Chronic crisis patients: a discrete clinical group

Patients who made repeated visits to a psychiatric emergency ward and who were studied appeared to comprise a discrete clinical group characterized by a distinct symptom profile, common psychiatric history, and similar styles of interacting with caretakers. They generally did not differ from nonrepeater patients with regard to acute symptomatology but were hospitalized more frequently. They were generally negativistic, had a lengthy psychiatric history consisting of multiple inpatient hospitalizations and current outpatient treatments, and had difficulty establishing rapport with the emergency ward therapists, often evoking intense feelings of dislike. The authors offer an approach to the management of these patients based on an understanding of their cycle of seeking and rejecting help.