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Negotiating styles adopted by consultant psychiatrists when prescribing antipsychotics

Robert Chaplin is a research fellow at the Royal College of Psychiatrists’ Research and Training Unit (CRTU) (21 Mansell Street, London E1 8AA, UK. Email: rchaplin{at}cru.rcpsych.ac.uk) and a consultant in general adult psychiatry at Oxfordshire Mental Healthcare NHS Trust. He has interests in audit and learning disability. Paul Lelliott is Director of the CRTU and a consultant psychiatrist employed by Oxleas NHS Trust, where he works as a member of a community mental health team. Alan Quirk is a research fellow at the CRTU. As a research sociologist he has used qualitative methods to study psychiatrist–patient communication in a range of situations, including Mental Health Act assessments, ward rounds on acute wards and out-patient consultations. Clive Seale is a professor of sociology at Brunel University. He is author of many books and articles on aspects of medical sociology and social research methods. He is presently pursuing projects in the fields of psychiatry, end-of-life care and treatment of health issues by the mass media.

A good therapeutic alliance between mental health professionals and patients with psychosis can enhance adherence to medication regimens and improve clinical outcome. This article explores how the therapeutic alliance might be developed with respect to decisions to prescribe antipsychotic medication. It does this by presenting the implications for practice that arise from a recent qualitative interview study with consultant psychiatrists. We consider strategies for strengthening the therapeutic alliance, occasions when it might be appropriate to suspend shared decision-making temporarily, techniques used to enable discussion of symptoms and side-effects, and how issues of adherence are uncovered and addressed. Psychiatrists already possess considerable skills in these areas. The dissemination of these to colleagues forms an important opportunity for CPD.

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				R. Chaplin How can clinicians help patients to take their psychotropic medication?: Invited commentary on... Why don't patients take their medicine? Advan. Psychiatr. Treat., September 1, 2007; 13(5): 347 - 349. [Abstract] [Full Text] [PDF]