Mental health staff reluctant to support service users tapering off antipsychotic medication, study finds

Many people with schizophrenia often express a desire to reduce or even stop taking antipsychotic medications, mainly because of the serious side effects associated with long-term use. However, a recent study found that people using these services receive little support from mental health professionals in this endeavour.

A new research paper by Kickan Roed, Niels Buus, Julie Midtgaard and colleagues, is published in the journal Qualitative health research, found that mental health staff appeared reluctant to allow service users to make decisions regarding their own treatment. These findings are concerning: despite the growing debate surrounding the balance between benefits and treatment-related side effects of long-term antipsychotic maintenance, many health care professionals Health remains hesitant to support tapering efforts.

This often leaves the service user with the difficult task of tapering off medication. The authors write:

Our findings indicate that interdisciplinary mental health staff appear reluctant to let service users make decisions and limit the ability of people with schizophrenia to be seen by mental health staff. psychotic response to requests for tapering of their antipsychotic medication.

Stopping gesture of senior doctor at clinic

The aim of this study was to investigate mental health professionals’ perspectives on reducing antipsychotic use. The researchers also aimed to determine how aware mental health staff were of their rights and responsibilities and the rights and responsibilities of service users.

To this end, 39 mental health workers from two regions in Denmark were recruited for the study and six focus groups were conducted between May and June 2022. Participants included a variety of mental health staff positions, with registered nurses (13) and nursing assistants (15) being the majority. Sixteen participants worked in community services, 13 in inpatient services and 10 in outpatient services, with an average of 13 years of experience in the mental health field. During focus group sessions, participants were presented with complaints related to the use of antipsychotic medications in people diagnosed with psychotic disorders, intended to create tension and arousal. like to discuss.

Three researchers carefully examined the transcripts and audio recordings of each focus group. They observed that mental health staff tended to hold one of three views about service users’ tapering of antipsychotic medication and recorded data around these three views.

The authors identified the following three perspectives surrounding antipsychotic tapering:

  • No, eventually the patient will realize that they need medication.
  • Yes, but tapering means there is a major risk of symptoms recurring.
  • Yes, we need to embrace risk to support personal recovery.

In focus groups, some participants expressed more than one perspective, but employees mainly related to one perspective. It’s important to note that these positions are not tied to a specific environment, professional experience, age, or gender.

Participants who believed that patients would eventually recognize their need for medication considered antipsychotics effective in reducing symptoms of psychosis. They compared these drugs to other drugs used to treat physical diseases, such as insulin. They view schizophrenia as a chronic illness and believe that symptom remission indicates that antipsychotic medication is working and should be continued. These participants tended to avoid discussing side effects caused by antipsychotic medications.

These participants relied heavily on concepts of adherence and illness insight, in which failure to take antipsychotics when prescribed was considered non-adherence and evidence that the person was service users lack insight into their condition. Tapering is seen primarily as a negotiation tactic where staff can eventually persuade the service user to take the full dose.

These participants often questioned the authenticity of service users’ preferences, for example by dismissing requests for tapering when service users follow trends or act impulsively. Mental health workers espousing this view see themselves as having the right to allow patients’ wishes and the responsibility to protect society from those who use psychiatric services. They see service users as ideally receiving treatment passively.

Participants endorsed the view Yes, but tapering means there is a large risk of relapse of symptoms considered antipsychotics to be useful in controlling symptoms and allowing recovery from the disorder mental. While this group views antipsychotics as an integral part of treatment, they also acknowledge that medications are often overused as a cheaper treatment option and can be heavily relied upon. ways for service users to quickly leave the hospital.

These participants endorsed tapering as good clinical practice that should be applied once the service user has stabilized. Although tapering was seen as positive in preventing overdoses and drug side effects, this group did not consider the priority of service users to be of primary importance in the process.

This group expressed some concerns about antipsychotic tapering. These participants endorsed both the risk of relapse and the risk of drug abuse as reasons not to reduce antipsychotic dosage. They believe that tapering should only be implemented with service users who do not have multiple psychotic episodes and only during prolonged periods of stability.

These mental health workers see themselves as knowledgeable professionals and have the power to protect service users. This means that service users are considered vulnerable and have a right to be protected from harm.

Participants endorsed the view that Yes, we need to take risks to support personal recovery given that schizophrenia spectrum disorders are transient with symptoms coming and going. This group advocates phasing in service user requests as a way to protect service user rights and respect their preferences.

They also like to reassess service users’ prescriptions regularly as the service user develops and learns coping strategies, to find the lowest amount of medication that can be used to control symptoms .

This group often reported discussing tapering with service users as part of regular conversations about the effects of their prescribed medication on them. They emphasize monitoring service users’ triggers, stressors, and other warning signs that may signal relapse throughout the tapering process. They also emphasize identifying effective coping strategies to help prevent relapse.

Tapering is also considered beneficial for recovery because service users are better able to connect and participate in recovery-oriented activities once they are no longer taking high doses of antipsychotic medication.

These mental health workers consider themselves to have limited knowledge so they seek the experiential knowledge of the service users they work with. They also see themselves as the result of regular dialogue with service users, because sometimes they know service users better than service users know themselves. In their eyes, this gives them the right to speak for service users in decisions regarding medication use and dose reduction.

There are several limitations to the current study. Participants were recruited exclusively from two regions of Denmark, severely limiting generalizability to other populations. The sample size was also small, limiting generalizability even within the two Danish regions where the study was conducted. The authors conclude:

The three distinctive perspectives identified in this article primarily reflect biomedical discourse and, to a lesser extent, recovery-oriented discourse. Notably, all three perspectives reflect a degree of paternalism with a limited view of mental health service users’ autonomous choice and active participation in related decision-making. come for treatment.

Research has shown that antipsychotics have many long-term side effects. Antipsychotic use has been linked to premature death, dementia, sexual dysfunction, and brain damage. It is also common to prescribe these medications without explicit consent.

Some studies show that tapering antipsychotic medications may reduce the risk of psychotic symptoms. However, it is best to taper slowly to avoid withdrawal symptoms and relapse.

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Roed, K., Buus, N., Nielsen, J., Christensen, P., & Midtgaard, J. (2023). Mental health staff’s perspectives on antipsychotic tapering: a focus group study. Qualitative health research. https://doi.org/10.1177/10497323231195821 (Link)

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