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BMC Psychiatry. 2018 May 22;18(1):142. doi: 10.1186/s12888-018-1707-x.

Continue, adjust, or stop antipsychotic medication: developing and user testing an encounter decision aid for people with first-episode and long-term psychosis.

Author information

Department of Rehabilitation Sciences, College of Public Health, Temple University, 1700 North Broad St., Philadelphia, PA, 19122, USA.
Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA.
Pat Deegan, PhD & Associates, LLC, Byfield, MA, USA.
The Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, USA.
VA Capitol Healthcare Network (VISN 5), Mental Illness Research, Education, and Clinical Center (MIRECC), Baltimore, MD, USA.
Columbia University Medical Center, New York, NY, USA.
New York State Psychiatric Institute, New York, USA.
The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth College, Lebanon, NH, USA.
Department of Psychiatry, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA.
Institute for Healthcare Delivery Science, Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA.



People with psychosis struggle with decisions about their use of antipsychotics. They often want to reduce the dose or stop, while facing uncertainty regarding the effects these decisions will have on their treatment and recovery. They may also fear raising this issue with clinicians. The purpose of this study was to develop and test a shared decision making (SDM) tool to support patients and clinicians in making decisions about antipsychotics.


A diverse editorial research team developed an Encounter Decision Aid (EDA) for patients and clinicians to use as part of the psychiatric consultation. The EDA was tested using 24 semistructured interviews with participants representing six stakeholder groups: patients with first-episode psychosis, patients with long-term psychosis, family members, psychiatrists, mental health counselors, and administrators. We used inductive and deductive coding of interview transcripts to identify points to revise within three domains: general impression and purpose of the EDA; suggested changes to the content, wording, and appearance; and usability and potential contribution to the psychiatric consultation.


An EDA was developed in an iterative process that yielded evidence-based answers to five frequently asked questions about antipsychotic medications. Patients with long-term psychosis and mental health counselors suggested more changes and revisions than patients with first-episode psychosis and psychiatrists. Family members suggested more revisions to the answers about potential risks of stopping or adjusting antipsychotics than other respondents.


The EDA was perceived as potentially useful and feasible in psychiatric routine care, especially if presented during the consultation.


Antipsychotic medication; Decision aid; Decision support tool; Option grid; Psychosis; Shared decision making

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