Schizophrenia

Middleton, Hugh

doi:10.1097/yco.0000000000000151

Cited by 29 publications

(8 citation statements)

References 11 publications

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“…These sceptical attitudes may relate to issues of risk aversion previously discussed, but they may also stem from the widely accepted medical model of psychosis itself—that suggests that antipsychotics correct a ‘chemical imbalance’ and are therefore necessary for recovery [47]. Even though this model is the subject of considerable debate [48,49], for many psychiatrists it is regarded as established fact.…”

Section: Discussionmentioning

confidence: 99%

Mental health professionals’ views and experiences of antipsychotic reduction and discontinuation

2019

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Background The widely established treatment for psychosis is long-term antipsychotic medication. However, many people stop taking this treatment, and request other options. There are also growing concerns about adverse effects, but currently no professional guidelines to support reducing or stopping these drugs. The views and experiences of individual mental health professionals around reducing and stopping antipsychotics are therefore crucial in treatment decisions. Methods We conducted 7 focus groups with prescribing psychiatrists and other members of community-based statutory mental health services in London. Participants discussed their views about, experiences, and processes of antipsychotic reduction and discontinuation. Data were analysed using thematic analysis. Results Participants acknowledged that antipsychotics can have severe adverse effects. They were generally supportive of trying to reduce these drugs to the lowest effective dose, although stopping antipsychotics was less acceptable. Prior experiences of adverse events after reduction or discontinuation meant that both were approached with caution. Reduction was also reported to be hampered by organisational and knowledge barriers. Lack of resources, pressure to discharge, and poor continuity of care were seen as organisational barriers. Knowledge barriers included inadequate evidence about who might be best suited to reduction, and lack of guidance about how this could be done safely. This meant that reduction was often prompted by patients, and sometimes actively discouraged, and stability with maintenance treatment was often favoured. Conclusions Concerns about risk and other barriers means that clinicians are often reluctant to implement reduction or discontinuation of antipsychotic medication. In order to increase the treatment options available to service users, more research and guidance on how to minimise the risks of antipsychotic reduction and discontinuation is required to enable clinicians to engage more constructively with service users requests, offering people more choice and control in managing their mental health condition.

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Section: Discussionmentioning

confidence: 99%

Mental health professionals’ views and experiences of antipsychotic reduction and discontinuation

2019

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“…Precision psychiatry seems to be the latest way of expressing the idea that mental disorders (mental states) can be traced back toand are ultimately caused byspecific biological abnormalities (physical states), although this idea is convincingly challenged in the literature (see e.g. Bentall, 1999;Johnstone et al, 2018;Moncrieff & Middleton, 2015;Putnam, 1967).…”

Section: Low Hanging Fruitmentioning

confidence: 99%

Precision psychiatry: promise for the future or rehash of a fossilised foundation?

Köhne

2021

Psychol. Med.

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Precision psychiatry is currently described as an approach that would bring significant advance to psychiatric clinical practice. Theaim of this article is to investigate Precision Psychiatry’s promise for the future; should we substantially invest in this new approach? Thearticle is based on a review of the literature and reports a conceptual analysis. A critical examination of Precision Psychiatry’s foundationsshows us that its fundaments are obsolete and flawed: we cannot reduce mental suffering to essences in biology. It is problematic to statethat biological processes hold and capture qualia and meaning, and in themselves and without context would hold and capture somethinglike abnormality. Despite its good efforts, precision psychiatry does not represent a sufficiently promising alternative to the phenotyping thatcomes with the current classification systems.

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“…Aetiologically, from a biological perspective, psychosis is conceptualised as something which originates within individuals, a form of brain disease or biological irregularity. This taxonomy fails to reflect either the diversity of experiences described as psychosis (Guloksuz & van Os, 2021), or the multiple complex factors associated with the aetiology of psychosis (Moncrieff & Middleton, 2015). However, since its Kraepelinian inception, this perspective has orientated psychiatry towards an understanding of psychosis as a discrete disorder originating from a biological or neurochemical abnormality (Broome, 2013;Ebert & Bar, 2010;Read & Dillon, 2013).…”

Section: The Anomaly Of Complex Aetiology and Taxonomymentioning

confidence: 99%

The biological paradigm of psychosis in crisis: A Kuhnian analysis

2023

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The philosophy of Thomas Kuhn proposes that scientific progress involves periods of crisis and revolution in which previous paradigms are discarded and replaced.Revolutions in how mental health problems are conceptualised have had a substantial impact on the work of mental health nurses. However, despite numerous revolutions within the field of mental health, the biological paradigm has remained largely dominant within western healthcare, especially in orientating the understanding and treatment of psychosis. This paper utilises concepts drawn from the philosophy of Thomas Kuhn to explore the impact of what Kuhn terms 'anomalies' within the dominant biological paradigm: the anomaly of the meaningful utterance, the anomaly of complex aetiology and taxonomy and the anomaly of pharmacological inefficacy in recovery. The paper argues that the biological paradigm for understanding psychosis is in crisis and explores the implications for mental health nursing.

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Schizophrenia

Cited by 29 publications

References 11 publications

Mental health professionals’ views and experiences of antipsychotic reduction and discontinuation

Mental health professionals’ views and experiences of antipsychotic reduction and discontinuation

Precision psychiatry: promise for the future or rehash of a fossilised foundation?

The biological paradigm of psychosis in crisis: A Kuhnian analysis

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