Experiences of taking neuroleptic medication and impacts on symptoms, sense of self and agency: a systematic review and thematic synthesis of qualitative data (original) (raw)
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Antipsychotic treatment – a systematic literature review and meta-analysis of qualitative studies
Journal of Mental Health
Background: The literature on antipsychotic medication in psychosis lack systematization of the empirical knowledge base on patients' subjective experiences of using antipsychotic drugs. Such investigations are pivotal to inform large-scale trials with clinically relevant hypotheses and to illuminate clinical implications for different subgroups of individuals. Aims: To re-analyze and summarize existing qualitative research literature on patient perspectives of using antipsychotic medication. Method: A systematic literature search was performed in September 2018 (Protocol registration no. CRD42017074394). Using an existing framework of meta-analyzing qualitative research, full text evaluation was conducted for 41 articles. Thirty-two articles were included for the final synthesis. Results: Four meta-themes were identified: (1) short-term benefits; (2) adverse effects and coping processes; (3) surrender and autonomy; (4) long-term compromise of functional recovery. Conclusions: While largely positive about acute and short-term use, patients are more skeptical about using antipsychotic drugs in the longer term. The latter specifically relates to processes of functional and social recovery. The clinical conversations about antipsychotic medication need to include evaluations of contexts of patient experience level, patient autonomy processes, patient values and risk preferences, and patient knowledge and knowledge needs in addition to assessing the severity of symptoms of psychosis.
• We do not know much about what it is like to take these drugs from the patient's point of view. What this paper adds to existing knowledge? • We talked to 20 young people with psychosis about their experiences of taking antipsychotic drugs. • Patients relationship with medication was complex, young people found medication often to be both good and bad at the same time. • We were interested in how seemingly trivial issues – colour, taste, size, name – could be very important to young people and could result in them stopping. What are the implications for practice? • We think our study highlights the complicated internal struggles that people with first episode psychosis have with medication. • Our study highlights how Nurses and Doctors need to try and better understand what it is like to take these drugs and work collaboratively with patients to support them to make informed choices about treatment. Abstract Background: Low-dose antipsychotic medication is an important part of treatment for people experiencing a first episode of psychosis. Little is known about this group of patients' experiences of taking medication. Method: A qualitative study of pur-posively sampled young people experiencing a first episode of psychosis was carried out. A mental health nurse working in the early psychosis team interviewed participants using a structured topic guide. Interviews were subjected to thematic analysis. Results: Interviews were completed with 20 young people. Thematic analysis generated six themes: (1) the drugs do work, (2) the drugs don't work (as well as I'd like), (3) side effects, (4) the indirect effects of medication, (5) rage against the machine and (6) the not trivial issues about medication. Conclusion: Our overarching meta-theme was that young people's experience of taking antipsychotics was complex; medication was often considered good and bad at the same time. Our observations underpin the importance of helping patients think through the use of antipsychotic medication in supporting their personal recovery. 108
Subjective experience and subjective response to neuroleptics in schizophrenia
Comprehensive Psychiatry, 2000
Although several studies have addressed the issue of the relationship between the subjective response to neuroleptics and drug compliance, very little attention has been given to the study of the subjective experience of psychosis and drug attitudes. The present study was therefore undertaken to examine the relationship between the subjective experience of psychosis as assessed by the Frankfurter Beschwerde-Fragebogen (FBF) and subjective response (SR) to neuroleptics as assessed by the Drug Attitude Inven-tory (DAI) in a group of schizophrenic patients. Significant correlations were found between the total scores on the FBF and DAI (r ؍ .46, P F .01). The DAI total score also correlated with all four factors (central cognitive disturbances, perception and motility, depressivity, and internal and external overstimulation) on the FBF. This finding suggests that the SR neuroleptics is partly explained by a ''positive'' subjective experience of psychosis.
Schizophrenia Bulletin, 2001
Converging evidence indicates that, in controlled drug trials, individuals receiving novel antipsychotlc medications have fewer adverse effects than those receiving conventional antlpsychotic medications. This in turn may lead to greater patient treatment satisfaction. This study examines patient satisfaction and burden of adverse effects in a county-wide epidemiologic study of first admission psychotic persons with psychosis who were receiving novel antipsychotic drugs (n = 42). Comparisons were made within this group, and between 25 of these persons and 25 others with the same diagnosis and sex, from the same epidemiologic study, who were receiving a comparable regimen of conventional antipsychotic drugs. Patients receiving novel antipsychotics were significantly more satisfied and were significantly less burdened by adverse effects than those receiving conventional antipsychotics. Among the group receiving novel antipsychotics, dosage was not related to satisfaction or burden of adverse effects. For those treated with risperidone (n = 27), there was a difference, approaching statistical significance, for greater satisfaction and less adverse effect burden among those persons with dosages less than 5 mg daily as compared to higher dosages.
How antipsychotics work: The patients' perspective
Background: While much is known about the neuropharmacology and objective efficacy of antipsychotics, little is known about how these drugs act on psychosis from the patients' perspective. Most previous studies of the patient's perspective have focused on drug tolerability and acceptability—rather than their effects on psychosis per se. Methods: The authors examined how antipsychotics work from a patient's perspective by analyzing their responses to a subjective questionnaire. Ninety-one patients with schizophrenia (cross-sectional component) and eight neuroleptic naı¨ve patients (before and after treatment, longitudinal component) participated. The patients' responses to the questionnaire were analyzed using Principal Component Analysis (PCA) and general linear models. Results: Analysis of the patients' responses showed that from their perspective the drugs were substantially more effective in: ''help deal, help stop thinking, and make the symptoms not bother'' rather than ''take away'' or ''change my mind''. This differentiation was clear in the raw data and was supported by a formal PCA. Two underlying factors – the first termed detachment and second eradication – explained 71% of the variance in the patients' perspective on how antipsychotics work for them. Neuroleptic naı¨ve patients, who had no prior exposure, expected drugs to help with both detachment and eradication, but, changed their mind with just 6 weeks of experience with the medications. Conclusions: From the patients' perspective the action of antipsychotics is best characterized by a detachment from symptoms—rather than an eradication or elimination of symptoms. They have more wide-ranging expectations prior to antipsychotic exposure, but, even 6 weeks of exposure is sufficient to change their mind in favor of detachment. This finding is consistent with some of the very earliest ideas that antipsychotics produced a state of ''indifference'' and is also consistent with the more recent, neurobiologically informed notions that antipsychotics work by dampening the salience of psychotic symptoms.