Lost in Translation: Barriers in Psychiatric Care for Patients With Communication Impairments

Effective communication is central to psychiatric evaluation and treatment. Patients with acquired communication impairments, such as post-stroke aphasia, are at increased risk for misdiagnosis, delayed care, and suboptimal treatment. We aim to better understand the unique needs of psychiatric patients with communication difficulties, common pitfalls in their care, and ways to improve clinical assessment, diagnosis, and treatment of their mental health conditions. We present the case of a 49-year-old woman with a history of major depressive disorder, generalized anxiety disorder, post-traumatic stress disorder, functional neurological symptom disorder, and a left middle cerebral artery ischemic stroke resulting in non-fluent aphasia. She was admitted to an inpatient psychiatric unit for suicidal ideation in the context of significant post-stroke functional decline. Her hospitalization was complicated by limited verbal communication and reliance on nonverbal modalities, cognitive fatigue related to communicating, persistent depression symptoms, as well as fluctuating reports of perceptual disturbances. Communication barriers significantly impacted assessment of mood, suicidality, and perceptual symptoms, contributing to diagnostic uncertainty and complex medical decision-making. This case highlights how expressive aphasia can obscure psychiatric assessment, increase reliance on interpretation by clinicians and caregivers, and contribute to potential misunderstanding of symptoms. It also underscores the importance of multimodal communication strategies and interdisciplinary collaboration. Psychiatric patients with communication impairments require tailored assessment approaches to reduce diagnostic error, gain greater understanding of the patient's clinical presentation, and improve overall patient care. Increased awareness and structured communication strategies may mitigate disparities in this vulnerable population.