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Original research
Prescribing in personality disorder: patients’ perspectives on their encounters with GPs and psychiatrists
  1. Dipen Patel1,2 and
  2. Haroula Konstantinidou3
  1. 1Department of Psychosis Studies, Institute of Psychiatry Psychology and Neuroscience, King's College London, London, UK
  2. 2South London and Maudsley NHS Foundation Trust, London, UK
  3. 3Leicestershire Partnership NHS Trust, Leicester, UK
  1. Correspondence to Dr Dipen Patel; dpatel12{at}nhs.net

Abstract

Objective The purpose of this study was to explore the views of patients with personality disorder on their experiences of prescribing practices by general practitioners (GPs) and psychiatrists, and their expectations of primary and secondary mental health services.

Design This was a qualitative study involving two focus groups. Discussion in the focus groups was recorded, transcribed verbatim and then analysed by a thematic analysis process to generate the key themes.

Setting The study took place at a specialist outpatient personality disorder service in the UK.

Participants A total of seven participants took part in the study. They were purposively sampled from an NHS specialist outpatient personality disorder service. All participants had a primary diagnosis of emotionally unstable personality disorder and their age ranged from 20 to 52 years.

Results Five key themes emerged. Participants felt that medication has a powerful impact on their mind and body but expressed confusion and uncertainty on how it is affecting them. Participants had a need for a good relationship with their doctors (GPs or psychiatrists). They described a feeling of being dismissed and not believed, expressing a desire to confront the ‘powerful’ position of their doctors by showing anger. The nature of the doctor-patient relationship was seen to moderate positively or negatively the experience of doctors’ prescribing. Finally, there were key expectations of the primary-secondary care interface, including continuity of care, diagnostic clarity and a desire for different healthcare professionals to communicate with one another.

Conclusion The doctor-patient relationship is an important medium for providing validation and seeking negotiation of therapeutic treatment strategies in patients with personality disorder. Given that personality disorder is associated with high rates of physical and mental health comorbidity, it is therefore vital for clinical guidelines and training packages to take more account of the relational aspects of prescribing in consultations for this patient group with a view to improve outcomes.

  • family medicine
  • psychiatry
  • qualitative research
http://creativecommons.org/licenses/by-nc/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/fmch-2020-000458

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    Footnotes

    • Contributors DP and HK designed the study and facilitated the focus groups. DP transcribed data verbatim. DP and HK contributed towards the thematic analysis. Both authors contributed to and approved the final manuscript.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient consent for publication Not required.

    • Ethics approval Ethical approval was gained from the National Health Service (NHS) Health Research Authority, East Midlands—Leicester Central Research Ethics Committee, reference 17/EM/0115. Management permission was gained from the host NHS Trust research and development department.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement No data are available. Research data are not shared. Due to the sensitive nature of the questions asked in this study, all individuals who participated in this study were assured that the data would be anonymised and the original full‐length transcripts of the interviews therefore are not available to be shared outside of the research team.