Patient participation in antipsychotic drug choice decisions

Patient inclusion in antipsychotic drug decisions is recommended by international treatment guidelines. For N=300 in patients with schizophrenia, we analysed patients' preferences for inclusion in decisions and physicians' estimates which patients actually participated in drug choice. Path analysis was used to examine the relationships between patients' preferences/actual participation and clinical variables measured. Forty percent of the patients expressed a wish to participate in clinical decisions. Those patients wishing to participate in medical decisions had less insight into the necessity of treatment. Psychiatrists gave better ratings of the doctor-patient relationship to those patients whom they rated as having participated in their drug choice. These patients had more positive attitudes towards antipsychotic medication. There was no relationship between the desire to participate and actual participation in the drug choice. When working with patients exhibiting poor insight and negative drug attitudes, psychiatrists use authoritative decision-making styles despite the patient's desire to participate.