Centre for Quality Improvement, Royal College of Psychiatrists, 4th Floor Standon House, 21 Mansell Street, London, E1 8AA, UK.
Soc Psychiatry Psychiatr Epidemiol. 2013 Apr;48(4):639-47. doi: 10.1007/s00127-012-0581-y. Epub 2012 Sep 25.
Partial or non-adherence is common in people taking antipsychotic medication. A good therapeutic alliance is thought by psychiatrists to encourage engagement with a service and improve adherence. This paper aims to examine how psychiatrists and patients communicate in outpatient consultations about partial or non-adherence to antipsychotic prescribing.
Ninety-two outpatient consultations involving patients prescribed antipsychotic medication and their psychiatrists were tape recorded. Parts of consultations where partial/non-adherence to antipsychotic medication was discussed were analysed using conversation analysis.
In 22 (24 %) consultations, partial/non-adherence was disclosed. Most commonly, it was volunteered without prompting and was more likely to be presented as a deliberate choice than omission by the patient. Psychiatrists responded to all but one disclosure, and patients delivered their reports in ways that minimised the prospect of this response being disciplinary. The most common outcome was a change in prescribing: a medication omission, swap or dosage reduction.
Patients and psychiatrists work together to create a safe conversational environment in which to discuss this potentially difficult issue. Unlike previous studies of patient reports of psychotic symptoms and side effects of drowsiness being ignored, psychiatrists nearly always respond to disclosures of partial/non-adherence. Psychiatrists should apply the same listening skills to patients' disclosures of troubling side effects and psychotic symptoms.
在服用抗精神病药物的人群中，部分或不依从的情况很常见。精神科医生认为，良好的治疗联盟可以鼓励患者与服务机构合作，并提高依从性。本文旨在探讨精神科医生和患者在门诊咨询中如何就部分或不依从抗精神病药物处方进行沟通。
对 92 例涉及服用抗精神病药物的患者及其精神科医生的门诊咨询进行录音。使用会话分析方法分析讨论部分或不依从抗精神病药物处方的咨询部分。
在 22 次（24%）咨询中，患者透露了部分/不依从抗精神病药物治疗的情况。最常见的情况是在没有提示的情况下自愿透露，而且患者更倾向于将其描述为有意选择而非遗漏。除了一次外，所有的披露都得到了精神科医生的回应，而且患者以尽量减少这种回应具有惩戒性的方式报告他们的情况。最常见的结果是改变处方：漏服、换药或减少剂量。
患者和精神科医生共同努力，营造一个安全的对话环境，讨论这个潜在的困难问题。与之前关于精神症状和嗜睡副作用被忽视的患者报告的研究不同，精神科医生几乎总是对部分/不依从的披露做出回应。精神科医生应该对患者关于困扰的副作用和精神症状的披露应用相同的倾听技巧。
