Laurent Béchard, Elizabeth Anderson, Olivier Corbeil, Maxime Huot-Lavoie, Sébastien Brodeur, Amal Abdel-Baki, Charles Massé, Mina Gabriel-Courval, Marie-Ève Coté, Annie LeBlanc, Marc-André Roy, Marie-France Demers, Sophie Lauzier
{"title":"影响继续或停止抗精神病药物决策过程的因素：对12例首发精神病缓解患者的探索性定性研究。","authors":"Laurent Béchard, Elizabeth Anderson, Olivier Corbeil, Maxime Huot-Lavoie, Sébastien Brodeur, Amal Abdel-Baki, Charles Massé, Mina Gabriel-Courval, Marie-Ève Coté, Annie LeBlanc, Marc-André Roy, Marie-France Demers, Sophie Lauzier","doi":"10.1192/bjo.2025.10817","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>The decision-making process regarding antipsychotic continuation or discontinuation following remission from first-episode psychosis (FEP) remains complex and underresearched. While discontinuation increases the risk of relapse, concerns over long-term side-effects such as metabolic disturbances and extrapyramidal symptoms also exist. Current guidelines recommend maintaining antipsychotics for 1-5 years, emphasising shared decision-making (SDM) between clinicians and patients.</p><p><strong>Aims: </strong>This study aimed to explore the decision-making process and describe the factors influencing the decision to discontinue or continue antipsychotic treatment following remission from FEP, from the patients' perspective.</p><p><strong>Method: </strong>A descriptive qualitative study was conducted with 12 individuals in remission from FEP who received care at early intervention services in Quebec, Canada. Data were collected through online semi-structured interviews and analysed thematically to identify key factors influencing treatment decisions.</p><p><strong>Results: </strong>The decision-making process was activated by treatment reflection triggers and shaped by various perceptions (of illness, treatment and stigma) and relationships (with friends, family and the clinical team), ultimately leading to decisions to either discontinue, continue (at standard or reduced dose) or remain ambivalent. This dynamic process was guided by participants' motivators, such as well-being and societal contribution. Most participants felt that discontinuation discussions were not initiated by the clinical team.</p><p><strong>Conclusions: </strong>The decision-making process is driven by motivators that were found to be linked to the concept of personal recovery. This study highlights the need for proactive, personalised discussions between clinicians and patients. Future research should focus on decision aids tailored to the FEP population to support SDM and improve treatment outcomes.</p>","PeriodicalId":9038,"journal":{"name":"BJPsych Open","volume":"11 5","pages":"e193"},"PeriodicalIF":3.5000,"publicationDate":"2025-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12451548/pdf/","citationCount":"0","resultStr":"{\"title\":\"Factors shaping the decision-making process to continue or discontinue antipsychotics: exploratory qualitative study of 12 individuals in remission from first-episode psychosis.\",\"authors\":\"Laurent Béchard, Elizabeth Anderson, Olivier Corbeil, Maxime Huot-Lavoie, Sébastien Brodeur, Amal Abdel-Baki, Charles Massé, Mina Gabriel-Courval, Marie-Ève Coté, Annie LeBlanc, Marc-André Roy, Marie-France Demers, Sophie Lauzier\",\"doi\":\"10.1192/bjo.2025.10817\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>The decision-making process regarding antipsychotic continuation or discontinuation following remission from first-episode psychosis (FEP) remains complex and underresearched. While discontinuation increases the risk of relapse, concerns over long-term side-effects such as metabolic disturbances and extrapyramidal symptoms also exist. Current guidelines recommend maintaining antipsychotics for 1-5 years, emphasising shared decision-making (SDM) between clinicians and patients.</p><p><strong>Aims: </strong>This study aimed to explore the decision-making process and describe the factors influencing the decision to discontinue or continue antipsychotic treatment following remission from FEP, from the patients' perspective.</p><p><strong>Method: </strong>A descriptive qualitative study was conducted with 12 individuals in remission from FEP who received care at early intervention services in Quebec, Canada. Data were collected through online semi-structured interviews and analysed thematically to identify key factors influencing treatment decisions.</p><p><strong>Results: </strong>The decision-making process was activated by treatment reflection triggers and shaped by various perceptions (of illness, treatment and stigma) and relationships (with friends, family and the clinical team), ultimately leading to decisions to either discontinue, continue (at standard or reduced dose) or remain ambivalent. This dynamic process was guided by participants' motivators, such as well-being and societal contribution. Most participants felt that discontinuation discussions were not initiated by the clinical team.</p><p><strong>Conclusions: </strong>The decision-making process is driven by motivators that were found to be linked to the concept of personal recovery. This study highlights the need for proactive, personalised discussions between clinicians and patients. Future research should focus on decision aids tailored to the FEP population to support SDM and improve treatment outcomes.</p>\",\"PeriodicalId\":9038,\"journal\":{\"name\":\"BJPsych Open\",\"volume\":\"11 5\",\"pages\":\"e193\"},\"PeriodicalIF\":3.5000,\"publicationDate\":\"2025-09-04\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12451548/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"BJPsych Open\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1192/bjo.2025.10817\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"PSYCHIATRY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"BJPsych Open","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1192/bjo.2025.10817","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"PSYCHIATRY","Score":null,"Total":0}
Factors shaping the decision-making process to continue or discontinue antipsychotics: exploratory qualitative study of 12 individuals in remission from first-episode psychosis.
Background: The decision-making process regarding antipsychotic continuation or discontinuation following remission from first-episode psychosis (FEP) remains complex and underresearched. While discontinuation increases the risk of relapse, concerns over long-term side-effects such as metabolic disturbances and extrapyramidal symptoms also exist. Current guidelines recommend maintaining antipsychotics for 1-5 years, emphasising shared decision-making (SDM) between clinicians and patients.
Aims: This study aimed to explore the decision-making process and describe the factors influencing the decision to discontinue or continue antipsychotic treatment following remission from FEP, from the patients' perspective.
Method: A descriptive qualitative study was conducted with 12 individuals in remission from FEP who received care at early intervention services in Quebec, Canada. Data were collected through online semi-structured interviews and analysed thematically to identify key factors influencing treatment decisions.
Results: The decision-making process was activated by treatment reflection triggers and shaped by various perceptions (of illness, treatment and stigma) and relationships (with friends, family and the clinical team), ultimately leading to decisions to either discontinue, continue (at standard or reduced dose) or remain ambivalent. This dynamic process was guided by participants' motivators, such as well-being and societal contribution. Most participants felt that discontinuation discussions were not initiated by the clinical team.
Conclusions: The decision-making process is driven by motivators that were found to be linked to the concept of personal recovery. This study highlights the need for proactive, personalised discussions between clinicians and patients. Future research should focus on decision aids tailored to the FEP population to support SDM and improve treatment outcomes.
期刊介绍：
Announcing the launch of BJPsych Open, an exciting new open access online journal for the publication of all methodologically sound research in all fields of psychiatry and disciplines related to mental health. BJPsych Open will maintain the highest scientific, peer review, and ethical standards of the BJPsych, ensure rapid publication for authors whilst sharing research with no cost to the reader in the spirit of maximising dissemination and public engagement. Cascade submission from BJPsych to BJPsych Open is a new option for authors whose first priority is rapid online publication with the prestigious BJPsych brand. Authors will also retain copyright to their works under a creative commons license.
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