Taking neuroleptics in NZ: Preliminary results of The Experiences of Antipsychotic Medication Survey (TEAMS

Larsen-Barr, Miriam; Seymour, Fred; Gibson, Kerry

doi:10.1037/e528472014-084

Cited by 2 publications

(7 citation statements)

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“…A convenience sample of people who had discontinued antipsychotics was recruited through an anonymous online survey exploring oral antipsychotic experiences among New Zealand residents aged 18 or older who had taken antipsychotics continuously for at least 3 months for any reason and were currently living in the community. 6 Survey participants ( n = 144) who had attempted discontinuation ( n = 105) and remained off antipsychotics for 1 year or more ( n = 52) were presented with an invitation to take part in an interview about what had enabled them to maintain their wellbeing during and after withdrawal. People who expressed an interest in being interviewed had an opportunity to ask questions before providing written consent to take part and completed a confidential screening questionnaire to establish that they were not currently taking oral or depot antipsychotics, had not taken them on a daily basis for at least 1 year, and considered themselves well at the time of the interview.…”

Section: Methodsmentioning

confidence: 99%

Service-user efforts to maintain their wellbeing during and after successful withdrawal from antipsychotic medication

Larsen-Barr

Seymour

2021

Therapeutic Advances in Psychopharmacology

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Background: It is well-known that attempting antipsychotic withdrawal can be a fraught process, with a high risk of relapse that often leads people to resume the medication. Nonetheless, there is a group of people who appear to be able to discontinue successfully. Relatively little is known about how people do this. Methods: A convenience sample of adults who had stopped taking antipsychotic medication for more than a year were recruited to participate in semi-structured interviews through an anonymous online survey that investigated antipsychotic medication experiences in New Zealand. Thematic analysis explored participant descriptions of their efforts to maintain their wellbeing during and after the withdrawal process. Results: Of the seven women who volunteered to participate, six reported bipolar disorder diagnoses and one reported diagnoses of obsessive compulsive disorder and depression. The women reported successfully discontinuing antipsychotics for 1.25–25 years; six followed a gradual withdrawal method and had support to prepare for and manage this. Participants defined wellbeing in terms of their ability to manage the impact of any difficulties faced rather than their ability to prevent them entirely, and saw this as something that evolved over time. They described managing the process and maintaining their wellbeing afterwards by ‘understanding myself and my needs’, ‘finding what works for me’ and ‘connecting with support’. Sub-themes expand on the way in which they did this. For example, ‘finding what works for me’ included using a tool-box of strategies to flexibly meet their needs, practicing acceptance, drawing on persistence and curiosity and creating positive life experiences. Conclusion: This is a small, qualitative study and results should be interpreted with caution. This sample shows it is possible for people who experience mania and psychosis to successfully discontinue antipsychotics and safely manage the impact of any symptoms that emerge as a result of the withdrawal process or other life stressors that arise afterwards. Findings suggest internal resources and systemic factors play a role in the outcomes observed among people who attempt to stop taking antipsychotics and a preoccupation with avoiding relapse may be counterproductive to these efforts. Professionals can play a valuable role in facilitating change.

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Section: Methodsmentioning

confidence: 99%

Service-user efforts to maintain their wellbeing during and after successful withdrawal from antipsychotic medication

Larsen-Barr

Seymour

2021

Therapeutic Advances in Psychopharmacology

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“…On the other hand, families, carers and clinicians may be reluctant to take the risk of having to endure another relapse, and this makes the process of withdrawal even more difficult, since many people report that they benefit from having support from other people when they try to reduce medication. 46 , 53 – 57…”

Section: Relapsementioning

confidence: 99%

“…Even if people do not succeed in stopping neuroleptics altogether, attempting to discontinue can be worthwhile by leading to lower doses and reduced adverse effects. 53 …”

Section: Overcoming the Barriers To Neuroleptic Discontinuationmentioning

confidence: 99%

“…People report using a variety of coping mechanisms to prepare for, and endure a period of, withdrawal including psychological, behavioural and medication-based strategies. 46 , 47 , 53 , 67 People also seek support from a variety of sources, including clinicians, friends and personal acquaintances. Several studies of non-pharmacological clinical interventions or strategies have been found to improve the outcomes for people who reduce, or wish to avoid, the use of medication.…”

Section: Overcoming the Barriers To Neuroleptic Discontinuationmentioning

confidence: 99%

“… 51 , 72 , 73 These and other sources suggest that a flexible approach, involving continual self-reflection and adjustment of the tapering plan according to the individual experience of withdrawal is most likely to be successful and acceptable. 53 Official guidance based on this experience would encourage clinicians to support people who wish to try and stop their neuroleptic medication. NICE is currently developing guidelines for stopping benzodiazepines, opiates and antidepressant drugs, and it is to be hoped that NICE, or a similar institution, will take up the challenge of providing guidelines for the withdrawal of neuroleptics in the future.…”

Section: Overcoming the Barriers To Neuroleptic Discontinuationmentioning

confidence: 99%

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Barriers to stopping neuroleptic (antipsychotic) treatment in people with schizophrenia, psychosis or bipolar disorder

Gupta

Horowitz

2020

Therapeutic Advances in Psychopharmacology

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Most guidelines recommend long-term, indefinite neuroleptic (or antipsychotic) treatment for people with schizophrenia, recurrent psychosis or bipolar disorder, on the basis that these medications reduce the chance of relapse. However, neuroleptics have significant adverse effects, including sexual dysfunction, emotional blunting, metabolic disturbance and brain shrinkage, and patients often request to stop them. Evidence for the benefits of long-term treatment is also not as robust as generally thought. Short-term randomised trials show higher rates of relapse among those whose neuroleptic treatment is discontinued compared with those on maintenance treatment, but they are confounded by adverse effects associated with the withdrawal of established medication. Some longer-term studies show possible advantages of medication reduction and discontinuation in terms of improved social functioning and recovery. Therefore, there is a good rationale for supporting patients who wish to stop their medication, especially given the patient choice agenda favoured by The National Institute for Clinical Excellence (NICE). The major barrier to stopping antipsychotics is an understandable fear of relapse among patients, their families and clinicians. Institutional structures also prioritise short-term stability over possible long-term improvements. The risk of relapse may be mitigated by more gradual reduction of medication, but further research is needed on this. Psychosocial support for patients during the process of reducing medication may also be useful, particularly to enhance coping skills. Guidelines to summarise evidence on ways to reduce medication would be useful. Many patients want to try and stop neuroleptic medication for good reasons, and psychiatrists can help to make this a realistic option by supporting people to do it as safely as possible, with the best chance of a positive outcome.

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Taking neuroleptics in NZ: Preliminary results of The Experiences of Antipsychotic Medication Survey (TEAMS

Cited by 2 publications

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Service-user efforts to maintain their wellbeing during and after successful withdrawal from antipsychotic medication

Service-user efforts to maintain their wellbeing during and after successful withdrawal from antipsychotic medication

Barriers to stopping neuroleptic (antipsychotic) treatment in people with schizophrenia, psychosis or bipolar disorder

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