Decision-making and Decision Support Among Emerging Adults With First Episode Psychosis
Condition: Early Psychosis
MeSH terms: Psychotic Disorders; Mental Disorders
Study type: Interventional

Summary: 
      The purpose of this study is to evaluate the impact of an antipsychotic medication decision
      aid and interpersonal and cognitive factors, such as attachment style and motivation, on
      emerging adults' ability to engage in shared decision making regarding their medications.
    

Detailed description: 
      The long-term occupational, social, and economic outcomes associated with psychosis make it
      an urgent public health problem. Coordinated specialty care (CSC) is now the gold standard
      for early psychosis, demonstrating positive clinical and functional effects in the
      short-term, and longer-term reduced hospitalization rates. These services include an array of
      treatment options, including psychotropic medications, individual psychotherapy, family
      education, and support, and occupational therapy and supported employment/education.

      While a shorter period between psychosis onset and receipt of appropriate care is associated
      with better outcomes, emerging adults often experience significant delays before receiving
      treatment, and a large percentage disengage from services once they are commenced. Decisional
      conflict about treatment options (i.e., feeling conflicted about which option to choose) and
      interpersonal factors such as attachment style and trust in health providers can contribute
      to decision delay and discontinuance of chosen options. Decision support tools (e.g.,
      decision aids), have been shown to reduce decisional conflict as well as improve service
      engagement. A requisite step in expanding the array of decision support tools available to
      emerging adults experiencing early psychosis is to better understand their decision-making
      ability, capacity, and motivation to engage in decision making and how these relate to their
      engagement in CSC.

      It is well recognized that individuals who are being prescribed antipsychotic medications
      often face decisional conflict about their treatment options. An especially controversial
      decision is whether individuals should continue taking medication at the same dose or adjust
      the dose whilst monitoring their symptoms. This dilemma is the result of some uncertainty
      about the appropriate treatment strategy for long-term management of psychosis. The present
      project focuses on evaluating the feasibility and effectiveness of the use of a decision aid
      for making decisions about antipsychotic medication.
    

Intervention name(s): Decision aid
Intervention type(s): Behavioral
Intervention description(s): The chosen intervention is a one-page DA developed by the first author, published and fully described elsewhere (Zisman-Ilani et al., 2017; Zisman et al., 2018) for use during the psychiatric consultation to help patients and clinicians discuss relevant treatment options pertaining to antipsychotics such as medication nonadherence and self-tapering. The DA format is a simple one-page table with rows containing frequently asked questions by patients about their treatment options and the benefits, risks, and implications of differing decisions. The columns display the treatment options available for the treatment decision in question: continuing, adjusting, or discontinuing antipsychotic medications.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Investigator)
Primary purpose: Other