Unit for Complicated Schizophrenia, Mental Health Center Glostrup, Mental Health Service Capital Region, Glostrup, Denmark; Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen.
Psychiatr Serv. 2024 Nov 1;75(11):1117-1124. doi: 10.1176/appi.ps.20230641. Epub 2024 Jun 19.
Over time, most patients with schizophrenia wish to reduce or discontinue their antipsychotic medication treatment. In Denmark, a specialized government-funded outpatient clinic was established to offer guided antipsychotic dose reduction. This study aimed to provide data on motivations for and previous experiences with antipsychotic tapering among patients attending the clinic.
Patients completed an open-ended survey on their motivations for discontinuing or tapering antipsychotic medication and recorded their expectations about these outcomes. They also provided information on previous experiences with discontinuing medication and their level of symptoms, functioning, and side effects.
The survey was completed by 76 (86%) of 88 patients. The main motivations for discontinuing antipsychotics were adverse effects (71%) and uncertainty about the necessity of taking antipsychotics (29%). Other factors included concerns about long-term effects, disagreeing with the diagnosis, experiencing an insufficient effect, and feeling stigmatized by taking medication. Previous experience with discontinuation of antipsychotics was reported by 42 patients, of whom 23 reported relapse as the outcome. Most patients believed they could succeed in dose reduction (N=73 of 75, 97%) or discontinuation (N=62 of 75, 83%).
Motivational factors reported for professionally guided antipsychotic dose reduction align with previous studies examining patients choosing to discontinue these medications. Despite reports of relapse during prior discontinuation attempts, most patients still reported motivation for and belief in successful dose reduction or discontinuation. An understanding of patients' motivations and beliefs is paramount to an optimal treatment alliance. Offering guided dose reduction may reduce sudden and unsupported discontinuation of antipsychotics.
随着时间的推移，大多数精神分裂症患者希望减少或停止使用抗精神病药物治疗。在丹麦，成立了一个专门的政府资助的门诊诊所，提供抗精神病药物剂量减少的指导。本研究旨在提供参加该诊所的患者停止或减少抗精神病药物剂量的动机和先前经验的数据。
患者完成了一份关于停止或减少抗精神病药物的开放性调查，记录了他们对这些结果的期望。他们还提供了关于以前停药经历以及他们的症状、功能和副作用水平的信息。
共有 88 名患者中的 76 名（86%）完成了调查。停止使用抗精神病药物的主要动机是不良反应（71%）和对抗精神病药物必要性的不确定性（29%）。其他因素包括对长期影响的担忧、不同意诊断、感觉效果不足和因服用药物而感到被污名化。42 名患者报告了以前停药的经历，其中 23 名报告了复发的结果。大多数患者认为他们可以成功减少剂量（N=73/75，97%）或停止用药（N=62/75，83%）。
专业指导的抗精神病药物剂量减少的报告动机与以前研究中检查选择停止这些药物的患者的研究结果一致。尽管以前停药尝试中报告了复发，但大多数患者仍报告了成功减少剂量或停药的动机和信念。了解患者的动机和信念对于建立最佳的治疗联盟至关重要。提供剂量减少指导可能会减少抗精神病药物的突然和无支持的停药。
