Symptoms have a major influence on expectations to the degree to which they affect patients’ perceptions of what might be wrong (cognitive states) and reactions to illness (emotional states).

This study investigated the relationship of patient and caregiver's expectations of illness to the diagnosis.

Two hundred new cases with their caregivers were consecutively included from the Out-Patient Department of psychiatry and assessed through a semi-structured proforma and Clinical Global Impression scale.

Somatic symptoms were the predominant complaints compared to psychic complaints. Patients presenting with more psychological symptoms had more uncommon and unmet expectations compared to those with biological symptoms. Most considered their illness to be of medical nature (71% in patients; 83% in caregivers). Patients gave social causes a higher priority (23.5% in patients and 6.5% in caregivers) while caregivers give higher priority to supernatural cause (5.5% in patients and 13% in caregivers). 54.5% patients and 63.5% caregivers considered the illness to be severe which on objective assessment was for only 38%. 54% patient had co morbid psychiatric illness and 46% had only psychiatric illness and 9% had only medical illness. More was the severity of illness; more the treatment in form of medication prescription was expected.

Objective severity of patients' disease condition, and their awareness of illness, can predict their adherence and can contribute to better targeting of health messages and treatment advice by providers.