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This qualitative study examined the client experience of psychiatric medication among an unusual and under-studied subpopulation, individuals diagnosed with SMI who eventually experienced functional recovery. Four themes emerged from in-depth qualitative interviews with 16 such individuals: (1) primacy of medication, (2) informed consent, (3) self-...
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Citations
... Not only do providers allow access to medications, but patients also need more information to feel comfortable about medication use [12,15,26,30,31,42,67]. Patients need a trusting relationship [27,36,39,40,66] with providers to engender a sense of security about their medications [11,44,52,72]. They depend on pharmacists and providers to give them accurate and understandable information about the effects and side effects of the drug and provide continuity and follow-up care to ensure safety and confidence [49,50,54,66]. ...
... There may also be the perception of taking too many medications [44,55], the burden of polypharmacy [62], or one's past experiences with medication use and side effects [57], all of which influence the medication experience. In addition, how one experiences health and illness influences how the use of medication is situated in the overall health and wellness process [11,14,35,36,54,55]. The context in which one receives health assessment and information may differ when more than one provider is involved [22] while clinic wait times, the type of environment, and attitudes of providers also have an influence on patients' perspectives [32,36,44], as does one's relationship with providers [12,59]. ...
... In addition, how one experiences health and illness influences how the use of medication is situated in the overall health and wellness process [11,14,35,36,54,55]. The context in which one receives health assessment and information may differ when more than one provider is involved [22] while clinic wait times, the type of environment, and attitudes of providers also have an influence on patients' perspectives [32,36,44], as does one's relationship with providers [12,59]. ...
This is a concept analysis of the medication experience with a focus on how it applies to the pharmaceutical care practice framework used by pharmacist practitioners. The medication experience is a vital component of pharmaceutical care practice and of patient-centered care. Although the experience of taking medication has been studied across disciplines for decades, a concept analysis of the medication experience is lacking. Rodgers’ evolutionary concept analysis method was utilized. Ovid Medline, CINAHL, PsycINFO, Sociological Abstracts and Google Scholar databases, references and hand searches were used to compile an international dataset of 66 papers published from 1982 to 2020. As a result of the available literature, the medication experience is defined as one of ambivalence and vulnerability in which the patient is actively engaged in an ongoing process or negotiation, which is pragmatic to the ways in which they live and experience life, contextualized and nuanced within the social construction of their individual realities. The concept of medication experience is an important addition to the scientific literature. The definition of medication experience from the perspective of the patient will help to better explain the concept for future research and theory development to move the discipline of pharmaceutical care practice forward.
... For many people, the medication represented the fact that they were a patient with a disease. A few participants welcomed this view [30,33,34,46,49,50]. Some others described how they had initially believed the medication represented a 'cure' for their disease, but later became disillusioned with this idea [30,34,35,44], coming to see their previous beliefs in the possibility of a 'miracle cure' [34] as overly simplistic or 'reductionist' [30]. ...
... The authors of one study commented that people who accepted neuroleptic medication were often unable to articulate exactly why they took it [31]. In various studies, participants described feelings of hopelessness, helplessness, fear, confusion or indifference concerning their neuroleptic medication [28,31,33,36,[48][49][50]52]. ...
... Others described broader social processes in which medication and reduced autonomy were related. Some were subject to formal legal controls, or felt that there was an informal threat of rehospitalisation if they did not accept medication [26,31,36,42,46,49]. Some described pressure from mental health professionals, relatives or friends [26,31,36,39,46], and some voiced concern about losing access to care and services if they refused medication [30,46]. ...
Purpose
Neuroleptic (antipsychotic) drugs reduce psychotic symptoms, but how they achieve these effects and how the drugs’ effects are experienced by people who take them are less well understood. The present study describes a synthesis of qualitative data about mental and behavioural alterations associated with taking neuroleptics and how these interact with symptoms of psychosis and people’s sense of self and agency.
Methods
Nine databases were searched to identify qualitative literature concerning experiences of taking neuroleptic medication. A thematic synthesis was conducted.
Results
Neuroleptics were commonly experienced as producing a distinctive state of lethargy, cognitive slowing, emotional blunting and reduced motivation, which impaired functioning but also had beneficial effects on symptoms of psychosis and some other symptoms (e.g. insomnia). For some people, symptom reduction helped restore a sense of normality and autonomy, but others experienced a loss of important aspects of their personality. Across studies, many people adopted a passive stance towards long-term medication, expressing a sense of resignation, endurance or loss of autonomy.
Conclusions
Neuroleptic drugs modify cognition, emotions and motivation. These effects may be associated with reducing the intensity and impact of symptoms, but also affect people’s sense of self and agency. Understanding how the effects of neuroleptics are experienced by those who take them is important in developing a more collaborative approach to drug treatment in psychosis and schizophrenia.
... Lacasse og medarbeidere benyttet dybdeintervjuer til å utforske brukere , som var blitt friske, sine erfaringer med lengre tids tvangsbehandling med legemidler (43). Deltakerne rapporterte at medisinering noen ganger var den eneste behandlingen de fikk tilbud om. ...
... Følelsen av å bli lyttet til og behandlet med respekt ble løftet frem som viktig for rehabiliteringsprosessen etter en tvangsmedisinering. Noen beskrev manglende eller forsinket tilbud om psykososiale tjenester og manglende eller forsinket informasjon om medisiners bivirkninger (43). ...
The Norwegian Institute of Public Health was commissioned by Centre for Medical Ethics at the University of Oslo to search for empirical research literature on coerced medication in mental health care. We performed a systematic mapping review where we searched for systematic reviews and primary studies of coerced medication
for adult patients. The search for primary studies resulted in 1601 references. We read 77 studies in full‐text and included eight reviews and 25 primary studies. The population was mainly patients with schizophrenia, bipolar disorder and psychosis. We categorised coerced medication as: 1) short‐term drugs used as coerced means, 2) long‐term coerced treatment with drugs, and 3) coerced medication
in out‐patient institution. Among other things, the authors of the included reviews described:
There has been done more research on seclusion and mechanical restraints than on foreced medication. Assault and risk of violence was the most common cause of forced medication. Adherance to treatment with antipsychotics depends on the patient's experience with efficacy, side effects and the use of other drugs. Patients who refused psychotropic medication in acute inpatient psychiatric care were longer in hospital, whereas involuntary medication was
associated with shorter admissions. The evidence for the efficacy of involuntarily outpatient treatment is inconlusive, and there is a
need for more randomized controlled studies with high methodological quality.
We also identified 25 possibly relevant primary studies that were not included in the identified reviews. These 25 primary studies were about: 1) Variation in practice, 2) The efficacy of coerced medication, 3) Prevalence and risk factors, 4) User satisfaction and user experience and 5) Health personnel's attitudes and experiences.
... The search resulted in 29 studies reported across 30 included papers for synthesis; 20,27-55 the flow of studies is outlined in Fig. 2. All study characteristics are detailed in the supplementary material (Tables DS2 and DS3). Of the 30 studies, 13 were conducted in the UK, 27,28,30,33,36,37,41,44,46,47,49,[51][52][53] ten in the USA, 20,29,31,32,34,38,39,43,48,50 four in Canada, 35,40,42,55 and one each in Norway 45 and Sweden 54 . Sixteen studies examined data from only patients' perspectives, 28,29,32,33,37,[39][40][41][42][43]45,46,49,50,53,55 six from only health professionals' perspectives, 30,34,35,47,51,52,54 and only one from carers' perspectives. ...
... Of the 30 studies, 13 were conducted in the UK, 27,28,30,33,36,37,41,44,46,47,49,[51][52][53] ten in the USA, 20,29,31,32,34,38,39,43,48,50 four in Canada, 35,40,42,55 and one each in Norway 45 and Sweden 54 . Sixteen studies examined data from only patients' perspectives, 28,29,32,33,37,[39][40][41][42][43]45,46,49,50,53,55 six from only health professionals' perspectives, 30,34,35,47,51,52,54 and only one from carers' perspectives. 36 The six remaining studies examined a combination of stakeholder perspectives, 27,31,38,44 two of these including carer viewpoints. ...
... Of the 22 studies that included patients, 20,[27][28][29][31][32][33][37][38][39][40][41][42][43][44][45][46][48][49][50]53,55 seven included participants with diagnosis of psychosis/ schizophrenia, 38,42,45,46,49,53,55 one involved participants with a diagnosis of bipolar 50 and one included participants with dual diagnoses. 20 Nine studies had a sample of mixed diagnoses, 29,32,33,37,39,41,43,44,48 and four described their sample as having 'SMI' but did not provide any further details on diagnosis. ...
Background
Despite policy and practice mandates for patient involvement, people with serious mental illness often feel marginalised in decisions about antipsychotic medication.
Aims
To examine stakeholder perspectives of barriers and facilitators to involving people with serious mental illness in antipsychotic prescribing decisions.
Method
Systematic thematic synthesis.
Results
Synthesis of 29 studies identified the following key influences on involvement: patient's capability, desire and expectation for involvement, organisational context, and the consultation setting and processes.
Conclusions
Optimal patient involvement in antipsychotic decisions demands that individual and contextual barriers are addressed. There was divergence in perceived barriers to involvement identified by patients and prescribers. For example, patients felt that lack of time in consultations was a barrier to involvement, something seldom raised by prescribers, who identified organisational barriers. Patients must understand their rights to involvement and the value of their expertise. Organisational initiatives should mandate prescriber responsibility to overcome barriers to involvement.
Declaration of interest
None.
... Evidently, the existing protocol for the distribution of medication represents a less than desirable level of care. The findings also align with prior research reporting limited access to providers and seeming overreliance on medication in lieu of potentially life-changing psychosocial interventions (Griffiths et al., 2012;Kilty, 2012;Langner et al., 2002), a problem that may not be isolated to correctional contexts (Lacasse et al., 2016). Additionally, the present findings seem to confirm the high rates of medication misuse in correctional contexts (Baillargeon et al., 2000;Bowens et al., 2009). ...
The study examines narrative data from in-depth, semi-structured interviews with 25 women in a medium security prison with the hope of deepening the knowledge base related to women’s beliefs about their mental health problems, mental health care during incarceration, and especially their experiences with psychotropic medication. The findings highlight the functional role of psychotropic medication in the lives of incarcerated women, while also emphasizing problems with limited access to prescribers, preferred medications, and other forms of mental health treatment. Trauma, substance use, and the impact of medication use on sense of self all emerged as interfacing with quality of life.
Inclusion of mental health care into primary care has occurred in several countries, including Brazil, to tackle the lack of assistance. The integration of services is seen as necessary, but at the same time a major challenge. The aim of this study was to conduct an exploratory analysis of discursive practices on the use of psychotropic drugs and non-pharmacological approaches to overcome negative life events. Interviews conducted with physicians working in family health on the clinical practice of primary mental health care made up our research corpus. Data were analyzed based on the assumptions of discourse analysis. The analytical descriptions were built based on the statements identified in the discursive formation of the medicalization of life. The results of the analysis showed the therapeutic pluralism of psychotropics and their effects, less frequently using non-pharmacological approaches. Prescription excludes broader social plots, captures the power of life by modulating individual and collective behavior, so that social life is assured and legitimized, thus ensuring the alleged common good.
Key words:
Medications; psychotropic; discourse analysis
HUMAN BEINGS ARE LIKE THAT, THEY SUFFER. BUT SOME DAYS ARE WORSE: PATIENTS’ PERCEPTIONS TO START USING PSYCHOTROPIC MEDICINES
ABSTRACT. The current process of medicalization in our society has occurred in several directions, indicating that any malaise can be treated with medicines. This study aimed to understand the beginning of the use of psychotropic medicines to overcome the problems faced in individuals’ daily lives. In-depth interviews were carried out with 19 individuals about their reasons to start taking psychotropic medicines. This study used Heidegger’s philosophical assumptions and data analysis as proposed by Max van Manen. The analysis revealed the theme, ‘Human beings are like that, we suffer. But some days are worse’, which refers to the difficulties experienced that triggered feelings of anger, anxiety, stress, sadness and anguish, leading to the use of psychotropic medicines. The experience of the difficulties faced in life was pointed out as the main reason to start using medicine to preserve individuals’ mental health.
Keywords: Medicalization; psychotropic; hermeneutics.
OBJECTIVE
In recent years, it has been stated that qualitative research has been drawing attention day by day in medicine and especially in psychiatry and it has become an increasingly important source of evidence for psychotherapy practices. it is underlined that qualitative research has gained importance in answering some innovative research questions emerging in psychiatry in 21st century Qualitative research involves mostly interviews, focus group interviews with open-ended questions, participant observation and document analysis as data collection tools and in which various techniques such as content analysis and descriptive analysis are used in data analysis. It is a type of research that includes approaches such as phenomenology, grounded theory and ethnography. Beyond measuring variables in the field of health, qualitative research is aimed at researchers who want to understand the experiences and beliefs underlying behavior. In the literature, there is a negative attitude towards qualitative research in the field of health. It is indicated that in the field of health, qualitative research is defined as "non-quantitative research" in a negative way and many people's stereotypes about qualitative research are shaped by their perceptions of quantitative research. This negative attitude is also seen in psychiatry. It is underlined that a positivist tradition is dominant in psychiatry, and it is stated that the word “research” is used synonymously with the term “quantitative research”. When most psychiatrists refer to this as "research", it often refers to quantitative research using objective outcome measures and inferential statistics. Compared to other health sciences, it is emphasized that the frequency of use of the qualitative method in psychiatry is low and that psychiatric research is overwhelmingly based on quantitative method. Especially in the second half of the 20th century, the search for more dignity and objectivity in psychiatry led to the adoption of quantitative methods, with larger samples and greater dependence on statistics. In this context, it is stated in the literature that expanding the methodological point of view in health sciences including social sciences will make the research process more attractive for clinicians. In this study, it is aimed to evaluate the possible contributions and uses of qualitative research to psychiatry in the context of current literature.
METHOD
In this study, a literature review was conducted to determine the benefits of using qualitative research in psychiatry. Taking into consideration the dominant perspective on the use of quantitative research, titles have been created as methodological contributions, gender, stigmatization, daily life, culture, implementation and mental health policy.
RESULTS
Under the title of methodological contributions, it was emphasized that qualitative researches can contribute to the interpretation, qualification or clarification of the findings, firstly during the creation of research hypotheses, secondly, together with or after quantitative studies. Finally, the importance of using qualitative-quantitative research together in the development of new measurement tools was mentioned. It was also emphasized that qualitative research may contribute to the research under the title "gender" in terms of reflecting the feminist perspective. As a matter of fact, it is indicated that many studies on gender and mental illnesses focus on the biological foundations of gender and the focus of gender is not mentioned. It is stated that stigmatization and discrimination phenomenon can contribute to the stigmatization phenomenon in the field of mental health by focusing on subjective experiences of qualitative research under the title of "stigmatization", based on the fact that it emphasizes everyday life in the context of social relations. It was highlighted under the title of "daily life" that filling the gap between scientific evidence and clinical practice can enable the understanding of subjective meanings of treatment. The greatest strength of qualitative research in terms of daily life is its acquaintance with real people in real situations and its interest in understanding people throughout their daily lives. The title "culture" attracts the attention to beliefs and ethnicity, and it was pointed out that qualitative research is an important methodology in terms of cultural codes and social context. The difference of qualitative research from quantitative research is to describe and analyze the beliefs of "society" and to obtain data that may affect health consequences, especially regarding drug compliance or service use. Under the "implementation" title, it was emphasized that qualitative research could focus on individual experiences, allowing for those working in the field of mental health to develop their own perspective, as well as the evaluation of facilitators and obstacles in practice such as chronic disease adaptation process, and anxiety of families. Finally, it was concluded that qualitative research should be given importance in terms of benefiting from services within the framework of mental health policy and comprehensive and in-depth evaluation of service delivery, researching the transition process from hospital to society and understanding the social needs of adults with mental health problems.
DISCUSSION
It is seen that qualitative research gains day-to-day value in the field of health in general and psychiatry in particular. In this sense, it is thought that the titles determined in this study will make important contributions in terms of developing and expanding the community based service delivery, which is the current approach in terms of service delivery in mental health. Similarly, it can be said that qualitative research will make important contributions to physician-patient relationship and make the treatment process more effective and efficient. In regards to data collection, it is thought that psychiatrists can easily use the in-depth interview and focus group interview technique, and in terms of data evaluation, accessing many current software (Nvivo, MaxQDA, Atlas ti etc.) will bring qualitative research closer to psychiatry day by day. From a methodological point of view, criticisms of quantitative research should be taken into consideration in terms of psychiatric research in the 21st century. In particular, mixed-method research designs in which quantitative and qualitative techniques are used are needed, and incentives and agenda-building activities that attract the attention of researchers become important for qualitative research.
Keywords: Qualitative research, mental illnesses and everyday life, gender, stigmatization
This qualitative study used a grounded theory approach to explore the lived experience of psychotropic medication use in the recovery process of 18 participants who had a diagnosis of schizophrenia, bipolar disorder, or major depression but who were successful in recovery without ongoing medication use. Participants’ narratives depicted a continuum of medication experiences in their recovery process centered on three key recovery factors identified by participants: basic functioning, deeper healing, and hope for recovery. For each recovery factor, participants’ experiences ranged from perceiving medication as promoting recovery to perceiving medication as impeding their recovery, with mixed experiences in between. Findings suggested that the role of medication in recovery is multifaceted and individualized. Mental health providers should avoid a one-size-fits-all philosophy on medication for major mental health conditions, and should be responsive to individual situations and needs.
