Martínez-Hernáez Ángel, Pié-Balaguer Asun, Serrano-Miguel Mercedes, Morales-Sáez Nicolás, García-Santesmases Andrea, Bekele Deborah, Alegre-Agís Elisa
Medical Anthropology Research Center, Rovira I Virgili University, Avinguda Catalunya, 35, 43002, Tarragona, Catalonia, Spain.
Department of Psychology and Education, Open University of Catalonia, Rambla Del Poblenou, 156, 08018, Barcelona, Spain.
Soc Sci Med. 2020 Jan 23;247:112811. doi: 10.1016/j.socscimed.2020.112811.
Antipsychotic medication is the primary treatment for psychotic conditions such as schizophrenia and schizoaffective disorders; nevertheless, its administration is not free from conflicts. Despite taking their medication regularly, 25-50% of patients report no benefits or perceive this type of treatment as an imposition. Following in the footsteps of a previous initiative in Quebec (Canada), the Gestion Autonome de la Médication en Santé Mentale (GAM), this article ethnographically analyses the main obstacles to the collaborative management of antipsychotics in Catalonia (Spain) as a previous step for the implementation of this initiative in the Catalan mental healthcare network. We conducted in-depth interviews with patients (38), family caregivers (18) and mental health professionals (19), as well as ten focus groups, in two public mental health services, and patients' and caregivers' associations. Data were collected between February and December 2018. We detected three main obstacles to collaboration among participants. First, different understanding of the patient's distress, either as deriving from the symptoms of the disorder (professionals) or the adverse effects of the medication (patients). Second, differences in the definition of (un)awareness of the disorder. Whereas professionals associated disorder awareness with treatment compliance, caregivers understood it as synonymous with self-care, and among patients "awareness of suffering" emerged as a comprehensive category of a set of discomforts (i.e., symptoms, adverse effects of medication, previous admissions, stigma). Third, discordant expectations regarding clinical communication that can be condensed in the differences in meaning between the Spanish words "trato" and "tratamiento", where the first denotes having a pleasant manner and agreement, and the second handling and management. We conclude that these three obstacles pave the way for coercive practices and promote patients' de-subjectivation, named here as the "total patient" effect. This study is the first GAM initiative in Europe.
抗精神病药物是治疗精神分裂症和分裂情感性障碍等精神病性疾病的主要手段；然而，其使用并非毫无冲突。尽管患者定期服药，但仍有25%至50%的患者表示没有从中受益，或者认为这种治疗是一种负担。本文效仿加拿大魁北克省先前的一项举措——精神卫生药物自主管理（GAM），通过人种志方法分析了西班牙加泰罗尼亚地区抗精神病药物协作管理的主要障碍，作为在加泰罗尼亚精神卫生保健网络中实施该举措的前期步骤。我们在两个公共精神卫生服务机构以及患者和护理人员协会中，对患者（38名）、家庭护理人员（18名）和精神卫生专业人员（19名）进行了深入访谈，并开展了十次焦点小组讨论。数据收集时间为2018年2月至12月。我们发现参与者之间协作存在三个主要障碍。第一，对患者痛苦的理解不同，专业人员认为痛苦源于疾病症状，而患者认为源于药物不良反应。第二，对疾病（不）知晓的定义存在差异。专业人员将疾病知晓与治疗依从性联系起来，护理人员则将其理解为自我护理的同义词，而在患者中，“痛苦意识”成为一系列不适（即症状、药物不良反应、既往住院、耻辱感）的综合类别。第三，对于临床沟通的期望不一致，这可以浓缩在西班牙语单词“trato”和“tratamiento”含义的差异中，前者表示态度友好和达成一致，后者表示处理和管理。我们得出结论，这三个障碍为强制行为铺平了道路，并促使患者去主体化，在此称为“全患者”效应。本研究是欧洲首个GAM举措。
