In his letter, Dr. Preda addresses two important questions: 1) are the results reported in our article unique for patients suffering from schizophrenia, or can they be generalized to all mental illnesses, and 2) what is the influence of specific psychopathology or schizophrenia subtype?
The amount of desired participation shown in our study is similar to that of patients with moderate to severe depression (1). Therefore, we would argue that the diagnostic type of a mental illness does not generally predict high or low interest in participation.
From our own data we can also add that neither overall psychopathology (total score on the Positive and Negative Syndrome Scale [PANSS], as reported in the article) nor PANSS subscores (positive and negative scales) correlate with interest in participation.
Therefore, we would argue that their interest in participation might be fairly stable over time and influenced more by the patients’ personalities or long-term experiences (with the illness or treatment) than by actual symptoms.
We share Dr. Preda’s interest in differences between diagnostic groups with regard to interest in participation but would argue that further research should focus more on practical issues, such as the topics that patients regard as important for inclusion in decisions (e.g., drug choice, psychosocial treatments) or the way in which participation is achieved (models such as shared decision making ).
Finally and most important, participation has to be practiced and studied to obtain insight into whether and how patients with severe mental illness can be engaged in therapeutic decisions and what the consequences of this inclusion will be.
Loh A, Kremer N, Giersdorf N, Jahn H, Hanselmann S, Bermejo I, Harter M: [Information and participation interests of patients with depression in clinical decision making in primary care.] Z Arztl Fortbild Qualitatssich 2004; 98:101–107 (German)
Hamann J, Leucht S, Kissling W: Shared decision making in psychiatry. Acta Psychiatr Scand 2003; 107:403–409