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The Royal College of Psychiatrists Improving the lives of people with mental illness

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How are decisions made?

How do psychiatrists and patients negotiate about medication? 

This study recorded 100 consultations during which psychiatrists discussed medication with patients. The analysis identified what makes for good consensual decision-making. The results are helping to educate psychiatrists about how best to engage in these negotiations.


Detailed information


Title: How are decisions made about prescribing of anti-psychotic drugs for psychiatric outpatients?

Funded from 2003 to 2006 by Eli Lilly.



Background to the study 


  • Randomised controls trials (RCTs) provide valuable evidence about the effectiveness of medication
  • There are great differences between the circumstances of an RCT and those of the real-life clinical setting
  • Little is known about how psychiatrists and their patients negotiate decisions about medication



Study aims 


  • To understand better how prescribing decisions are made in psychiatric outpatient consultations





  • Highly detailed conversation analysis of 100 tape recorded outpatient consultations
  • Participant-observation on 3 wards (inner London, outer London, South East England)
  • Observation & interviews with patients and staff
  • Findings have been disseminated widely and fed into training materials and courses for psychiatrists







  • Chaplin, R., Lelliott, P., Quirk, A. & Seale, C. (2007) ‘Negotiating styles adopted by consultant psychiatrists when prescribing antipsychotics’, Advances in Psychiatric Treatment 13, 43 – 50
  • Quirk, A., Chaplin, R., Lelliott, P. & Seale, C. (2009)  The negotiation of prescribing decisions:  some good practice issues.  In N. Harris, J. Baker & R. Gray (eds) Medicines Management in Mental Health. Wiley-Blackwell.
  • Quirk, A., Chaplin, R., Lelliott, P. & Seale, C. How pressure is applied in ‘negotiated’ decisions about medication.  Sociology of Health & Illness, in press.
  • Quirk, A., Chaplin, R., Lelliott, P. & Seale, C. Communication about adherence to long-term anti-psychotic prescribing. British Journal of Psychiatry. Submitted.
  • Seale, C., Chaplin, R., Lelliott, P. & Quirk, A. (2007) ‘Antipsychotic medication, sedation and mental clouding: An observational study of psychiatric consultations’, Social Science & Medicine, 65(4), 698-711.
  • Seale, S., Chaplin, R., Lelliott, .P, & Quirk, A. (2006) Sharing decisions in consultations involving anti-psychotic medication: a qualitative study of psychiatrists’ experiences. Social Science & Medicine, 62: 2861-2873.




Health Services Research, Royal College of Psychiatrists, 4th Floor Standon House, 21 Mansell Street, London E1 8AA    





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