European Psychiatry - Volume 41 - April 2017

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25th European Congress of Psychiatry / European Psychiatry 41S (2017) S710–S771 S719
EV0965
Client versus patient – The clinical.
Economical, moral, legal and other
implications of a choice
B. Latecki
LIfe Empangeni Private Hospital, Psychiatric private practice,
Empangeni, South Africa
The presentation discusses the overt and hidden meaning of the
terms between “patient” or “client” regarding persons undergoing
psychotherapy and implications of using these terms. Some histor-
ical and recent opinions and points of view are presented. As the
outcome of the discussion, it is concluded that to weigh pros and
cons and to decide on which name would be more appropriate, one
must resort to taking into consideration the definitions of therapy,
suffering, and healing. It is suggested that the criterium should be
the level and nature of suffering experienced by the “taker” and
the level and nature of care performed by the “giver” (provider).
The relations between both parties are also discussed in terms of
existential phenomenology–as opposed to dualistic approach – and
holism versus atomism. It is the intention of the author to deliver
some practical and not only theoretical contribution to clinical
practice.
Disclosure of interest The author has not supplied his/her decla-
ration of competing interest.
EV0966
I choose, therefore I am. The Jaspers
concept of choice and implications on
the ability to act
A. Riolo , F. Babici , F. Tassi ∗
ASS 1 Triestina, Department of Mental Health, Trieste, Italy
∗ Corresponding author.
Introduction According to Jaspers, with the term of choice you
should not be understood the possibility to choose between objects
but freedomas a choice for themselves. Because I choose, then I am;
in fact, I feel my freedom in my mind. Choose what is best for the
psychiatric patient in different contexts (relational, occupational,
social, therapeutic) is the ability to act. The best practices provide
that psychiatrists, nurses, social workers, rehabilitation profession-
als are committed to enhancing the capacity to choose but the legal
protection measures are likely to be a contradiction.
Objective We try to explore the theme of choice based on the
capacity to act or failure to act from a phenomenological approach.
Method Through some concrete cases, extrapolated from clinical
practice, highlight the contradictions between enunciation of prin-
ciples and procedures for responding to the problems of psychiatric
patients who are not able to choose.
Conclusions Protections of health and individual freedom are the
weights of a balance poised, since there is uncertainty about the
anthropological paradigm of the mentally ill.
Disclosure of interest The authors have not supplied their decla-
ration of competing interest.
EV0967
Challenging patient-doctor
interactions in psychiatry – Difficult
patient syndrome
M. Roque Pereira ∗, A. Fornelos , A.R. Figueiredo
Centro Hospitalar Trás-os-Montes e Alto Douro, Departamento de
Psiquiatria e Saúde Mental, Vila Real, Portugal
∗ Corresponding author.
Introduction The factors contributing to a challenging interac-
tion between the roles of patient and physician may come from
several sources. Each interrelation has its own modus operandis in
which one of the individualsmay not condone the persona the other
individual is portraying. A mental illness or diagnosis is often stig-
matised by the burden of stereotypical bizarre associations. That
means the patient is generally not guilty and this is not another label
they should carry. Though the mental health professional should
be impervious to this, some degree of discomfort may throw some
shadowon the clinical mediation of the interviewandmanagement
of the pathology.
Objective To provide an overview of what is beyond the label
“difficult patient” in mental health care.
Aims Evaluation of conflicts inside the patient-illness-physician
triad.
Methods Search for articles in Pubmed, Athens, Google Scholar
databases, along with the hospital library.
Results Characteristics of problematic interactions in psychiatric
care were described consistently across our references. Causality
for these difficulties is vast and surpasses the patient’s behaviour.
Plus they are not unique in psychiatry. They can be explained by
individual, interpersonal, and social factors.
Conclusion Situational issues, along with patient and physician
characteristics, modulate and frame what should potentially be a
productive encounter. To become aware of what contributes to dif-
ficult clinical encounters and to be prepared to address themwhile
cultivating good interpersonal communication skills is fundamen-
tal.
Disclosure of interest The authors have not supplied their decla-
ration of competing interest.
EV0968
Mental illness is an inevitable
consequence of the singular diversity
of human beings
M. Schwartz ∗ Moskalewicz chwartz
1 Texas A&M Health Science Center College of Medicine, Psychiatry
and Humanities in Medicine, West Lake Hills, USA
2 University of Oxford, Philosophy, Oxford, United Kingdom
3 George Washington University School of Medicine, Psychiatry,
Washington DC, USA
∗ Corresponding author.
Nowadays, we increasing value the broad physical, ethnic, racial,
and cultural diversity of human beings. “How wonderful that
humans come in all sorts of sizes, shapes, colors, ethnic groups and
cultures.” So long as we conduct our behaviour within sanctioned
norms. This presentation will focus upon the above paradox: In
stark contrast to our delight in the physical, ethnic and cultural
expressions of human diversity, there is, at the same time, a per-
haps increasingly narrow tolerance for a variety of behavioural and
experiential human differences. In such human realms, present-
day cosmopolitan societies increasingly call for behavioural and
experiential conformity rather than diversity. And if we cannot con-
form? We propose that the phenomenon of mental illness arises as
a consequence of the phenomenon of human diversity coming up
against constraints and limitations in expressed and experienced
mental and behavioural realms. This presentation will focus upon
the primary role that human diversity plays in mental illness. We
will discuss adaptive strengths associated with the extraordinary
diversity of humans (and our pets and domestic animals) as well as
vulnerabilities accompanying this diversity. For example, diversity
associated with skin pigmentation has enabled humans to extend
across the globe. A consequence, however, is an enhanced vulner-
ability to skin cancer for some with fair skin and to Vitamin D
deficiency for others with dark skin. Psychological diversities can
be viewed in an analogous, pervasively more problematic man-