Advances in Psychiatric Treatment (2009) 15: 72-79. doi: 10.1192/apt.bp.107.005298
© 2009 The Royal College of Psychiatrists
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How psychiatrists think

Niall Crumlish and Brendan D. Kelly

Niall Crumlish is Lecturer in Psychiatry in Trinity College, Dublin. His primary research interests are early psychosis, insight and transcultural psychiatry. Brendan D. Kelly is Senior Lecturer in Psychiatry at University College Dublin. His research interests include the epidemiology of psychosis and relationships between mental illness and social factors.

Correspondence: Correspondence Dr Niall Crumlish, Jonathan Swift Clinic, St James’s Hospital, James’s Street, Dublin 8, Ireland. Email: niall.crumlish{at}tcd.ie

Over the past decade, the study of error in medicine has expanded to incorporate new insights from cognitive psychology, generating increased research and clinical interest in cognitive errors and clinical decision-making. The study of cognitive error focuses on predictable errors in thinking that result from the use of cognitive shortcuts or ‘heuristics’. Heuristics reduce the time, resources and cognitive effort required for clinical decision-making and are a feature of mature clinical thinking. Heuristics can also lead to bias and must be used with an awareness of their weaknesses. In this article, we describe heuristics commonly used in clinical decision-making and discuss how failure of heuristics results in cognitive error. We apply research findings on decision-making in medicine to decision-making in psychiatry and suggest directions for training and future research into cognitive error in psychiatry.


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