[The"difficult" patient in psychiatric care].

A small subgroup of patients who access psychiatric care proves to be "difficult" in many respects. Characteristic features include excessive use of services that entail high costs, enormous problems involved in interacting with the professional staff and fellow patients, and a high complication rate. The central problems comprise noncompliance, aggressiveness, and highly disruptive behavior. Young men predominate and the diagnosis frequently consists of schizophrenic psychoses and cluster B personality disorders. There are often signs of organic brain impairment and substance abuse as well as various comorbid mental disorders. In addition to psychopharmacological and psychotherapeutic treatment options, social psychiatric approaches play a prominent role in satisfactory problem solving. Attitude adjustments and suitable supervision and support of the therapeutic staff are essential.