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Revista de la Asociación Española de Neuropsiquiatría

On-line version ISSN 2340-2733Print version ISSN 0211-5735

Abstract

VILLAGRAN, José M.; LARA RUIZ-GRANADOS, Ignacio  and  GONZALEZ-SAIZ, Francisco. Conceptual analysis of shared decision-making process in mental health. Rev. Asoc. Esp. Neuropsiq. [online]. 2015, vol.35, n.127, pp.455-472. ISSN 2340-2733.  http://dx.doi.org/10.4321/S0211-57352015000300002.

One of the most important changes in health care in recent decades, regarding the therapeutic decisions, has been the transition from a model focused on the disease to other one focused on the patient. This entails the progressive replacement of a paternalistic approach by a more deliberative one and, in relation to pharmacological treatments, the concept of compliance or adherence to the therapeutic agreement. The concept of therapeutic agreement, on the other hand, has been referred to as the ultimate goal of a process of negotiation and co-responsibility in the decision to choose a treatment which has been called "shared decisionmaking process" (SDM). So far, the SDM has been poorly implemented in severe mental disorders, when not answered as inadequate given the alleged alteration of the seriously ill psychiatric patient's ability to make decisions. However, this inability is not always present so shared decision should be viewed as a premise and not as an exception. SDM involves the introduction of a procedure in stages (doctor-patient partnership, information about options, pros and cons, deliberation about them and their relationship with the values and preferences of the patient, consensual decision). One of the most important barriers for the implementation of the shared mental health decision-making process is the question of the capacity of the mentally ill. Therefore, the evaluation of the capacity must be central in psychiatric clinical practice.

Keywords : Decision making; psychiatry; therapeutics; ethics; mental competency.

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