What is helpful and unhelpful when people try to withdraw from antipsychotics: An international survey

IF 2.6 3区 医学 Q2 PSYCHIATRY Psychology and Psychotherapy-Theory Research and Practice Pub Date : 2024-10-24 DOI:10.1111/papt.12551
John Read
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Abstract

Objective

Antipsychotics remain the first-line treatment for people diagnosed with psychotic disorders despite adverse effects which lead many people to stop their medication. Many stop without the support of the prescriber, who may fear relapse. The objective of this study is to better understand the process of withdrawal from antipsychotics, from the perspective of people taking antipsychotics.

Design

Online survey.

Methods

An international online survey elicited quantitative responses about pre-withdrawal planning (560) and qualitative responses about what was helpful and unhelpful when withdrawing from antipsychotics (443). Responses came from users of antipsychotics in 29 countries.

Results

Forty-seven per cent did not consult their psychiatrist before discontinuing. Only 40% made preparations, most commonly making a plan, gathering information and informing family. The most frequently reported helpful factors were focussing on the benefits of getting off the drugs (including ending adverse effects and feeling more alive), information about withdrawal symptoms and how to withdraw safely, withdrawing slowly, and support from psychologists, counsellors and psychotherapists. The most common unhelpful factor was the psychiatrist/doctor, largely because of their lack of knowledge, refusal to support the patient's wishes and the threat or use of coercion.

Conclusions

Evidence-based, respectful, collaborative responses to patients' concerns about adverse effects and desires to withdraw would probably reduce relapse rates and improve long-term outcomes. It would definitely help end pervasive breaching of the principle of informed consent and human rights legislation.

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当人们试图停用抗精神病药物时,什么是有用的,什么是无用的:一项国际调查。
目的:尽管抗精神病药物的不良反应导致许多人停药,但抗精神病药物仍然是诊断出患有精神障碍的患者的一线治疗药物。许多人停药时没有得到处方医生的支持,因为处方医生可能会担心复发。本研究旨在从服用抗精神病药物者的角度出发,更好地了解抗精神病药物的停药过程:设计:在线调查:一项国际在线调查收集了有关停药前计划的定量回复(560 份),以及有关停用抗精神病药物时有帮助和无帮助的定性回复(443 份)。答复来自 29 个国家的抗精神病药物使用者:结果:47%的人在停药前没有咨询过精神科医生。只有 40% 的人做了准备,最常见的是制定计划、收集信息和通知家人。据报告,最常见的有益因素是关注停药的益处(包括结束不良反应和感觉更有活力)、关于停药症状和如何安全停药的信息、缓慢停药以及心理学家、辅导员和心理治疗师的支持。最常见的不利因素是精神科医师/医生,主要是因为他们缺乏知识、拒绝支持病人的意愿以及威胁或使用胁迫手段:结论:以证据为基础,以尊重为前提,以合作为方式来应对患者对不良反应的担忧和退出治疗的愿望,很可能会降低复发率并改善长期疗效。这无疑将有助于终止普遍存在的违反知情同意原则和人权法律的行为。
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来源期刊
CiteScore
6.10
自引率
5.90%
发文量
68
审稿时长
6 months
期刊介绍: Psychology and Psychotherapy: Theory Research and Practice (formerly The British Journal of Medical Psychology) is an international scientific journal with a focus on the psychological and social processes that underlie the development and improvement of psychological problems and mental wellbeing, including: theoretical and research development in the understanding of cognitive and emotional factors in psychological problems; behaviour and relationships; vulnerability to, adjustment to, assessment of, and recovery (assisted or otherwise) from psychological distresses; psychological therapies with a focus on understanding the processes which affect outcomes where mental health is concerned.
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