Consensus judgments of discharge readiness based on paranoid behavior: to what are clinical staff responding

Background Salinas et al. (J Consult Clin Psychol 4:1029–1039, 2002) found that, contrary to widely held beliefs, paranoid behavior was a positive prognostic indicator for psychiatric inpatients only due to artifactual restrictions on overall level of functioning that result from traditional classification procedures. Paranoid functioning, in fact, negatively impacted consensus staff discharge-readiness judgments. This discrepancy between clinical lore and empirical findings raises a question about the aspects of paranoid functioning to which staff responds. Method Those aspects of paranoid functioning are examined in this study, using the same sample of 469 inpatients from 19 treatment units reported in the Salinas et al. investigation. Results Both dimensionally measured paranoid functioning and overall level of disability were independently associated with negative discharge-readiness decisions. However, rather than delusions or hallucinations, hostility entirely accounted for the contribution of paranoid functioning to these prognostic judgments. Conclusion We discuss implications of an alternative approach to classifying patients’ problem behavior for clinical research and practice.