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Published Online: 1 August 2011

Becoming Adherent to Antipsychotics: A Qualitative Study of Treatment-Experienced Schizophrenia Patients

Abstract

Objective:

Discontinuation of antipsychotic medication is a pervasive clinical problem in the treatment of patients suffering from psychosis. The aim of this study was to complement a largely quantitative body of research by focusing on patients' perspectives on the topic.

Methods:

In-depth semistructured interviews were conducted with 20 persons who have schizophrenia spectrum disorders. Narratives were elicited on illness and medication use and emphasized key turning points, such as periods of nonadherence and illness relapses.

Results:

Respondents had extensive experience with antipsychotic treatment (15±12 years of treatment). Nineteen (95%) reported at least one extended period of nonadherence. A complex picture of medication use or refusal emerged from patients' descriptions. An array of external factors influenced initiation of medication and treatment maintenance: pressure from family or clinicians, secondary benefits from initiating and maintaining treatment, and a variety of coercive measures. Moreover, personal factors transcended rational models in deciding whether to take medication; patients' responses stressed the importance of trust, emotional reactions, and subjective experiences with medication and stigma.

Conclusions:

These findings call into question the validity of a purely voluntaristic model of the use of antipsychotic medication. Its use was part of a long and painful fight with a debilitating disorder, and off-medication periods were essential parts of a learning process. (Psychiatric Services 62:888–892, 2011)

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Go to Psychiatric Services
Go to Psychiatric Services
Cover: The South Gorge, Appeldore, Isles of Shoals, by Childe Hassam. Oil on canvas, 22¼ × 18 inches. Collection of the Newark Museum, Newark, New Jersey. Photo credit: the Newark Museum/Art Resource, New York.
Psychiatric Services
Pages: 888 - 892
PubMed: 21807827

History

Published online: 1 August 2011
Published in print: August 2011

Authors

Details

Constantin Tranulis, M.D. [email protected]
Dr. Tranulis is affiliated with the Department of Psychiatry, University of Montreal, Montreal, C.P. 6128 succursale Centre-ville, Montréal, Québec H3C 3J7, Canada (e-mail: [email protected]).
The other authors are with the Schizophrenia Program, Massachusetts General Hospital, Boston, and Harvard Medical School, Boston, with which Dr. Tranulis is also affiliated.
Donald Goff, M.D.
The other authors are with the Schizophrenia Program, Massachusetts General Hospital, Boston, and Harvard Medical School, Boston, with which Dr. Tranulis is also affiliated.
David C. Henderson, M.D.
The other authors are with the Schizophrenia Program, Massachusetts General Hospital, Boston, and Harvard Medical School, Boston, with which Dr. Tranulis is also affiliated.
Oliver Freudenreich, M.D.
The other authors are with the Schizophrenia Program, Massachusetts General Hospital, Boston, and Harvard Medical School, Boston, with which Dr. Tranulis is also affiliated.

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