Gates Jesse, Ellinghaus Carli, Valentine Lee, Kamitsis Ilias, Stainton Alexandra, Harrigan Susy, Thompson Andrew, Alvarez-Jimenez Mario, Wood Stephen, Polari Andrea, Gleeson John F, Bartholomeusz Cali, Allott Kelly, Killackey Eóin, Bendall Sarah
Orygen.
Centre for Mental Health, Melbourne School of Population and Global Health, University of Melbourne.
Psychiatr Rehabil J. 2024 Dec;47(4):313-321. doi: 10.1037/prj0000606. Epub 2024 Jul 18.
The current guidelines recommend continuation of antipsychotic medication for a minimum of at least 1 year following a first episode of psychosis (FEP). There have been several trials investigating whether early dose reduction or cessation leads to improved functional outcomes. The aim of this study was to explore the experience of consenting to and participating in a randomized controlled trial (RCT) of antipsychotic medication cessation.
Five participants in the Reduce trial-an RCT evaluating early antipsychotic medication dose reduction/cessation following FEP-aged 22-24 years completed a semistructured qualitative interview following the RCT. Interpretive phenomenological analysis was undertaken to understand the key themes.
A superordinate theme was derived from interviews: the Liminal Space of FEP and treatment. Themes within the Liminal Space included: rejection versus identification with psychosis, medication as symbolic of illness versus wellness, embodiment of wellness and illness with medication, medication as symbolic of independence versus dependence, discovery of independence when autonomously choosing medication, the Reduce trial offered safety to navigate the liminal space, and self-exploration versus altruism.
The experience and treatment of FEP involves young people feeling torn between multiple, competing perspectives, demands, and priorities. Participation in an RCT exploring dose reduction provided additional supports contributing to the perception of greater safety to navigate their own experiences of treatment that was appropriate for them. When treatment is experienced as collaborative, involves shared decision making and support, other than medication, young people feel more equipped to navigate the liminal space. (PsycInfo Database Record (c) 2024 APA, all rights reserved).
当前指南建议在首次精神病发作（FEP）后至少持续使用抗精神病药物1年。已有多项试验研究早期减药或停药是否能改善功能结局。本研究的目的是探讨同意并参与抗精神病药物停药随机对照试验（RCT）的经历。
“减少”试验（一项评估FEP后早期抗精神病药物剂量减少/停药的RCT）中的5名年龄在22 - 24岁的参与者在RCT结束后完成了半结构化定性访谈。采用解释现象学分析来理解关键主题。
从访谈中得出一个上位主题：FEP与治疗的临界空间。临界空间内的主题包括：对精神病的排斥与认同、药物作为疾病与健康的象征、药物体现的健康与疾病、药物作为独立与依赖的象征、自主选择药物时发现的独立性、“减少”试验为穿越临界空间提供了安全性、自我探索与利他主义。
FEP的经历和治疗使年轻人在多种相互竞争的观点、需求和优先事项之间感到矛盾。参与一项探索减药的RCT提供了额外的支持，有助于他们更有安全感地应对适合自己的治疗经历。当治疗被体验为协作性的，涉及共同决策和除药物之外的支持时，年轻人会觉得更有能力穿越临界空间。（PsycInfo数据库记录（c）2024美国心理学会，保留所有权利）
