Factors shaping the decision-making process to continue or discontinue antipsychotics: exploratory qualitative study of 12 individuals in remission from first-episode psychosis.

Background: The decision-making process regarding antipsychotic continuation or discontinuation following remission from first-episode psychosis (FEP) remains complex and underresearched. While discontinuation increases the risk of relapse, concerns over long-term side-effects such as metabolic disturbances and extrapyramidal symptoms also exist. Current guidelines recommend maintaining antipsychotics for 1-5 years, emphasising shared decision-making (SDM) between clinicians and patients.

Aims: This study aimed to explore the decision-making process and describe the factors influencing the decision to discontinue or continue antipsychotic treatment following remission from FEP, from the patients' perspective.

Method: A descriptive qualitative study was conducted with 12 individuals in remission from FEP who received care at early intervention services in Quebec, Canada. Data were collected through online semi-structured interviews and analysed thematically to identify key factors influencing treatment decisions.

Results: The decision-making process was activated by treatment reflection triggers and shaped by various perceptions (of illness, treatment and stigma) and relationships (with friends, family and the clinical team), ultimately leading to decisions to either discontinue, continue (at standard or reduced dose) or remain ambivalent. This dynamic process was guided by participants' motivators, such as well-being and societal contribution. Most participants felt that discontinuation discussions were not initiated by the clinical team.

Conclusions: The decision-making process is driven by motivators that were found to be linked to the concept of personal recovery. This study highlights the need for proactive, personalised discussions between clinicians and patients. Future research should focus on decision aids tailored to the FEP population to support SDM and improve treatment outcomes.