same time, the psychiatrist completed an identical checklist. Patients were observed for discharge against medical advice (AMA) and absent without leave (AWOL) within the first six weeks of hospitalization.;Findings pertaining to disagreements on problems, goals, and methods for treatment, of an environmental and psychological nature, were consistently of the type whereby psychiatrists identified items when their patients did not. In addition, the relationship between patient variables; psychiatrist variables; variables related to both the patient and psychiatrist; and disagreements were examined. Few of these variables, with the exception of involuntary detainment, were found to be associated with disagreements. There was a strong relationship between involuntary detainment and disagreements on problems, goals, and methods for treatment. Also, a significant relationship was found between disagreements and the likelihood of patient discharge AMA or AWOL.;In summary, disagreements were of the type whereby the psychiatrist identified problems, goals, and methods for treatment, when the patient did not. A consequence of these disagreements was found to be patient discharge AMA or AWOL. The above findings have implications for clinical practice. Awareness of disagreements would enable the psychiatrist to attempt appropriate interventions to prevent or mitigate adverse consequences. This, in turn, would provide for the effective management of psychiatric patients.



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