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Dijkstra SA, Rijkeboer J, Noordhof A, Boyette LL, Berendsen S, de Koning M, Bennen RLJ, Hofman T, de Haan L. Making Sense of Recovery From First Psychosis With Antipsychotic Medication: A Qualitative Phenomenological Study. Schizophr Bull 2024:sbae104. [PMID: 39004928 DOI: 10.1093/schbul/sbae104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/16/2024]
Abstract
BACKGROUND AND HYPOTHESIS Recovering from a first psychosis is a highly individual process and requires the person to make sense of their experiences. Clinicians, in turn, need to comprehend these first-person perspectives, creating a mutual sense-making dynamic. Antipsychotic medication is a substantial part of psychosis treatment. Providing insight in the lived experience of recovery with antipsychotics could improve the mutual understanding and help bridge the gap between the perspective of the clinician and that of the person recovering from psychosis. STUDY DESIGN 14 persons in recovery from a first psychosis with the use of antipsychotics were interviewed. Their narratives were analyzed using Interpretative Phenomenological Analysis (IPA). STUDY RESULTS Five overarching themes were found, representing important and meaningful experiences in recovering with antipsychotic medication. Theme 1: antipsychotics as external dampening (4 subthemes); Theme 2: shifting of realities; Theme 3: pace of recovery; Theme 4: antipsychotics' influence on identity; and Theme 5: is it truly the antipsychotics? CONCLUSIONS Our findings show that recovery from psychosis with antipsychotics is an all-encompassing, multi-faceted, and ambivalent experience. The themes found in this research could inspire clinicians to discuss less obvious aspects of the experience of recovering with antipsychotics. Even more so, paying attention to the first-person perspective could lead to a more thorough understanding and benefit therapeutic relationships.
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Affiliation(s)
- Stéphanie Astrid Dijkstra
- Department of Psychiatry, Amsterdam University Medical Center, Location Academic Medical Center, Amsterdam, The Netherlands
| | - Jennifer Rijkeboer
- Department of Psychiatry, Amsterdam University Medical Center, Location Academic Medical Center, Amsterdam, The Netherlands
| | - Arjen Noordhof
- Department of Clinical Psychology, University of Amsterdam, Amsterdam, The Netherlands
| | - Lindy-Lou Boyette
- Department of Clinical Psychology, University of Amsterdam, Amsterdam, The Netherlands
| | - Steven Berendsen
- Department of Psychiatry, Amsterdam University Medical Center, Location Academic Medical Center, Amsterdam, The Netherlands
- Dimence Mental Health Care, Deventer, The Netherlands
| | - Mariken de Koning
- Department of Research, Arkin Institute for Mental Health, Amsterdam, The Netherlands
| | - Romy Liza Japien Bennen
- Department of Psychiatry, Amsterdam University Medical Center, Location Academic Medical Center, Amsterdam, The Netherlands
| | - Tim Hofman
- Department of Psychiatry, Amsterdam University Medical Center, Location Academic Medical Center, Amsterdam, The Netherlands
- Department of Psychiatry, Amsterdam University Medical Center, Location VU University Medical Center, Amsterdam, The Netherlands
| | - Lieuwe de Haan
- Department of Psychiatry, Amsterdam University Medical Center, Location Academic Medical Center, Amsterdam, The Netherlands
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Rippe W, Weisner L, Ewen J, Mench P, Koppius T, Borgwardt S, Tari B, Heath M, Sprenger A, Wilms B, Lencer R. We like to move it - patients with schizophrenia spectrum disorders are impaired in estimating their physical fitness levels and benefit from individualized exercise. Eur Arch Psychiatry Clin Neurosci 2024:10.1007/s00406-024-01844-6. [PMID: 38953981 DOI: 10.1007/s00406-024-01844-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2024] [Accepted: 06/06/2024] [Indexed: 07/04/2024]
Abstract
BACKGROUND People with schizophrenia spectrum disorders (SSD) engage less in physical activity than healthy individuals. The impact of subjectively assessed physical fitness levels on motivation for sports engagement and its relation to objective fitness parameters in SSD is unclear. METHODS 25 patients with SSD (P-SSD) and 24 healthy controls (H-CON) participated in a randomized controlled study. Individual anaerobic thresholds (AT) were determined by an incremental exercise test and on separate days, aerobic exercise (cycling at 80% of workload at AT) and non-exercise control (sitting on an ergometer without cycling) sessions were performed. Demographic, clinical and objective physical fitness data (i.e., weekly physical activity, workload at AT, heart rate) were collected. Subjective physical fitness parameters were assessed before and after exercise and control sessions. RESULTS Weekly physical activity in P-SSD was lower than in H-CON (p < 0.05) attributed to reduced engagement in sport activities (p < 0.001). Workload and percentage of predicted maximal heart rate at AT were also reduced in P-SSD compared to H-CON (both p < 0.05). Although objective and subjective physical fitness parameters were related in H-CON (p < 0.01), this relationship was absent in P-SSD. However, during exercise sessions subjective physical fitness ratings increased to a stronger extent in P-SSD than H-CON (p < 0.05). CONCLUSION The missing relationship between subjective and objective physical fitness parameters in people with SSD may represent a barrier for stronger engagement in physical activity. Accordingly, supervised exercise interventions with individually adjusted workload intensity may support realistic subjective fitness estimations and enhance motivation for sports activity in individuals with SSD.
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Affiliation(s)
- Wido Rippe
- Department of Psychiatry and Psychotherapy, University of Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany.
- Center of Brain, Behavior and Metabolism, University of Lübeck, Lübeck, Germany.
| | - L Weisner
- Center of Brain, Behavior and Metabolism, University of Lübeck, Lübeck, Germany
- Institute for Endocrinology and Diabetes, University of Lübeck, Lübeck, Germany
| | - J Ewen
- Department of Psychiatry and Psychotherapy, University of Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany
| | - P Mench
- Department of Psychiatry and Psychotherapy, University of Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany
| | - T Koppius
- Institute of Psychology, University of Lübeck, Lübeck, Germany
| | - S Borgwardt
- Department of Psychiatry and Psychotherapy, University of Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany
- Center of Brain, Behavior and Metabolism, University of Lübeck, Lübeck, Germany
| | - B Tari
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - M Heath
- School of Kinesiology, University of Western Ontario, London, Canada
| | - A Sprenger
- Center of Brain, Behavior and Metabolism, University of Lübeck, Lübeck, Germany
- Institute of Psychology, University of Lübeck, Lübeck, Germany
- Department of Neurology, University of Lübeck, Lübeck, Germany
| | - B Wilms
- Center of Brain, Behavior and Metabolism, University of Lübeck, Lübeck, Germany
- Institute for Endocrinology and Diabetes, University of Lübeck, Lübeck, Germany
| | - R Lencer
- Department of Psychiatry and Psychotherapy, University of Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany
- Center of Brain, Behavior and Metabolism, University of Lübeck, Lübeck, Germany
- Institute for Translational Psychiatry, University Münster, Münster, Germany
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Gangadin SS, Enthoven AD, van Beveren NJM, Laman JD, Sommer IEC. Immune Dysfunction in Schizophrenia Spectrum Disorders. Annu Rev Clin Psychol 2024; 20:229-257. [PMID: 38996077 DOI: 10.1146/annurev-clinpsy-081122-013201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/14/2024]
Abstract
Evidence from epidemiological, clinical, and biological research resulted in the immune hypothesis: the hypothesis that immune system dysfunction is involved in the pathophysiology of schizophrenia spectrum disorders (SSD). The promising implication of this hypothesis is the potential to use existing immunomodulatory treatment for innovative interventions for SSD. Here, we provide a selective historical review of important discoveries that have shaped our understanding of immune dysfunction in SSD. We first explain the basic principles of immune dysfunction, after which we travel more than a century back in time. Starting our journey with neurosyphilis-associated psychosis in the nineteenth century, we continue by evaluating the role of infections and autoimmunity in SSD and findings from assessment of immune function using new techniques, such as cytokine levels, microglia density, neuroimaging, and gene expression. Drawing from these findings, we discuss anti-inflammatory interventions for SSD, and we conclude with a look into the future.
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Affiliation(s)
- S S Gangadin
- Department of Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands;
| | - A D Enthoven
- Department of Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands;
| | - N J M van Beveren
- Department of Neuroscience, Erasmus MC, Rotterdam, The Netherlands
- Parnassia Group for Mental Health Care, The Hague and Rotterdam, The Netherlands
| | - J D Laman
- Department of Pathology and Medical Biology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - I E C Sommer
- Department of Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands;
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Conneely M, Roe D, Hasson-Ohayon I, Pijnenborg GHM, van der Meer L, Speyer H. Antipsychotics and Identity: The Adverse Effect No One is Talking About. Community Ment Health J 2024:10.1007/s10597-024-01255-w. [PMID: 38427277 DOI: 10.1007/s10597-024-01255-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 02/15/2024] [Indexed: 03/02/2024]
Abstract
People who take antipsychotics, and people who are prescribed antipsychotics without taking them, experience effects which are not frequently discussed: effects on their identity and sense of self. Qualitative research indicates the relationship between taking APs and identity is multilayered, and changeable. Taking APs can restore people to their earlier, pre-symptom sense of self. Being prescribed and taking APs can also, on the other hand, be experienced as damaging, erasing and dulling people's sense of who they are. This complexity deserves exploration in clinical practice, which we believe is currently not done routinely. More work is needed to understand whether, and how, the relationship between identity and APs is being addressed. We outline the importance of having discussions in a clinical space around identity, and a sense of agency, on the grounds that true recovery-oriented care, which enacts shared decision-making principles, demands it. Further, we argue that it will allow for better therapeutic alliance and trust to be forged between clinician and client, ultimately leading to better care.
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Affiliation(s)
- M Conneely
- Division of Psychiatry, University College London, Maple House, W1T 7BN, London, UK.
| | - D Roe
- Department of Psychology, Bar-Ilan University, Ramat-Gan, Israel
| | - I Hasson-Ohayon
- Department of Psychology, Bar-Ilan University, Ramat-Gan, Israel
| | - G H M Pijnenborg
- Department of Clinical and Developmental Neuropsychology, University of Groningen, Groningen, Netherlands
| | - L van der Meer
- Department of Clinical and Developmental Neuropsychology, University of Groningen, Groningen, Netherlands
| | - H Speyer
- Mental Health Centre Copenhagen, Copenhagen University Hospital, Copenhagen, Denmark
- Institute of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
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Howe J, MacPhee M, Duddy C, Habib H, Wong G, Jacklin S, Oduola S, Upthegrove R, Carlish M, Allen K, Patterson E, Maidment I. A realist review of medication optimisation of community dwelling service users with serious mental illness. BMJ Qual Saf 2023:bmjqs-2023-016615. [PMID: 38071586 DOI: 10.1136/bmjqs-2023-016615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Accepted: 10/14/2023] [Indexed: 12/22/2023]
Abstract
BACKGROUND Severe mental illness (SMI) incorporates schizophrenia, bipolar disorder, non-organic psychosis, personality disorder or any other severe and enduring mental health illness. Medication, particularly antipsychotics and mood stabilisers are the main treatment options. Medication optimisation is a hallmark of medication safety, characterised by the use of collaborative, person-centred approaches. There is very little published research describing medication optimisation with people living with SMI. OBJECTIVE Published literature and two stakeholder groups were employed to answer: What works for whom and in what circumstances to optimise medication use with people living with SMI in the community? METHODS A five-stage realist review was co-conducted with a lived experience group of individuals living with SMI and a practitioner group caring for individuals with SMI. An initial programme theory was developed. A formal literature search was conducted across eight bibliographic databases, and literature were screened for relevance to programme theory refinement. In total 60 papers contributed to the review. 42 papers were from the original database search with 18 papers identified from additional database searches and citation searches conducted based on stakeholder recommendations. RESULTS Our programme theory represents a continuum from a service user's initial diagnosis of SMI to therapeutic alliance development with practitioners, followed by mutual exchange of information, shared decision-making and medication optimisation. Accompanying the programme theory are 11 context-mechanism-outcome configurations that propose evidence-informed contextual factors and mechanisms that either facilitate or impede medication optimisation. Two mid-range theories highlighted in this review are supported decision-making and trust formation. CONCLUSIONS Supported decision-making and trust are foundational to overcoming stigma and establishing 'safety' and comfort between service users and practitioners. Avenues for future research include the influence of stigma and equity across cultural and ethnic groups with individuals with SMI; and use of trained supports, such as peer support workers. PROSPERO REGISTRATION NUMBER CRD42021280980.
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Affiliation(s)
- Jo Howe
- Pharmacy School, College of Health and Life Sciences, Aston University, Birmingham, UK
| | - Maura MacPhee
- School of Nursing, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Claire Duddy
- Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Hafsah Habib
- Pharmacy School, Aston University College of Health and Life Sciences, Birmingham, UK
| | - Geoff Wong
- Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Simon Jacklin
- School of Pharmacy and Bioengineering, Keele University, Keele, UK
| | - Sheri Oduola
- School of Health Sciences, University of East Anglia, Norwich, UK
| | - Rachel Upthegrove
- Institute for Mental Health, University of Birmingham, Birmingham, UK
- Birmingham Early Intervention Service, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - Max Carlish
- Birmingham and Solihull Mental Health NHS Foundation Trust, Birmingham, UK
| | - Katherine Allen
- Birmingham and Solihull Mental Health NHS Foundation Trust, Birmingham, UK
| | - Emma Patterson
- Birmingham and Solihull Mental Health NHS Foundation Trust, Birmingham, UK
| | - Ian Maidment
- Pharmacy School, College of Health and Life Sciences, Aston University, Birmingham, UK
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Morant N, Long M, Jayacodi S, Cooper R, Akther-Robertson J, Stansfeld J, Horowitz M, Priebe S, Moncrieff J. Experiences of reduction and discontinuation of antipsychotics: a qualitative investigation within the RADAR trial. EClinicalMedicine 2023; 64:102135. [PMID: 37936655 PMCID: PMC10626156 DOI: 10.1016/j.eclinm.2023.102135] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 07/07/2023] [Accepted: 07/18/2023] [Indexed: 11/09/2023] Open
Abstract
Background Antipsychotics are a core treatment for psychosis, but the evidence for gradual dose reductions guided by clinicians is under-developed. The RADAR randomised controlled trial (RCT) compared antipsychotic reduction and possible discontinuation with maintenance treatment for people with recurrent psychotic disorders. The current study explored participants' experiences of antipsychotic reduction or discontinuation within this trial. Methods This qualitative study was embedded within the RADAR RCT (April 2017-March 2022) that recruited 253 participants from specialist community mental health services in 19 public healthcare localities in England. Participants were adults with recurrent non affective psychosis who were taking antipsychotic medication. Semi-structured interviews, lasting 30-90 min, were conducted after the trial final 24-month follow-up with 26 people who reduced and/or discontinued antipsychotics within the trial, sampled purposively for diversity in sociodemographic characteristics, trial variables, and pre-trial medication and clinical factors. Data were analysed using thematic analysis and findings are reported qualitatively. Findings Most participants reported reduced adverse effects of antipsychotics with dose reductions, primarily in mental clouding, emotional blunting and sedation, and some positive impacts on social functioning and sense of self. Over half experienced deteriorations in mental health, including psychotic symptoms and intolerable levels of emotional intensity. Nine had a psychotic relapse. The trial context in which medication reduction was explicitly part of clinical care provided various learning opportunities. Some participants were highly engaged with reduction processes, and despite difficulties including relapses, developed novel perspectives on medication, dose optimisation, and how to manage their mental health. Others were more ambivalent about reduction or experienced less overall impact. Interpretation Experiences of antipsychotic reductions over two years were dynamic and diverse, shaped by variations in dose reduction profiles, reduction effects, personal motivation and engagement levels, and relationships with prescribers. There are relapse risks and challenges, but some people experience medication reduction done with clinical guidance as empowering. Clinicians can use findings to inform and work flexibly with service users to establish optimal antipsychotic doses. Funding National Institute for Health Research.
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Affiliation(s)
- Nicola Morant
- Division of Psychiatry, University College London, London, UK
| | - Maria Long
- Division of Psychiatry, University College London, London, UK
- Health Services Research & Management, City University, London, UK
- Research & Development Department, North East London NHS Foundation Trust, London, UK
| | | | - Ruth Cooper
- Unit for Social and Community Psychiatry, Queen Mary University of London, London, UK
- East London NHS Foundation Trust, Newham Centre for Mental Health, London, UK
- NIHR Mental Health Policy Research Unit, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | | | - Jacki Stansfeld
- Research & Development Department, North East London NHS Foundation Trust, London, UK
| | - Mark Horowitz
- Division of Psychiatry, University College London, London, UK
- Research & Development Department, North East London NHS Foundation Trust, London, UK
| | - Stefan Priebe
- Unit for Social and Community Psychiatry, Queen Mary University of London, London, UK
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7
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Allott K, Yuen HP, Baldwin L, O'Donoghue B, Fornito A, Chopra S, Nelson B, Graham J, Kerr MJ, Proffitt TM, Ratheesh A, Alvarez-Jimenez M, Harrigan S, Brown E, Thompson AD, Pantelis C, Berk M, McGorry PD, Francey SM, Wood SJ. Effects of risperidone/paliperidone versus placebo on cognitive functioning over the first 6 months of treatment for psychotic disorder: secondary analysis of a triple-blind randomised clinical trial. Transl Psychiatry 2023; 13:199. [PMID: 37301832 DOI: 10.1038/s41398-023-02501-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 05/17/2023] [Accepted: 05/30/2023] [Indexed: 06/12/2023] Open
Abstract
The drivers of cognitive change following first-episode psychosis remain poorly understood. Evidence regarding the role of antipsychotic medication is primarily based on naturalistic studies or clinical trials without a placebo arm, making it difficult to disentangle illness from medication effects. A secondary analysis of a randomised, triple-blind, placebo-controlled trial, where antipsychotic-naive patients with first-episode psychotic disorder were allocated to receive risperidone/paliperidone or matched placebo plus intensive psychosocial therapy for 6 months was conducted. A healthy control group was also recruited. A cognitive battery was administered at baseline and 6 months. Intention-to-treat analysis involved 76 patients (antipsychotic medication group: 37; 18.6Mage [2.9] years; 21 women; placebo group: 39; 18.3Mage [2.7]; 22 women); and 42 healthy controls (19.2Mage [3.0] years; 28 women). Cognitive performance predominantly remained stable (working memory, verbal fluency) or improved (attention, processing speed, cognitive control), with no group-by-time interaction evident. However, a significant group-by-time interaction was observed for immediate recall (p = 0.023), verbal learning (p = 0.024) and delayed recall (p = 0.005). The medication group declined whereas the placebo group improved on each measure (immediate recall: p = 0.024; ηp2 = 0.062; verbal learning: p = 0.015; ηp2 = 0.072 both medium effects; delayed recall: p = 0.001; ηp2 = 0.123 large effect). The rate of change for the placebo and healthy control groups was similar. Per protocol analysis (placebo n = 16, medication n = 11) produced similar findings. Risperidone/paliperidone may worsen verbal learning and memory in the early months of psychosis treatment. Replication of this finding and examination of various antipsychotic agents are needed in confirmatory trials. Antipsychotic effects should be considered in longitudinal studies of cognition in psychosis.Trial registration: Australian New Zealand Clinical Trials Registry ( http://www.anzctr.org.au/ ; ACTRN12607000608460).
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Affiliation(s)
- Kelly Allott
- Orygen, Parkville, VIC, Australia.
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia.
| | - Hok Pan Yuen
- Orygen, Parkville, VIC, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | - Lara Baldwin
- Orygen, Parkville, VIC, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | - Brian O'Donoghue
- Orygen, Parkville, VIC, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
- Department of Psychiatry, University College Dublin, Belfield, Ireland
| | - Alex Fornito
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, VIC, Australia
- Monash Biomedical Imaging, Monash University, Clayton, VIC, Australia
| | - Sidhant Chopra
- Department of Psychology, Yale University, New Haven, CT, USA
| | - Barnaby Nelson
- Orygen, Parkville, VIC, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | | | - Melissa J Kerr
- Orygen, Parkville, VIC, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | | | - Aswin Ratheesh
- Orygen, Parkville, VIC, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | - Mario Alvarez-Jimenez
- Orygen, Parkville, VIC, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | - Susy Harrigan
- Department of Social Work, School of Primary and Allied Health Care, Monash University, Melbourne, VIC, Australia
- Centre for Mental Health, Melbourne School of Global and Population Health, The University of Melbourne, Parkville, VIC, Australia
| | - Ellie Brown
- Orygen, Parkville, VIC, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | - Andrew D Thompson
- Orygen, Parkville, VIC, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
- Division of Mental Health and Wellbeing, Warwick Medical School, University of Warwick, Warwick, UK
| | - Christos Pantelis
- Melbourne Neuropsychiatry Centre, Department of Psychiatry, The University of Melbourne, Parkville, VIC, Australia
- Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Parkville, VIC, Australia
- NorthWestern Mental Health, Western Hospital Sunshine, St Albans, VIC, Australia
| | - Michael Berk
- Orygen, Parkville, VIC, Australia
- Deakin University, IMPACT - the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Geelong, VIC, Australia
| | - Patrick D McGorry
- Orygen, Parkville, VIC, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | - Shona M Francey
- Orygen, Parkville, VIC, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | - Stephen J Wood
- Orygen, Parkville, VIC, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
- School of Psychology, University of Birmingham, Edgbaston, UK
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8
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Berg M, Riehle M, Rief W, Lincoln T. Does partial blockade of dopamine D2 receptors with Amisulpride cause anhedonia? An experimental study in healthy volunteers. J Psychiatr Res 2023; 158:409-416. [PMID: 36680855 DOI: 10.1016/j.jpsychires.2023.01.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 12/22/2022] [Accepted: 01/09/2023] [Indexed: 01/12/2023]
Abstract
BACKGROUND Anhedonia is a frequent cause of functional impairment in psychosis. Although it is plausible that medication-induced D2 receptor blockade could diminish hedonic responding, there is little experimental research testing this hypothesis in humans. METHODS To inspect possible effects of partial D2 blockade on hedonic experiences, we administered 300 mg of Amisulpride or placebo to 85 participants in a randomized, double-blind, placebo-controlled trial. Participants were then subjected to an emotional evocation task utilizing standardized pictorial pleasant, neutral, and unpleasant stimuli. RESULTS We observed lower positivity ratings in the Amisulpride group compared to placebo across all stimulus categories (p = .026, f = 0.25) and no group differences in negativity or arousal ratings. The Amisulpride group also showed lower electrodermal responses across all stimulus categories compared to placebo (p = .017, f = 0.27). The electrodermal response was especially diminished for pleasant stimuli. CONCLUSION We interpret our findings as evidence that D2 blockade via Amisulpride can reduce at-the-moment hedonic responsivity in healthy volunteers. If these results can be confirmed in drug-naïve clinical samples, this would indicate that antipsychotic medication contributes to clinical anhedonia, probably via antagonistic effects at the dopamine D2 receptor.
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Affiliation(s)
- Max Berg
- Philipps-University of Marburg, Dept. of Psychology, Division of Clinical Psychology and Psychotherapy, Gutenbergstraße 18, D-35032, Marburg, Germany.
| | - Marcel Riehle
- Universität Hamburg, Dept. of Psychology, Clinical Psychology and Psychotherapy, Von-Melle-Park 5, D-20146, Hamburg, Germany
| | - Winfried Rief
- Philipps-University of Marburg, Dept. of Psychology, Division of Clinical Psychology and Psychotherapy, Gutenbergstraße 18, D-35032, Marburg, Germany
| | - Tania Lincoln
- Universität Hamburg, Dept. of Psychology, Clinical Psychology and Psychotherapy, Von-Melle-Park 5, D-20146, Hamburg, Germany
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Grasing KW, Burnell K, De A. Biphasic reward effects are characteristic of both lorcaserin and drugs of abuse: implications for treatment of substance use disorders. Behav Pharmacol 2022; 33:238-248. [PMID: 35324488 PMCID: PMC9149059 DOI: 10.1097/fbp.0000000000000672] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Lorcaserin is a modestly selective agonist for 2C serotonin receptors (5-HT2CR). Despite early promising data, it recently failed to facilitate cocaine abstinence in patients and has been compared with dopamine antagonist medications (antipsychotics). Here, we review the effects of both classes on drug reinforcement. In addition to not being effective treatments for cocaine use disorder, both dopamine antagonists and lorcaserin can have biphasic effects on dopamine and reward behavior. Lower doses can cause enhanced drug taking with higher doses causing reductions. This biphasic pattern is shared with certain stimulants, opioids, and sedative-hypnotics, as well as compounds without abuse potential that include agonists for muscarinic and melatonin receptors. Additional factors associated with decreased drug taking include intermittent dosing for dopamine antagonists and use of progressive-ratio schedules for lorcaserin. Clinically relevant doses of lorcaserin were much lower than those that inhibited cocaine-reinforced behavior and can also augment this same behavior in different species. Diminished drug-reinforced behavior only occurred in animals after higher doses that are not suitable for use in patients. In conclusion, drugs of abuse and related compounds often act as biphasic modifiers of reward behavior, especially when evaluated over a broad range of doses. This property may reflect the underlying physiology of the reward system, allowing homeostatic influences on behavior.
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Affiliation(s)
- Ken W Grasing
- Substance Use Research Laboratory, Research Service, Kansas City Veterans Affairs Medical Center, Kansas City, Missouri
- Division of Clinical Pharmacology, Department of Medicine, University of Kansas School of Medicine, Kansas City, Kansas, USA
| | - Kim Burnell
- Substance Use Research Laboratory, Research Service, Kansas City Veterans Affairs Medical Center, Kansas City, Missouri
| | - Alok De
- Substance Use Research Laboratory, Research Service, Kansas City Veterans Affairs Medical Center, Kansas City, Missouri
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10
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Lewins A, Morant N, Akther-Robertson J, Crellin NE, Stansfeld JL, Smith R, Moncrieff J. A qualitative exploration of family members' perspectives on reducing and discontinuing antipsychotic medication. J Ment Health 2022:1-8. [PMID: 35521675 DOI: 10.1080/09638237.2022.2069710] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 02/24/2022] [Accepted: 03/08/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Antipsychotics are routinely prescribed to people diagnosed with schizophrenia or psychosis on a long-term basis. Considerable literature explores service users' opinions and experiences of antipsychotics, but studies investigating family members' views are lacking. AIMS To explore family members' perspectives on antipsychotics, particularly their views on long-term use, reduction and discontinuation of antipsychotics. METHODS Semi-structured interviews were conducted with 11 family members of people experiencing psychosis. Participants were recruited through community support groups and mental health teams. Interviews were analysed thematically. RESULTS The majority of family members valued antipsychotic medication primarily in supporting what they saw as a fragile stability in the person they cared for. Their views of medication were ambivalent, combining concerns about adverse effects with a belief in the importance of medication due to fears of relapse. They described a need for constant vigilance in relation to medication to ensure it was taken consistently, and often found changes, particularly reduction in medication difficult to contemplate. CONCLUSIONS Findings highlight that family members' attitudes to medication sometimes conflict with those of the people they care for, impacting on their health and the caring relationship. Family members may need more support and could be usefully involved in medication decision-making.
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Affiliation(s)
- Amy Lewins
- Population Policy and Practice, UCL Great Ormond Street Institute of Child Health Population Policy and Practice, London, United Kingdom of Great Britain and Northern Ireland
| | - Nicola Morant
- Division of Psychiatry, University College London, London, United Kingdom of Great Britain and Northern Ireland
| | - Johura Akther-Robertson
- Division of Psychiatry, University College London, London, United Kingdom of Great Britain and Northern Ireland
- NELFT Research & Development Department, North East London NHS Foundation Trust Maggie Lilley Suite, Goodmayes Hospital, London, United Kingdom of Great Britain and Northern Ireland
| | - Nadia E Crellin
- Division of Psychiatry, University College London, London, United Kingdom of Great Britain and Northern Ireland
| | - Jacki L Stansfeld
- Division of Psychiatry, University College London, London, United Kingdom of Great Britain and Northern Ireland
- NELFT Research & Development Department, North East London NHS Foundation Trust Maggie Lilley Suite, Goodmayes Hospital, London, United Kingdom of Great Britain and Northern Ireland
| | - Ruth Smith
- Independent consultant, Brighton, United Kingdom of Great Britain and Northern Ireland
| | - Joanna Moncrieff
- Division of Psychiatry, University College London, London, United Kingdom of Great Britain and Northern Ireland
- Havering Community Recovery Team, Harold Wood, United Kingdom of Great Britain and Northern Ireland
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11
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Crellin NE, Priebe S, Morant N, Lewis G, Freemantle N, Johnson S, Horne R, Pinfold V, Kent L, Smith R, Darton K, Cooper RE, Long M, Thompson J, Gruenwald L, Freudenthal R, Stansfeld JL, Moncrieff J. An analysis of views about supported reduction or discontinuation of antipsychotic treatment among people with schizophrenia and other psychotic disorders. BMC Psychiatry 2022; 22:185. [PMID: 35291964 PMCID: PMC8925064 DOI: 10.1186/s12888-022-03822-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Accepted: 02/22/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Antipsychotic medication can reduce psychotic symptoms and risk of relapse in people with schizophrenia and related disorders, but it is not always effective and adverse effects can be significant. We know little of patients' views about continuing or discontinuing antipsychotic treatment. AIMS To explore the views of people with schizophrenia and other psychotic disorders about continuing their antipsychotic medication or attempting to reduce or discontinue this medication with clinical support. METHODS We collected quantitative and qualitative data by conducting semi-structured interviews in London, UK. Factors predicting a desire to discontinue medication were explored. Content analysis of qualitative data was undertaken. RESULTS We interviewed 269 participants. 33% (95% CI, 27 to 39%) were content with taking long-term antipsychotic medication. Others reported they took it reluctantly (19%), accepted it on a temporary basis (24%) or actively disliked it (18%). 31% (95% CI, 25 to 37%) said they would like to try to stop medication with professional support, and 45% (95% CI, 39 to 51%) wanted the opportunity to reduce medication. People who wanted to discontinue had more negative attitudes towards the medication but were otherwise similar to other participants. Wanting to stop or reduce medication was motivated mainly by adverse effects and health concerns. Professional support was identified as potentially helpful to achieve reduction. CONCLUSIONS This large study reveals that patients are commonly unhappy about the idea of taking antipsychotics on a continuing or life-long basis. Professional support for people who want to try to reduce or stop medication is valued.
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Affiliation(s)
- Nadia E. Crellin
- grid.439781.00000 0000 8541 7374Research & Development Department, Goodmayes Hospital, North East London NHS Foundation Trust, Essex, IG3 8XJ UK ,grid.83440.3b0000000121901201Division of Psychiatry, University College London, London, W1T 7NF UK
| | - Stefan Priebe
- grid.4868.20000 0001 2171 1133Unit for Social and Community Psychiatry, Queen Mary University of London, London, E1 4NS UK
| | - Nicola Morant
- grid.83440.3b0000000121901201Division of Psychiatry, University College London, London, W1T 7NF UK
| | - Glyn Lewis
- grid.83440.3b0000000121901201Division of Psychiatry, University College London, London, W1T 7NF UK
| | - Nick Freemantle
- grid.83440.3b0000000121901201Institute of Clinical Trials and Methodology, University College London, London, WC1V 6LJ UK
| | - Sonia Johnson
- grid.83440.3b0000000121901201Division of Psychiatry, University College London, London, W1T 7NF UK
| | - Rob Horne
- grid.83440.3b0000000121901201School of Pharmacy, University College London, London, WC1N 1AX UK
| | | | - Lyn Kent
- Independent consultant, London, UK
| | | | | | - Ruth E. Cooper
- grid.4868.20000 0001 2171 1133Unit for Social and Community Psychiatry, Queen Mary University of London, London, E1 4NS UK ,grid.36316.310000 0001 0806 5472University of Greenwich, Faculty of Education, Health and Human Sciences, London, SE10 9LS UK ,grid.450709.f0000 0004 0426 7183East London NHS Foundation Trust, Newham Centre for Mental Health, London, E13 8SP UK
| | - Maria Long
- grid.439781.00000 0000 8541 7374Research & Development Department, Goodmayes Hospital, North East London NHS Foundation Trust, Essex, IG3 8XJ UK ,grid.83440.3b0000000121901201Division of Psychiatry, University College London, London, W1T 7NF UK
| | - Jemima Thompson
- grid.83440.3b0000000121901201Faculty of Medical Sciences, University College London, London, UK
| | - Lisa Gruenwald
- grid.439781.00000 0000 8541 7374Research & Development Department, Goodmayes Hospital, North East London NHS Foundation Trust, Essex, IG3 8XJ UK ,grid.83440.3b0000000121901201Division of Psychiatry, University College London, London, W1T 7NF UK
| | - Robert Freudenthal
- grid.451052.70000 0004 0581 2008Barnet Enfield Haringey Mental Health NHS Trust, London, UK
| | - Jacki L. Stansfeld
- grid.439781.00000 0000 8541 7374Research & Development Department, Goodmayes Hospital, North East London NHS Foundation Trust, Essex, IG3 8XJ UK ,grid.83440.3b0000000121901201Division of Psychiatry, University College London, London, W1T 7NF UK
| | - Joanna Moncrieff
- grid.439781.00000 0000 8541 7374Research & Development Department, Goodmayes Hospital, North East London NHS Foundation Trust, Essex, IG3 8XJ UK ,grid.83440.3b0000000121901201Division of Psychiatry, University College London, London, W1T 7NF UK
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12
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Kamitsis I, Harms L, Bendall S. The subjective effect of antipsychotic medication on trauma-related thoughts, emotions, and physical symptoms: A qualitative study with people who have experienced childhood trauma and psychosis. Psychol Psychother 2022; 95:256-276. [PMID: 34617384 DOI: 10.1111/papt.12367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 09/06/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Among people with psychosis, those with a history of childhood trauma are likely to experience trauma-related symptoms, such as trauma memory intrusions. Irrespective of whether these individuals continue to remember and re-experience trauma, their treatment very often includes alleviating psychotic symptoms through the use of antipsychotic medication. Antipsychotics, while primarily used to treat psychotic symptoms, can influence non-psychotic symptoms and alter how people think and feel. We thus aimed to explore how people with childhood trauma and psychosis experience the effects that antipsychotics have on their (1) thoughts, images, and memories, (2) emotions, and (3) physical responses, related to their childhood trauma. DESIGN A qualitative phenomenological research design using semi-structured interviews was implemented. METHODS Data were analysed using interpretative phenomenological analysis. RESULTS Nineteen participants were interviewed. Two super-ordinate themes were conceptualized. Many participants spoke about the impact of antipsychotics on trauma-related experiences (Theme 1). Some indicated that antipsychotics alleviated the intensity and frequency of trauma-related thoughts, emotions, and physical symptoms. A few others reported that their trauma-related flashbacks, thoughts, and physical symptoms intensified while taking antipsychotics. Participants spoke about the role of antipsychotics in confronting and processing trauma (Theme 2). A few participants reported that by suppressing trauma-related thoughts and emotions antipsychotics prevented them from confronting their trauma. CONCLUSIONS The effects of antipsychotics can be subjectively experienced as beneficial or detrimental depending on how they influence trauma-related thoughts, emotions, and physical responses. Intervention studies are needed to determine how people with childhood trauma and psychosis respond to antipsychotic drugs. PRACTITIONER POINTS Antipsychotics may alter the way in which people with childhood trauma and psychosis remember and re-experience trauma. These alterations can be beneficial or detrimental, and thus play a role in whether people consider their medication helpful. By suppressing trauma-related thoughts and emotions, antipsychotics can prevent people from confronting their trauma. This may be considered beneficial to some, but other people may need or want to confront their trauma to heal. The effectiveness of trauma-focused psychological therapies may be influenced by the emotional, cognitive, and physiological effects of antipsychotic medications. The ability of antipsychotics to suppress people's trauma memories may contribute to post-traumatic avoidance. People with post-traumatic stress symptoms and psychosis should be provided with psycho-education about post-traumatic avoidance and its role in the maintenance of post-traumatic stress disorder.
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Affiliation(s)
- Ilias Kamitsis
- Orygen, Parkville, Victoria, Australia.,The Centre for Youth Mental Health, The University of Melbourne, Victoria, Australia
| | - Louise Harms
- Department of Social Work, The University of Melbourne, Victoria, Australia
| | - Sarah Bendall
- Orygen, Parkville, Victoria, Australia.,The Centre for Youth Mental Health, The University of Melbourne, Victoria, Australia
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13
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Wand T, Glover S, Paul D. What should be the future focus of mental health nursing? Exploring the perspectives of mental health nurses, consumers, and allied health staff. Int J Ment Health Nurs 2022; 31:179-188. [PMID: 34679235 DOI: 10.1111/inm.12947] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 09/26/2021] [Accepted: 10/08/2021] [Indexed: 12/11/2022]
Abstract
The landscape of mental health care and service delivery is changing, as is our understanding of the underlying causes for mental distress. It is now apparent that biogenic explanations have been overstated and instead experiences of trauma and adversity constitute the main contributor to people's experiences of mental health challenges. The shortcomings of treatments traditionally used in mental health care are also evident, and with a contemporary focus on person-centred care, the utility of diagnostic labels has been called into question. Taking all this into consideration, this study sought to explore, what should be the future focus of mental health nursing? Three separate focus groups were conducted. One with a sample of senior clinical mental health nurses, one with a sample of consumer representatives and another with allied health professionals. The common theme across all three focus groups was the centrality of the therapeutic role of mental health nurses (MHNs). Consumers and allied health participants, in particular, advocated for a de-emphasis on medications, psychiatric diagnoses, and custodial practices. The MHNs role in health promotion, working collaboratively with consumers, being hopeful, understanding the individual perspective, and appreciating the social determinants of mental health were all highlighted in framing the future focus of MHN practice.
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Affiliation(s)
- Timothy Wand
- Emergency Department, Royal Prince Alfred Hospital, University of Sydney and Sydney Local Health District, Sydney, New South Wales, Australia
| | - Suzanne Glover
- Northern Sydney Local Health District, Sydney, New South Wales, Australia
| | - Diane Paul
- Northern Sydney Local Health District, Sydney, New South Wales, Australia
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14
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Going the extra mile? The influence of Amisulpride on effort-based decisions. Schizophr Res 2022; 240:113-115. [PMID: 34991041 DOI: 10.1016/j.schres.2021.12.036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Revised: 12/17/2021] [Accepted: 12/24/2021] [Indexed: 11/22/2022]
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15
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Horowitz MA, Moncrieff J, de Haan L, Bogers JPAM, Gangadin SS, Kikkert M, Veling W, Sommer IEC. Tapering antipsychotic medication: practical considerations. Psychol Med 2022; 52:32-35. [PMID: 34542027 DOI: 10.1017/s0033291721003299] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Mark A Horowitz
- Department of Psychiatry, University College London, London, UK
- Goodmayes Hospital, North East London NHS Foundation Trust, London, UK
| | - Joanna Moncrieff
- Department of Psychiatry, University College London, London, UK
- Goodmayes Hospital, North East London NHS Foundation Trust, London, UK
| | - Lieuwe de Haan
- Amsterdam UMC, location AMC/Arkin, Amsterdam, Netherlands
| | - Jan P A M Bogers
- Mental Health Organisation Rivierduinen, High Care Clinics, Leiden, The Netherlands
| | - Shiral S Gangadin
- Department of Biomedical Sciences of Cells and Systems, Rijksuniversiteit Groningen, University Medical Center Groningen, Groningen, Netherlands
| | | | - Wim Veling
- Department of Psychiatry, Rijksuniversiteit Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Iris E C Sommer
- Department of Biomedical Sciences of Cells and Systems, Rijksuniversiteit Groningen, University Medical Center Groningen, Groningen, Netherlands
- Department of Psychiatry, Rijksuniversiteit Groningen, University Medical Center Groningen, Groningen, Netherlands
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16
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Watts M, Murphy E, Keogh B, Downes C, Doyle L, Higgins A. Deciding to discontinue prescribed psychotropic medication: A qualitative study of service users' experiences. Int J Ment Health Nurs 2021; 30 Suppl 1:1395-1406. [PMID: 34101332 DOI: 10.1111/inm.12894] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 04/29/2021] [Accepted: 05/13/2021] [Indexed: 11/29/2022]
Abstract
Many mental health service users decide to discontinue their psychotropic medication at some stage in the treatment process; however, few studies have captured these experiences. This study aimed to explore people's experiences of coming off medication. A qualitative descriptive design and individual interviews with 23 people who experienced coming off medication were employed. COREQ checklist was used. Data were analysed using inductive and deductive approaches and six major themes were developed. Findings suggest that while medication was useful for many in the short-term, the adverse effects had significant impact and contributed to the decision to come off medication. Participants also reported being driven by a questioning of the biomedical model of treatment and the belief that there were other strategies to manage their distress. Mixed experiences of support from healthcare professionals for the medication cessation process were reported. The discontinuation process was often difficult resulting in changes in mood and behaviour which for many culminated in relapse of distress, rehospitalization and return to medication. To support the process of coming off and staying off medication, participants identified a range of useful strategies but particularly highlighted the importance of peer support. Findings from this study demonstrate the importance of mental health nurses having a collaborative discussion with service users which may support safer decision-making and lessen the risk of people discontinuing medication abruptly. Finding also indicates a need for robust studies that develop and test interventions to support people who wish to discontinue psychotropic medications.
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Affiliation(s)
- Mike Watts
- School of Nursing and Midwifery, Trinity College Dublin, Ireland
| | - Esther Murphy
- School of Nursing and Midwifery, Trinity College Dublin, Ireland
| | - Brian Keogh
- School of Nursing and Midwifery, Trinity College Dublin, Ireland
| | - Carmel Downes
- School of Nursing and Midwifery, Trinity College Dublin, Ireland
| | - Louise Doyle
- School of Nursing and Midwifery, Trinity College Dublin, Ireland
| | - Agnes Higgins
- School of Nursing and Midwifery, Trinity College Dublin, Ireland
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17
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Keogh B, Murphy E, Doyle L, Sheaf G, Watts M, Higgins A. Mental health service users experiences of medication discontinuation: a systematic review of qualitative studies. J Ment Health 2021; 31:227-238. [PMID: 34126035 DOI: 10.1080/09638237.2021.1922644] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND The use of psychotropic medication is often the first line of treatment for people with mental distress. However, many service users discontinue their prescribed medication, and little is known about their experiences or the reasons why they choose to stop taking medication. AIM The aim of this review is to synthesize research literature focused on the experiences of people who decided to discontinue taking medication for their mental health problem. METHODS A systematic review of qualitative studies was conducted. Data bases were searched for qualitative research which explored participants' motivations for discontinuing medication and their experiences of the process. RESULTS Six themes were identified: (1) Taking medications: a loss of autonomy, (2) Discontinuing medication: a thought-out process, (3) Factors influencing the decision to discontinue medication, (4) Discontinuing medication: experiences of the process, (5) Outcomes of discontinuing medication, (6) Managing mental distress in the absence of medication. CONCLUSION Service providers need to be aware that for some service user's psychotropic medication is not deemed a suitable treatment approach. Those who wish to discontinue medication need to be supported in the context of positive, therapeutic risk where their mental and physical health can be monitored and the likelihood of success increased.
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Affiliation(s)
- Brian Keogh
- Trinity College Dublin, the University of Dublin, School of Nursing and Midwifery, Dublin, Ireland
| | - Esther Murphy
- Trinity College Dublin, the University of Dublin, School of Nursing and Midwifery, Dublin, Ireland
| | - Louise Doyle
- Trinity College Dublin, the University of Dublin, School of Nursing and Midwifery, Dublin, Ireland
| | - Greg Sheaf
- The Library of Trinity College, Trinity College Dublin, The University of Dublin, Dublin, Ireland
| | - Mike Watts
- Grow, Mental Health Organisation, Dublin, Ireland
| | - Agnes Higgins
- Trinity College Dublin, the University of Dublin, School of Nursing and Midwifery, Dublin, Ireland
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18
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Grünwald LM, Thompson J. Re-starting the conversation: improving shared decision making in antipsychotic prescribing. PSYCHOSIS 2021. [DOI: 10.1080/17522439.2021.1903979] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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19
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Fiore G, Bertani DE, Marchi M, Cardoso G, Galeazzi GM. Patient subjective experience of treatment with long-acting injectable antipsychotics: a systematic review of qualitative studies. JORNAL BRASILEIRO DE PSIQUIATRIA 2021. [DOI: 10.1590/0047-2085000000311] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
ABSTRACT Objective: To gain a better understanding of how long-acting injectable antipsychotic (LAI) therapy is perceived by patients. Methods: A search for qualitative studies has been carried out on PubMed, Google Scholar, PsycINFO and PsycArticles, yielding 11 studies suitable for a review of qualitative studies. The reporting approach chosen was meta-ethnography, following the ENTREQ statement recommendations. Key concepts common to the different studies were extrapolated and then analysed in a systematic and comparative way. Results: Some recurrent issues were associated with LAIs, such as fear of coercion, fear of needles and lack of knowledge about depot therapy. These topics are linked to each other and the patients most concerned about the disadvantages of LAIs are those who are less informed about them, or who have experienced coercion and trauma during hospitalisation. On the other hand, patients who had already received LAIs, and those who had a good therapeutic relationship with their healthcare providers expressed satisfaction with this form of treatment and its continuation. Conclusion: Long-acting injectable antipsychotics are a tool in the management of mental disorders, and a viable alternative to oral medication. Patients show curiosity towards this method of administration, but lack of knowledge is a common finding. Shared decision making about the use of LAIs antipsychotics requires that patients receive accurate information and support for their decision regarding medication.
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20
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Caballero R, Valiente C, Espinosa R. The perception of well-being: Do people with severe psychiatric conditions and their therapists put themselves in each other’s shoes? JOURNAL OF POSITIVE PSYCHOLOGY 2021. [DOI: 10.1080/17439760.2021.1871943] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Affiliation(s)
- Rocío Caballero
- Department of Psychology, Complutense University of Madrid, Madrid, Spain
| | - Carmen Valiente
- Department of Psychology, Complutense University of Madrid, Madrid, Spain
| | - Regina Espinosa
- Department of Psychology, Camilo José Cela University of Madrid, Madrid, Spain
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21
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Moncrieff J. Misleading information about antipsychotics. Psychol Med 2020; 50:2810-2811. [PMID: 33267927 DOI: 10.1017/s0033291720004523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Joanna Moncrieff
- Division of Psychiatry, University College London, Gower Street, London, WC1E 6BT, UK
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22
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Smilan LE. The Revised Common Rule and Mental Illness: Enduring Gaps in Protections. AMERICAN JOURNAL OF LAW & MEDICINE 2020; 46:413-444. [PMID: 33413011 DOI: 10.1177/0098858820975532] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Affiliation(s)
- Lisa E Smilan
- Lisa E. Smilan, Visiting Scholar, Institute of Law, Psychiatry, and Public Policy, University of Virginia, Charlottesville, VA; J.D., George Washington University Law School, Washington, D.C.; LL.M., specialization in health law, University of Maryland Francis King Carey School of Law, Baltimore, MD; Member, National Institutes of Health Intramural Institutional Review Board, Bethesda, MD. The opinions here expressed are those of the Author and completely independent of the National Institutes of Health. The Author thanks Ellen Wright Clayton for supporting this scholarship and for comments on earlier drafts. Thanks, also, to Leslie Meltzer Henry for her guidance and encouragement, and both Richard Bonnie and Xuemei Ding for their hospitality at the University of Virginia and for facilitating access to university libraries. Finally, thanks to the anonymous peer reviewers for their observations, probing questions, and helpful suggestions, and AJLM editors Jessa Boubker and Sharon Jaquez for their dedication and meticulous care in preparing this Article for publication
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23
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Abstract
Studies of antipsychotic medication, which are increasingly prescribed for a broad range of problems and circumstances, rarely ask the people who take them to describe their experiences with the drugs. In this study, 650 people, from 29 countries, responded, in an online survey, to "Overall in my life antipsychotic medications have been _____?" and "Is there anything else you would like to say, or emphasise, about your experiences with antipsychotic drugs?" Of the total participants, 14.3% were categorized as reporting purely positive experiences, 27.9% had mixed experiences, and 57.7% reported only negative ones. Negative experiences were positively correlated with age. Thematic analysis identified 749 negative, 180 positive, and 53 mixed statements. The 2 positive themes were "symptom reduction" (14) and "sleep" (14), with the majority (153) unspecified. The 4 negative themes (besides "unspecified"-191) were: "adverse effects" (316), "interactions with prescriber" (169), "withdrawal/difficult to get off them" (62), and "ineffective" (11). The adverse effects included: weight gain, emotional numbing, cognitive dysfunction, sedation, akathisia, effects on relationships, and suicidality. "Interactions with prescriber" included lack of information about withdrawal effects, support, or discussion of alternatives. The only mixed theme was "short-term good, long-term bad" (28). Open questions can add to findings from methodologies focused on symptom reduction. Clinicians should pay more attention to the need for respectful and collaborative patient-prescriber relationships. At the point of prescription, this must include providing the full range of information about antipsychotics, including potential benefits and harms, difficulties withdrawing, and information on alternatives treatments such as psychological therapies.
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Affiliation(s)
- John Read
- Department of Psychology, University of East London – Stratford Campus, London, UK,To whom correspondence should be addressed; University of East London – Stratford Campus, Water Lane, London E15 4LZ; tel: +44 (0)208 223 4943, e-mail:
| | - Ann Sacia
- Department of Psychology, University of East London – Stratford Campus, London, UK
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24
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Moncrieff J, Gupta S, Horowitz MA. Barriers to stopping neuroleptic (antipsychotic) treatment in people with schizophrenia, psychosis or bipolar disorder. Ther Adv Psychopharmacol 2020; 10:2045125320937910. [PMID: 32670542 PMCID: PMC7338640 DOI: 10.1177/2045125320937910] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Accepted: 06/03/2020] [Indexed: 12/19/2022] Open
Abstract
Most guidelines recommend long-term, indefinite neuroleptic (or antipsychotic) treatment for people with schizophrenia, recurrent psychosis or bipolar disorder, on the basis that these medications reduce the chance of relapse. However, neuroleptics have significant adverse effects, including sexual dysfunction, emotional blunting, metabolic disturbance and brain shrinkage, and patients often request to stop them. Evidence for the benefits of long-term treatment is also not as robust as generally thought. Short-term randomised trials show higher rates of relapse among those whose neuroleptic treatment is discontinued compared with those on maintenance treatment, but they are confounded by adverse effects associated with the withdrawal of established medication. Some longer-term studies show possible advantages of medication reduction and discontinuation in terms of improved social functioning and recovery. Therefore, there is a good rationale for supporting patients who wish to stop their medication, especially given the patient choice agenda favoured by The National Institute for Clinical Excellence (NICE). The major barrier to stopping antipsychotics is an understandable fear of relapse among patients, their families and clinicians. Institutional structures also prioritise short-term stability over possible long-term improvements. The risk of relapse may be mitigated by more gradual reduction of medication, but further research is needed on this. Psychosocial support for patients during the process of reducing medication may also be useful, particularly to enhance coping skills. Guidelines to summarise evidence on ways to reduce medication would be useful. Many patients want to try and stop neuroleptic medication for good reasons, and psychiatrists can help to make this a realistic option by supporting people to do it as safely as possible, with the best chance of a positive outcome.
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Affiliation(s)
- Joanna Moncrieff
- Division of Psychiatry, University College London, Maple House, 149 Tottenham Court Road, Fitzrovia, London W1T 7BN, UK
| | - Swapnil Gupta
- Psychiatry, Yale School of Medicine, New Haven, CT, USA
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25
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Cohen D, Recalt A. Withdrawal effects confounding in clinical trials: another sign of a needed paradigm shift in psychopharmacology research. Ther Adv Psychopharmacol 2020; 10:2045125320964097. [PMID: 33224467 PMCID: PMC7656873 DOI: 10.1177/2045125320964097] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Accepted: 09/09/2020] [Indexed: 11/24/2022] Open
Abstract
Randomized controlled trials' ability to produce evidence useful for people to decide whether to take, continue taking, or stop taking psychotropic drugs has been intensely critiqued, along with the trials' commercial, ideological, and regulatory contexts. This article applies the critique to the topic of withdrawal effects confounding the outcomes of relapse-prevention trials where prescribed psychotropic drugs are discontinued. Until recently, the complexity and reach of withdrawal and post-withdrawal effects were neglected by mainstream psychiatry, but not by lay users of prescribed psychotropics. This article discusses withdrawal effects as part of the pharmacology of psychotropic drugs but shaped by psychosocial factors, and possibly shaping the presentation of psychological distress generally. It outlines biases and misconceptions in assumptions, design, and reporting of general efficacy trials and findings from a recent review of 80 discontinuation trials. In theory, relapse-prevention trials are tautological and exaggerate efficacy. In publications, they pay little attention to the central feature of their design, favor abrupt or rapid discontinuations, do not attend to environmental factors, and provide insufficient data to allow re-analyses. Thus, relapse-prevention RCTs likely confound the detection of their main outcome of interest: "relapse." Using slower tapers, active placebo controls, and specific covariates in analyses would reduce the risk of withdrawal confounding, and better reporting would reduce the opaqueness of trials. The crisis in psychopharmacology is fueled partly by the disconnect between claims of therapeutic efficacy from so-called best-evidence methods despite unchanging population-level indicators of psychiatric sickness. Only by "stacking the deck" against trial sponsors' hoped-for outcomes can psychopharmacology trials regain scientific credibility.
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Affiliation(s)
- David Cohen
- UCLA Luskin School of Public Affairs, 3250 Public Affairs Building, Los Angeles, CA 90095-1656, USA
| | - Alexander Recalt
- Department of Social Welfare, Luskin School of Public Affairs, and Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, CA, USA
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