Medication discontinuation in first episode psychosis: thinking about the offset of psychotic disorders

Galletly, Cherrie; Suetani, Shuichi; Dark, Frances

doi:10.1177/0004867418790087

Cited by 3 publications

(3 citation statements)

References 6 publications

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“…These choices also carry risks. Abruptly stopping medication without the clinical and social support provided by the EPI clinic can put young people at risk for the negative short- and long-term outcomes of untreated psychosis that EPI programs were developed to prevent (Galletly, Suetani, and Dark 2018). Ironically, the hospital’s accountability standards of efficiency, which operate to ensure that service providers’ meetings with clients are maximized, not only contribute to the production of informal coercive practices but also to young people’s discharge from the clinic.…”

Section: Discussionmentioning

confidence: 99%

“…The shift currently being called for by some EPI researchers and clinicians concerns the move from a riskaverse culture where antipsychotic medication management is limited to promoting adherence, toward one that provides choices along a spectrum of continuation-discontinuation, postponement, or no medication (Alvarez-Jimenez et al 2016;Bjornestad et al 2017b;McGorry et al 2013). Indications of this shift in perspective are starting to occur in emerging discussions of the need to consider alternatives to current EPI medication guidelines (McGorry et al 2013;Morrison et al 2012) while maintaining psychosocial strategies (Galletly et al 2018) as well as in studies examining medication discontinuation (Hui et al 2020). S. G. Berkhout (2018) goes further in her critical sociohistorical analysis of the emergence of FEP and suggests a more expansive shift to substantiate EPI's claim of being the paradigm shift from mainstream psychiatry.…”

Section: Implications and Conclusionmentioning

confidence: 99%

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The Disjuncture between Medication Adherence and Recovery-centered Principles in Early Psychosis Intervention: An Institutional Ethnography

Stasiulis

Gibson

Webster

et al. 2021

Society and Mental Health

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To examine how recovery principles are enacted in an early psychosis intervention (EPI) clinic, we used an institutional ethnographic approach focused on how the ideology of medication adherence organizes young people’s experiences of EPI services. Methods included ethnographic observation, in-depth interviews with 27 participants (18 clinic staff, four young people, and five family members), and textual analysis of clinic documents (e.g., case files, administrative forms, policy reports). The disjuncture between service providers’ intent to provide recovery-principled care and the actual experiences of young people is actualized in institutionalized practices of informal coercion around medication adherence, which we identify as “enticing,”“negotiating,” and “taking responsibility.” We link these practices to institutional accountability, risk, and efficiencies, and discuss the need for a shift in medication management approaches in EPI settings.

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Section: Discussionmentioning

confidence: 99%

Section: Implications and Conclusionmentioning

confidence: 99%

The Disjuncture between Medication Adherence and Recovery-centered Principles in Early Psychosis Intervention: An Institutional Ethnography

Stasiulis

Gibson

Webster

et al. 2021

Society and Mental Health

View full text Add to dashboard Cite

show abstract

“…A shift in the focus of service provision may also lead to an increase in clinical research into improving non-pharmacological interventions for this group. For example, it would be possible to assess the feasibility of a trial of reduction or discontinuation of antipsychotic medication in the older population, such as has been proposed for the early psychosis population (Galletly et al, 2018). This is particularly important in view of established physical side effects and possible cognitive side effects on long-term exposure to…”

Section: Discussionmentioning

confidence: 99%

Ageing with psychosis – Fifty and beyond

Galletly

Suetani

Hahn

et al. 2021

Aust N Z J Psychiatry

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Objective: While there is considerable current emphasis on youth and early psychosis, relatively little is known about the lives of people who live with psychotic disorders into middle age and beyond. We investigated social functioning, physical health status, substance use and psychiatric symptom profile in people with psychotic disorders aged between 50 and 65 years. Methods: Data were collected as part of the Survey of High Impact Psychosis, a population-based survey of Australians aged 18–65 years with a psychotic disorder. We compared those aged 50–65 years ( N = 347) with those aged 18–49 years ( N = 1478) across a range of measures. Results: The older group contained more women and more people with affective psychoses compared to the younger group. They were also more likely to have had a later onset and a chronic course of illness. The older group were more likely to have negative symptoms but less likely to exhibit positive symptoms; they also had lower current cognition, compared to the younger group. Compared to the younger group, the older group were more likely to be divorced/separated, to be living alone and to be unemployed. They had substantially lower lifetime use of alcohol and illicit substances, but rates of obesity, metabolic syndrome and diabetes mellitus were higher. Conclusion: Our findings suggest that the characteristics of people with psychosis change significantly as they progress into the middle age and beyond. A better understanding of these differences is important in informing targeted treatment strategies for older people living with psychosis.

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Psychosocial Intervention With or Without Antipsychotic Medication for First-Episode Psychosis: A Randomized Noninferiority Clinical Trial

Francey

O’Donoghue

Nelson

et al. 2020

Schizophrenia Bulletin Open

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This triple-blind (participants, clinicians, and researchers) randomized controlled noninferiority trial examined whether intensive psychosocial intervention (cognitive-behavioral case management, CBCM) for first-episode psychosis (FEP) in 15–25 year-olds managed in a specialized early intervention for psychosis service was noninferior to usual treatment of antipsychotic medication plus CBCM delivered during the first 6 months of treatment. To maximize safety, participants were required to have low levels of suicidality and aggression, a duration of untreated psychosis (DUP) of less than 6 months, and be living in stable accommodation with social support. The primary outcome was level of functioning as assessed by the Social and Occupational Functioning Scale (SOFAS) at 6 months. Ninety young people were randomized by computer, 46 to placebo, and 44 antipsychotic medication and 33% of those who commenced trial medication completed the entire 6-month trial period. On the SOFAS, both groups improved, and group differences were small and clinically trivial, indicating that treatment with placebo medication was no less effective than conventional antipsychotic treatment (mean difference = −0.2, 2-sided 95% confidence interval = −7.5 to 7.0, t = 0.060, P = .95). Within the context of a specialized early intervention service, and with a short DUP, the immediate introduction of antipsychotic medication may not be required for all cases of FEP in order to see functional improvement. However, this finding can only be generalized to a very small proportion of FEP cases at this stage, and a larger trial is required to clarify whether antipsychotic-free treatment can be recommended for specific subgroups of those with FEP. Trial Registration: ACTRN12607000608460 (www.anzctr.org.au).

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Medication discontinuation in first episode psychosis: thinking about the offset of psychotic disorders

Cited by 3 publications

References 6 publications

The Disjuncture between Medication Adherence and Recovery-centered Principles in Early Psychosis Intervention: An Institutional Ethnography

The Disjuncture between Medication Adherence and Recovery-centered Principles in Early Psychosis Intervention: An Institutional Ethnography

Ageing with psychosis – Fifty and beyond

Psychosocial Intervention With or Without Antipsychotic Medication for First-Episode Psychosis: A Randomized Noninferiority Clinical Trial

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