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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 2024; 33:333-340. [PMID: 35521675 DOI: 10.1080/09638237.2022.2069710] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [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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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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Asher M, Roe D, Hasson-Ohayon I. Attitudes toward and patterns of medication use among people with serious mental illness: There's more than meets the eye. Front Psychiatry 2023; 14:1133140. [PMID: 36873214 PMCID: PMC9983815 DOI: 10.3389/fpsyt.2023.1133140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Accepted: 01/25/2023] [Indexed: 02/19/2023] Open
Abstract
BACKGROUND AND AIM There are growing concerns about the long-term effects of psychiatric medication after a major psychiatric crisis. Recent evidence shows a diverse impact of long-term use on various outcome domains, which may help explain why non-adherence is so common. In the current study we explored the subjective perceptions of factors that impact both attitudes toward and patterns of use of medication among individuals with serious mental illness (SMI). METHOD Sixteen individuals with an SMI and a recognized psychiatric disability who had used psychiatric medication for at least 1 year were recruited for the study via mental health clinics and social media. Participants were interviewed using a semi-structured interview based on the narrative approach, focusing on attitudes toward and patterns of use of psychiatric medication. All interviews were transcribed and analyzed using thematic analysis. RESULTS Three discrete sequential phases emerged, each characterized by different themes referring to attitudes toward medication and patterns of use: (1) "loss of self" and a high level of medication use; (2) accumulating experiences of using/reducing/stopping medication; and (3) forming more stable attitudes toward medication and developing one's own pattern of use. The transition between phases was dynamic in nature and represents a non-linear process. Complex interactions were generated at different phases between the related themes, which shaped attitudes toward medication and patterns of use. CONCLUSIONS AND IMPLICATIONS The current study reveals the complex ongoing process of forming attitudes toward medication and patterns of use. Recognizing and identifying them via a joint reflective dialog with mental health professionals can enhance alliance, shared decision-making, and person-centered recovery-oriented care.
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Affiliation(s)
- Maia Asher
- Department of Psychology, Bar-Ilan University, Ramat Gan, Israel
| | - David Roe
- Department of Community Mental Health, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
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User Perspectives on Professional Support and Service Use During Psychiatric Medication Discontinuation. Community Ment Health J 2022; 58:1416-1424. [PMID: 35020115 DOI: 10.1007/s10597-021-00933-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 12/11/2021] [Indexed: 11/03/2022]
Abstract
Psychiatric medication discontinuation is common and can have negative impacts. Until recently, most research on discontinuation happened in an adherence/compliance framework. There is now recognition that discontinuation may be a desired goal for many individuals. The purpose of the present paper is to describe the results of a pioneering survey to explore professional support to service users during medication discontinuation to inform clinical practice and guide future research. Survey responses from 250 service users were summarized with regard to their use of prescriber and psychotherapy services during the process of discontinuing psychiatric medication. Only 65% of respondents reported seeing a prescriber and less than 50% reported seeing a psychotherapist while attempting to discontinue psychiatric medication. Combined with respondents' answers describing the decision-making process and support received from these services, this paper identifies gaps in service and the need to improve providers' ability to support individuals while they discontinue psychiatric medication.
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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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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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Larsen-Barr M, Seymour F. Service-user efforts to maintain their wellbeing during and after successful withdrawal from antipsychotic medication. Ther Adv Psychopharmacol 2021; 11:2045125321989133. [PMID: 33796264 PMCID: PMC7970681 DOI: 10.1177/2045125321989133] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Accepted: 12/28/2020] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND It is well-known that attempting antipsychotic withdrawal can be a fraught process, with a high risk of relapse that often leads people to resume the medication. Nonetheless, there is a group of people who appear to be able to discontinue successfully. Relatively little is known about how people do this. METHODS A convenience sample of adults who had stopped taking antipsychotic medication for more than a year were recruited to participate in semi-structured interviews through an anonymous online survey that investigated antipsychotic medication experiences in New Zealand. Thematic analysis explored participant descriptions of their efforts to maintain their wellbeing during and after the withdrawal process. RESULTS Of the seven women who volunteered to participate, six reported bipolar disorder diagnoses and one reported diagnoses of obsessive compulsive disorder and depression. The women reported successfully discontinuing antipsychotics for 1.25-25 years; six followed a gradual withdrawal method and had support to prepare for and manage this. Participants defined wellbeing in terms of their ability to manage the impact of any difficulties faced rather than their ability to prevent them entirely, and saw this as something that evolved over time. They described managing the process and maintaining their wellbeing afterwards by 'understanding myself and my needs', 'finding what works for me' and 'connecting with support'. Sub-themes expand on the way in which they did this. For example, 'finding what works for me' included using a tool-box of strategies to flexibly meet their needs, practicing acceptance, drawing on persistence and curiosity and creating positive life experiences. CONCLUSION This is a small, qualitative study and results should be interpreted with caution. This sample shows it is possible for people who experience mania and psychosis to successfully discontinue antipsychotics and safely manage the impact of any symptoms that emerge as a result of the withdrawal process or other life stressors that arise afterwards. Findings suggest internal resources and systemic factors play a role in the outcomes observed among people who attempt to stop taking antipsychotics and a preoccupation with avoiding relapse may be counterproductive to these efforts. Professionals can play a valuable role in facilitating change.
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Affiliation(s)
| | - Fred Seymour
- School of Psychology, The University of Auckland, Auckland, New Zealand
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10
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Hack SM, Muralidharan A, Brown CH, Drapalski AL, Lucksted AA. Stigma and discrimination as correlates of mental health treatment engagement among adults with serious mental illness. Psychiatr Rehabil J 2020; 43:106-110. [PMID: 31380672 PMCID: PMC7000289 DOI: 10.1037/prj0000385] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
OBJECTIVE The negative impacts of stigma on mental health treatment initiation are well established, but the relationship of stigma to proactive engagement in mental health treatment (e.g., actively working toward therapy goals) is largely unexamined. This study examined the relationship between mental health treatment engagement and stigma experiences, discrimination experiences, and internalized stigma among adults with serious mental illness. Age, race, gender, and education were tested as moderators of the relationships between stigma-related variables and treatment engagement. METHOD Data were collected from 167 adults with serious mental illnesses who were receiving services at 5 psychosocial rehabilitation programs. Treatment engagement was assessed by participants' primary mental health care providers, using the Service Engagement Scale. The relationship between treatment engagement, stigma, and discrimination as well as potential demographic moderators were tested with Pearson's correlations and multiple linear regressions. RESULTS Treatment engagement was not correlated with experiences of stigma, experiences of discrimination, or application of stigmatizing beliefs to self. Gender, race, and age were not significant moderators but education was. Experiences of stigma were associated with greater treatment engagement in those with a higher level of education (p = .007), whereas application of stigma to one's self was associated with poorer treatment engagement in those with a higher level of education (p = .005). CONCLUSIONS AND IMPLICATIONS FOR PRACTICE Among individuals with higher levels of education, efforts to prevent internalization of public stigma may be crucial to promote proactive mental health treatment. Replication studies are needed to confirm these findings. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
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Larsen-Barr M, Seymour F, Read J, Gibson K. Attempting to discontinue antipsychotic medication: Withdrawal methods, relapse and success. Psychiatry Res 2018; 270:365-374. [PMID: 30300866 DOI: 10.1016/j.psychres.2018.10.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Revised: 09/30/2018] [Accepted: 10/01/2018] [Indexed: 01/07/2023]
Abstract
Few studies explore subjective experiences of attempting to discontinue antipsychotic medication, the withdrawal methods people use, or how their efforts affect their outcomes. People who take antipsychotics for off-label purposes are poorly represented in the literature. This study investigates experiences of attempting to discontinue antipsychotics in a cross-sectional sample and explores potential associations between withdrawal methods, relapse, and success. An anonymous online survey was completed by 105 adults who had taken antipsychotics for any reason and had attempted discontinuation at least once. A mixed methods approach was used to interpret the responses. Just over half (55.2%) described successfully stopping for varying lengths of time. Half (50.5%) reported no current use. People across diagnostic groups reported unwanted withdrawal effects, but these were not universal. Withdrawing gradually across more than one month was positively associated, and relapse was negatively associated with both self-defined successful discontinuation and no current use. Gradual withdrawal was negatively associated with relapse during withdrawal. We conclude it is possible to successfully discontinue antipsychotic medication, relapse during withdrawal presents a major obstacle to successfully stopping AMs, and people who withdraw gradually across more than one month may be more likely to stop and to avoid relapse during withdrawal.
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Affiliation(s)
- Miriam Larsen-Barr
- The University of Auckland, School of Psychology, Auckland, New Zealand.
| | - Fred Seymour
- The University of Auckland, School of Psychology, Auckland, New Zealand
| | - John Read
- University of East London, School of Psychology, London, England
| | - Kerry Gibson
- The University of Auckland, School of Psychology, Auckland, New Zealand
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