Antipsychotic treatment – a systematic literature review and meta-analysis of qualitative studies

Abstract

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.

To Choose or not to Choose? -User Perspectives on Medication Free Treatment for Persons With Psychosis: a Qualitative Study

“…Mol (35) what can at times be uncomfortable and difficult discussions. This finding is consistent with a recent meta-analysis where patients preferred professionals who considered AP medication as one of many tools to achieve personal recovery (36), and a cornerstone of the recovery-oriented practice framework being to increase people's choice and self-determination in their health care (37,38).…”

Experiences of taking neuroleptic medication and impacts on symptoms, sense of self and agency: a systematic review and thematic synthesis of qualitative data

“…The passivity and occasional indifference described in several studies may also reflect the effects of neuroleptics on energy and motivation, or might alternatively be a manifestation of the negative symptoms of schizophrenia in some cases. A previous systematic review also highlighted loss of autonomy in neuroleptic users, identifying this as occurring in relation to early treatment of the acute stages of the condition, and suggesting that people regain a sense of agency as their condition stabilises [13]. In contrast, the current review found that across studies, there appeared to be a group of people who had fallen into a longterm state of passivity and hopelessness in relation to their neuroleptic medication.…”

“…Several qualitative studies have been conducted that describe the experiences of taking neuroleptics [13]. The rich nature of qualitative data means these studies can highlight the complex alterations to conscious experience, mental functions and behaviour that neuroleptics produce, arguably more successfully than quantitative approaches (e.g.…”

“Needing different things from different people” – a qualitative exploration of recovery in first episode psychosis

“…Mange av deltakerne ga uttrykk for at de hadde behov for å snakke med noen som forstod hva de slet med, noe de mente at familie og venner ikke hadde forutsetning for. I en litteraturgjennomgang som så naermere på folks erfaringer med antipsykotisk medisinering, gjorde Bjornestad et al (2019) også funn som antydet at eksperthjelp ble sett som nyttig i en tidlig fase av behandlingen. I den medisinske modellen vil hovedansvaret for behandlingen nettopp ligge hos de profesjonelle.…”