When Doing Nothing Feels Safer: A Multilevel Framework for Therapeutic Inertia in Psychiatry

Area of Science:

• Psychiatry
• Clinical Decision-Making
• Health Services Research

Background:

• Therapeutic inertia is well-studied in chronic medical conditions but not in psychiatry.
• It is defined as failure to modify care despite unmet goals and available alternatives.

Purpose of the Study:

• To conceptually define and review therapeutic inertia in psychiatry.
• To identify its determinants and potential interventions.

Main Methods:

• Structured narrative review of PubMed literature.
• Supplemented by citation searching, focusing on psychiatric evidence and decision-making literature.

Main Results:

• Therapeutic inertia is a multilevel phenomenon with diverse determinants (cognitive, patient, systemic).
• Clozapine underutilization in schizophrenia is a key example; evidence in depression and bipolar disorder is emerging.
• Distinguished from related concepts like caution, futility, and deprescribing.

Conclusions:

• Interventions like explicit goals, reassessment, and shared decision-making are proposed.
• Future research needs operational definitions and real-world data to guide interventions effectively.