Bad things happen and can drive you crazy: The causal beliefs of 701 people taking antipsychotics

How important are informed consent, informed choice, and patient-doctor relationships, when prescribing antipsychotic medication?

BACKGROUND

Antipsychotic medications (APs) are used for people with psychosis diagnoses and, increasingly for other problems and groups.

AIMS

This study examines how APs are prescribed, from the perspective of recipients.

METHODS

757 people, from 30 countries, responded to questions about their experiences with APs, in an online survey.

RESULTS

Most (70%) were told nothing about adverse effects. Fewer than 2% recalled being told about the risks of diabetes, suicidality, sexual dysfunction, or reduced life span. None recalled being told about reduced brain volume or withdrawal effects. Only 28% recalled being offered other treatments; with only 14% offered talking therapies. 46% were not told how long to take the APs; and, of those who were told something, 48% were told to take them forever. Most respondents (76%) were not told how APs work. Only 19% were satisfied with the prescribing process, and only 25% reported a good, or very good, relationship with the prescriber. Information, satisfaction with the process, and the prescriber relationship were all positively related to three self-reported outcomes: reduction of problems the drugs were prescribed for, general helpfulness, and quality of life.

CONCLUSIONS

Steps need to be taken to ensure people prescribed antipsychotics are fully informed, especially about adverse effects and alternatives.

Risk versus recovery: Care planning with individuals on community treatment orders

Community treatment orders (CTOs) require individuals with a mental illness to accept treatment from mental health services. CTO legislation in South Australia states that treatment and care should be recovery-focused, although justification for use is predominantly risk-based, and care often coercive. Although CTOs are contested, individuals, families, and clinicians frequently engage in care planning within this context. This paper examines how the concepts of risk and risk management impact care planning from the perspectives of individuals on CTOs, their families, and clinicians. Ethnographic methods of observation and interview provided a detailed account of the perspectives of each group over an 18-month period from two community mental health teams in South Australia. Findings show that care planning occurred within a culture of practice dominated by risk. Risk, however, was understood differently by each participant group, with the dominant narrative informed by biogenetic understandings of mental illness. This dominance impacted on the positioning of participant groups in care planning, focus of care contacts, and care options available. To improve care experiences and outcomes for individuals on CTOs, narrow conceptualizations of risk and recovery need to broaden to include an understanding of personal and social adversities individuals face. A broader understanding should reposition participants in the care planning context and rebalance care discussions, from a focus on clinical recovery to recovering citizenship.

Voice-hearers' beliefs about the causes of their voices

Despite empirical evidence for multifactorial causes of voice-hearing, people's own beliefs about what caused their voices are understudied. People with distressing voices (n=125) completed measures of trauma, post-traumatic stress disorder (PTSD) symptoms, and beliefs about causality. Most participants reported trauma in the past (97%) and PTSD symptoms were prevalent. Traumatic experiences were the most commonly endorsed causal factor of voice-hearing (64%), followed by distress (62%). Beliefs about biological causes, including drug use (22%), were least endorsed. Those who experienced more traumatic events and more PTSD symptoms were more likely to endorse trauma as a causal factor of voice-hearing (R²=0.38).

An empirical examination of the biogenetic approach in schizophrenia stigma reduction through an attribution lens

BACKGROUND

The biogenetic approach in mental health stigmatization reduction has received increased attention. Taking the perspective of Weiner's attribution theory, the biogenetic explanations can be helpful in reducing the perceptions of controllability of mental illnesses (e.g., schizophrenia). However, recent studies reveal that biogenetic explanations may increase social stigma and discrimination against people with schizophrenia.

AIMS

The current research, using Weiner's attribution theory, empirically examined the effects of biogenetic beliefs on the desire for social distance via perceptions of controllability and stability of schizophrenia using a Chinese sample.

METHODS

A cross-sectional study (n = 156) and an experiment (n = 124) were carried out. Participants were recruited from an urban city in China. In the experiment, participants were randomly assigned to receive a biogenetic/control lecture and filled out a survey.

RESULTS

Biogenetic beliefs had indirect effects on the desire for social distance via decreased perceived controllability and increased perceived stability, which resulted in little to no change on the desire for social distance.

CONCLUSION

The biogenetic approach could decrease the perceptions of controllability of schizophrenia which may reduce the desire for social distance; however, it could also increase the perceptions of stability which may increase the desire for social distance, especially among close others. Cautions are warranted when using and disseminating the biogenetic causes of schizophrenia amongin the general public.