Reitan Elisabeth C Klæbo, Riley Henriette, Iversen Valentina C, Høye Anne
Division of Mental Health and Substance Abuse, University Hospital of North Norway (UNN), Tromsø, Norway.
Department of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, Norway.
BMC Psychiatry. 2024 Dec 2;24(1):872. doi: 10.1186/s12888-024-06327-5.
As a response to the political decision by the Norwegian Ministry of Health and Care Services to establish some kind of "medication free treatment" for patients with severe mental illness throughout the country, a 6-bed ward unit dedicated to offer such treatment was in 2017 established in Tromsø, Norway by the North Norway Health Care Region. The aim of the present study was to explore the experiences of patients admitted to this ward unit.
Semi-structured interviews were conducted with 19 persons who had received treatment from the ward during the period January 2017 to October 2021. Analysis was done in line with Systematic Text Condensation and interviews were recorded, transcribed and analyzed using software NVivo.
The importance of engaging in a dialogue about the possibilities of living a life without medication was unanimously validated, along with a focus on empowerment, motivation, activity and flexibility. Not everyone reported fulfillment of their own wishes or the ward's goal of tapering down, and reflected upon emotions such as ambivalence or fear. Three core concepts were identified to describe the participants' experiences: 1) Tapering off, 2) Relations, and 3) Frames and content. A fourth concept overarches the process formed by these concepts; 4) Processes across categories.
The study contributes to a deeper understanding of what "medication free" truly means, going beyond simply taking or not taking medications. It adds nuance to the debate surrounding medication free treatment. The ability to taper off medications is linked to intrapersonal factors, such as readiness and personal commitment, as well as the therapeutic environment, including the frames and values present on the ward. "Medication free" is more complex than it may initially appear, as many participants continue to use some form of psychotropic drugs. The sense of being part of something new and "exclusive" can be understood in light of what participants felt was lacking in previous treatment. It appears to be a need of rediscovering the significance of empowerment and empathic relationships in treatment of severe mental illness, in order to foster a sense of coherence and meaning.
作为对挪威卫生和社会事务部关于在全国为重度精神疾病患者建立某种“无药物治疗”的政治决定的回应，2017年挪威北部医疗保健区在特罗姆瑟设立了一个拥有6张床位的病房单元，专门提供此类治疗。本研究的目的是探索入住该病房单元的患者的经历。
对2017年1月至2021年10月期间在该病房接受治疗的19人进行了半结构化访谈。分析采用系统文本浓缩法进行，访谈进行了录音、转录，并使用NVivo软件进行分析。
一致认可了就不服用药物生活的可能性进行对话的重要性，同时强调了赋权、动机、活动和灵活性。并非每个人都报告实现了自己的愿望或病房逐渐减少用药的目标，并反思了矛盾心理或恐惧等情绪。确定了三个核心概念来描述参与者的经历：1）逐渐减药，2）关系，3）框架与内容。第四个概念涵盖了由这些概念形成的过程；4）跨类别过程。
该研究有助于更深入地理解“无药物”的真正含义，而不仅仅是简单地服用或不服用药物。它为围绕无药物治疗的辩论增添了细微差别。逐渐减少用药的能力与个人因素有关，如准备情况和个人承诺，也与治疗环境有关，包括病房的框架和价值观。“无药物”比最初看起来更复杂，因为许多参与者继续使用某种形式的精神药物。鉴于参与者认为以前的治疗缺乏某些东西，他们对成为新的、“独特”事物一部分的感觉是可以理解的。为了培养连贯感和意义感，似乎需要重新发现赋权和共情关系在重度精神疾病治疗中的重要性。
