Shared and Supported Decision Making in Medication in a Mental Health Setting: How Far Have We Come?

Pappa, Sofia; Barnett, Joshua; Gomme, Sally; Iliopoulou, Anthi; Moore, Ivan; Whitaker, Michael; McGrath, Jane; Sie, Michele

doi:10.1007/s10597-021-00780-2

Cited by 15 publications

(14 citation statements)

References 33 publications

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“…In addition, there may have been a shift in the availability of hospital resources during this time as well as prescribing practices including the implementation of shared and supported decision making process. 33 Selection bias was minimised by including a consecutive sample of eligible patients prescribed ALAI and PP1M at the discretion of clinicians in the absence of any restrictive or prescriptive practice.…”

Section: Discussionmentioning

confidence: 99%

Effectiveness of 2-year treatment with aripiprazole long-acting injectable and comparison with paliperidone palmitate

Mason

Barnett

Pappa

2021

Therapeutic Advances in Psychopharmacology

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Background: The pragmatic management of psychotic disorders is more complex than that delivered in a controlled trial environment. Therefore, this study aims to evaluate the real-world effectiveness of aripiprazole long-acting injectable (ALAI) and compare it with another commonly used long-acting anti-psychotic, once-monthly paliperidone palmitate (PP1M). Methods: This naturalistic, independent 4-year mirror image study compared the mean number and length of hospital admissions 2 years before and 2 years after treatment initiation with ALAI. Retention rates, discontinuation reasons and level of adherence were also recorded. Furthermore, indirect comparisons were made between treatment outcomes on ALAI and PP1M. Results: A total of 109 eligible patients with a severe mental illness (65% with schizophrenia and 35% with other diagnosis) commenced on ALAI and 173 patients (69% with schizophrenia and 31% with other diagnoses) initiated on PP1M were included. Of these, 37% on ALAI and 34% on PP1M stopped treatment at 2 years; retention rates were most favourable for the schizophrenia group on PP1M. Patients were more likely to discontinue due to lack of effectiveness on ALAI and due to tolerability issues on PP1M. Those who continued for 2 years on ALAI ( n = 69), demonstrated an overall decrease of 84% in the mean number and 88% in the mean length of hospital admissions compared with the 2 years before initiation. Although patients on ALAI appeared to have a significantly higher bed occupancy the 2-year period before initiation than patients on PP1M, the reductions in hospitalizations were comparable across both cohorts after 2 years of treatment. Conclusions: The introduction of ALAI had a substantial impact on long-term clinical outcomes in this naturalistic cohort; more than half of patients continued treatment and had no admission during 2 years of follow up. There were no significant differences in hospitalisation rates between patients on ALAI and PP1M at 2 years.

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Section: Discussionmentioning

confidence: 99%

Effectiveness of 2-year treatment with aripiprazole long-acting injectable and comparison with paliperidone palmitate

Mason

Barnett

Pappa

2021

Therapeutic Advances in Psychopharmacology

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“…It is indeed concerning that this alarming side effect remains potentially under-diagnosed and under-reported. Our findings clearly highlight the paucity of evidence thus far and it is hoped that this systematic review will help emphasize both the importance of patient experience and shared decision making in medication in clinical practice 37 as well the need to prioritise funding and co-produced, participatory research in this area together with service users, carers and clinicians. 38 …”

Section: Strengths and Limitations Of Our Reviewmentioning

confidence: 75%

The Relationship Between Antipsychotic-Induced Akathisia and Suicidal Behaviour: A Systematic Review

Kalniunas¹,

Chakrabarti²,

Mandalia³

et al. 2021

NDT

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Objective We aim to systematically review evidence for a relationship between antipsychotic-induced akathisia and suicidal behaviour, in order to guide further clinical decision making in this area. Methods Several electronic databases (Embase, Medline, Cochrane and PsychINFO) were systemically searched for articles published up to February 2021, using search terms related to akathisia, antipsychotics and suicidal behaviour. Two reviewers independently evaluated all the relevant studies using predetermined criteria and assessed the risk of bias for each included study. The systematic review was conducted in line with PRISMA methodology and reporting. Results Following de-duplication, screening and application of exclusion criteria, four eligible studies were identified. All of the available studies were in English and included adult patients. Nevertheless, there was significant variability regarding methodology and overall quality was deemed low due to small sample sizes. There was insufficient data to perform statistical analyses of the results. Of the four studies, two found a weak correlation between antipsychotic-related akathisia and suicidal behaviour, a finding that was not supported by the remaining two studies. Conclusion The search yielded very few studies for inclusion. On the basis of the existing evidence, akathisia cannot be reliably linked to the presence of suicidal behaviour in patients treated with antipsychotic medication. However, proactive screening for emerging suicidal behaviour in this vulnerable patient group is advisable. Our findings highlight the pressing need for further research in this area.

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“…This contrasts with a previous study among inpatients with schizophrenia using Autonomy Preference Index scores, in which patients with schizophrenia had slightly higher mean scores than those reported for the primary care patients ( 60 ). Role preference among mental health service users, in general, was reported to be high (82%) in a very recent study whereby the majority of them preferred active and shared decision-making regarding their medication ( 26 ). Generally, patients with psychiatric illnesses appeared to prefer autonomous roles.…”

Section: Discussionmentioning

confidence: 99%

“…Role preference among mental health service users, in general, was reported to be high (82%) in a very recent study whereby the majority of them preferred active and shared decisionmaking regarding their medication (26). Generally, patients with psychiatric illnesses appeared to prefer autonomous roles.…”

Section: Role Preferencementioning

confidence: 99%

“…For example, a review on published surveys showed that a majority of patients wanted a shared responsibility on their healthcare decisions with their doctors ( 25 ). A very recent study revealed 82% of mental health service users preferred autonomous roles ( 26 ). SDM experiences and role preference may be associated with multiple factors, such as demographic variables, clinical characteristics, and types of clinical decisions ( 25 , 27 ).…”

Section: Introductionmentioning

confidence: 99%

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Shared Decision-Making and Role Preference Among Patients With Schizophrenia in Malaysia: A Cross-Sectional Study

Ismail

Midin

2021

Front. Psychiatry

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Introduction: Shared decision-making (SDM) is recognized as a promising strategy for improving collaboration between clinicians and their patients in achieving recovery. In Malaysia, SDM among people with schizophrenia is still lacking both in practice and in research. This study aimed to determine the level of SDM and role preference and their associated factors among patients with schizophrenia in Malaysia.Methods: A cross-sectional study was conducted on 86 outpatient attendees with schizophrenia at a teaching hospital in Kuala Lumpur, Malaysia. The nine-item Shared Decision Making Questionnaire and Control Preference Scale were used to assess perceived SDM experience and role preference, respectively. Linear and logistic regression models were used to analyze the factors associated with SDM and role preference, respectively. Factors with a p <0.25 from the simple regression analyses were controlled as the covariates in the multiple regression analyses.Results: The study respondents were predominantly female, single, and unemployed, with a mean age of 44 years. Only 35% of the participants reported having high SDM experiences, even though the majority (56%) preferred autonomous role preference. Among the participants who preferred autonomous roles, only 40% experienced high SDM. High SDM was found to be significantly associated with being younger (B = −0.33, 95% CI = −0.67 to −0.003) and being non-clozapine users (B = 19.90, 95% CI = 9.39–30.41), while autonomous role preference was significantly associated with a lower level of insight [adjusted odds ratio (AOR) = 0.84, 95% CI = 0.72–0.99] and being on oral antipsychotic drugs only (AOR = 2.94, 95% CI = 1.10–7.82).Conclusion: The practice of SDM is still lacking in the treatment of patients with schizophrenia in Malaysia, even though many of them preferred to be involved in the decision-making pertaining to their treatment. This study indicates the need for clinicians to improve their patients' involvement in the treatment process. More research is needed on how SDM can be implemented in patients with schizophrenia, especially in Asian population settings.

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Shared and Supported Decision Making in Medication in a Mental Health Setting: How Far Have We Come?

Cited by 15 publications

References 33 publications

Effectiveness of 2-year treatment with aripiprazole long-acting injectable and comparison with paliperidone palmitate

Effectiveness of 2-year treatment with aripiprazole long-acting injectable and comparison with paliperidone palmitate

The Relationship Between Antipsychotic-Induced Akathisia and Suicidal Behaviour: A Systematic Review

Shared Decision-Making and Role Preference Among Patients With Schizophrenia in Malaysia: A Cross-Sectional Study

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