Motivations for and Experiences With Antipsychotic Tapering Among Patients With Schizophrenia Seeking Guided Dose Reduction.

Autor:	Nøstdal A; 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., Hilker R; 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., Nielsen J; 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., Nielsen MØ; 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.
Jazyk:	angličtina
Zdroj:	Psychiatric services (Washington, D.C.) [Psychiatr Serv] 2024 Nov 01; Vol. 75 (11), pp. 1117-1124. Date of Electronic Publication: 2024 Jun 19.
DOI:	10.1176/appi.ps.20230641
Abstrakt:	Objective: 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. Methods: 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. Results: 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%). Conclusions: 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. Competing Interests: Dr. Nøstdal has received honoraria from Lundbeck. Dr. Hilker has received honoraria from Lundbeck, Otsuka, and Janssen. Dr. J. Nielsen has received honoraria from Lundbeck and Bristol Myers Squibb. Dr. M. Ø. Nielsen reports no financial relationships with commercial interests.
Databáze:	MEDLINE
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