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Published in: Social Psychiatry and Psychiatric Epidemiology 7/2018

01-07-2018 | Original Paper

Attempting to stop antipsychotic medication: success, supports, and efforts to cope

Authors: Miriam Larsen-Barr, Fred Seymour, John Read, Kerry Gibson

Published in: Social Psychiatry and Psychiatric Epidemiology | Issue 7/2018

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Abstract

Purpose

To explore supports and coping strategies used during attempts to discontinue antipsychotic medication and test for associations with success.

Method

144 people who were taking or had taken antipsychotics completed The Experiences of Antipsychotic Medication Survey. Among them, 105 people had made at least one discontinuation attempt and answered a series of questions about their most recent attempt to stop. Content analysis and Chi-square tests of independence were used to categorise the data and explore associations. Success was defined as stopping all AM use irrespective of the duration of the medication-free period or whether relapse occurred, which were explored separately.

Results

Among the 105 people who had attempted discontinuation, 61.9% described unwanted withdrawal effects and 27.6% of the group described psychotic or manic relapse during the withdrawal period. Within this group 55% described successfully stopping all AM for varying lengths of time, half reported no current use, and half described having some form of professional, family, friend, and/or service user or peer support for their attempt. Having support was positively associated with success and negatively associated with both current use, and relapse during withdrawal. A range of coping efforts were described, but having coping strategies failed to show significant associations with any of the dependent variables explored. Among those who described successfully stopping, some described returning to AM for short periods when needed, while others reported managing well with alternative methods alone.

Conclusions

Findings cannot be readily generalised due to sampling constraints, but results suggest a wide range of supports and coping strategies may be used when attempting to discontinue antipsychotics. Many people may attempt to discontinue antipsychotics without any support. Those who have support for their attempts may be significantly less likely to relapse during withdrawal and more likely to succeed in their attempt. There is a pressing need for further research in this area.
Literature
1.
go back to reference Lieberman JA, Stroup TS, McEvoy JP, Swartz MS, Rosenheck RA, Perkins DO et al (2005) Effectiveness of antipsychotic drugs in patients with chronic schizophrenia. N Engl J Med 353:1209–1223CrossRefPubMed Lieberman JA, Stroup TS, McEvoy JP, Swartz MS, Rosenheck RA, Perkins DO et al (2005) Effectiveness of antipsychotic drugs in patients with chronic schizophrenia. N Engl J Med 353:1209–1223CrossRefPubMed
2.
go back to reference Cooper D, Moisan J, Gaudet M, Abdous B, J Gregoire (2005) Ambulatory use of olanzapine and risperidone: a population-based study on persistence and the use of concomitant therapy in the treatment of schizophrenia. Can J Psychiatry 50:901–908CrossRefPubMed Cooper D, Moisan J, Gaudet M, Abdous B, J Gregoire (2005) Ambulatory use of olanzapine and risperidone: a population-based study on persistence and the use of concomitant therapy in the treatment of schizophrenia. Can J Psychiatry 50:901–908CrossRefPubMed
3.
go back to reference Nishikawa T, Hayashi T, Koga I, Uchida Y. (2007) Neuroleptic withdrawal with remitted schizophrenics: a naturalistic follow-up study. Psychiatry: Interpers Biol Process 70:68CrossRef Nishikawa T, Hayashi T, Koga I, Uchida Y. (2007) Neuroleptic withdrawal with remitted schizophrenics: a naturalistic follow-up study. Psychiatry: Interpers Biol Process 70:68CrossRef
4.
go back to reference Harrow MH, Jobe TH, Faull RN (2012) Do all schizophrenia patients need antipsychotic treatment continuously throughout their lifetime? A 20-year longitudinal study. PsycholMed 42:2145–2155 Harrow MH, Jobe TH, Faull RN (2012) Do all schizophrenia patients need antipsychotic treatment continuously throughout their lifetime? A 20-year longitudinal study. PsycholMed 42:2145–2155
5.
go back to reference Schooler NR, Goldberg SC, Boothe H, Cole JO (1967) One year after discharge: community adjustment of schizophrenic patients. Am J Psychiatry 123:986CrossRefPubMed Schooler NR, Goldberg SC, Boothe H, Cole JO (1967) One year after discharge: community adjustment of schizophrenic patients. Am J Psychiatry 123:986CrossRefPubMed
6.
go back to reference Chouinard G, Chouinard V (2008) Atypical antipsychotics: CATIE study, drug-induced movement disorder and resulting iatrogenic psychiatric-like symptoms, supersensitivity rebound psychosis and withdrawal discontinuation syndromes. Psychother Psychosom 77:69CrossRefPubMed Chouinard G, Chouinard V (2008) Atypical antipsychotics: CATIE study, drug-induced movement disorder and resulting iatrogenic psychiatric-like symptoms, supersensitivity rebound psychosis and withdrawal discontinuation syndromes. Psychother Psychosom 77:69CrossRefPubMed
7.
go back to reference Baldessarini RJ, Viguera AC (1995) Neuroleptic withdrawal in schizophrenic patients. Arch Gen Psychiatry 52:189CrossRefPubMed Baldessarini RJ, Viguera AC (1995) Neuroleptic withdrawal in schizophrenic patients. Arch Gen Psychiatry 52:189CrossRefPubMed
8.
go back to reference Wunderink L, Nieboer RM, Wiersma D, Sytema S, Nienhuis FJ (2013) Recovery in remitted first-episode psychosis at 7 years of follow-up of an early dose reduction/ discontinuation or maintenance treatment strategy: long-term follow-up of a 2-year randomized clinical trial. JAMA Psychiatry 70:913CrossRefPubMed Wunderink L, Nieboer RM, Wiersma D, Sytema S, Nienhuis FJ (2013) Recovery in remitted first-episode psychosis at 7 years of follow-up of an early dose reduction/ discontinuation or maintenance treatment strategy: long-term follow-up of a 2-year randomized clinical trial. JAMA Psychiatry 70:913CrossRefPubMed
9.
go back to reference Landolt K, Rössler W, Ajdacic-Gross V, Derks EM, Libiger J, Kahn RS et al (2016) Predictors of discontinuation of antipsychotic medication and subsequent outcomes in the European First Episode Schizophrenia Trial (EUFEST). Schizophrenia Res 172:145–151CrossRef Landolt K, Rössler W, Ajdacic-Gross V, Derks EM, Libiger J, Kahn RS et al (2016) Predictors of discontinuation of antipsychotic medication and subsequent outcomes in the European First Episode Schizophrenia Trial (EUFEST). Schizophrenia Res 172:145–151CrossRef
10.
go back to reference Steiner W, Laporta M, Chouinard G (1990) Neuroleptic-induced supersensitivity psychosis in patients with bipolar affective disorder. Acta Psychiatr Scand 81:437–440CrossRefPubMed Steiner W, Laporta M, Chouinard G (1990) Neuroleptic-induced supersensitivity psychosis in patients with bipolar affective disorder. Acta Psychiatr Scand 81:437–440CrossRefPubMed
11.
go back to reference Chouinard G (1991) Severe cases of neuroleptic-induced supersensitivity psychosis: diagnostic criteria for the disorder and its treatment, Schizophr Res 5:21–33CrossRefPubMed Chouinard G (1991) Severe cases of neuroleptic-induced supersensitivity psychosis: diagnostic criteria for the disorder and its treatment, Schizophr Res 5:21–33CrossRefPubMed
12.
go back to reference Moncrieff J (2013) The bitterest pills: the troubling story of antipsychotic drugs. Palgrave Macmillan, LondonCrossRef Moncrieff J (2013) The bitterest pills: the troubling story of antipsychotic drugs. Palgrave Macmillan, LondonCrossRef
13.
go back to reference Moncrieff J, Cohen D, Porter S (2013) The psychoactive effects of psychiatric medication: the elephant in the room. J Psychoact Drugs 45:409–415CrossRef Moncrieff J, Cohen D, Porter S (2013) The psychoactive effects of psychiatric medication: the elephant in the room. J Psychoact Drugs 45:409–415CrossRef
14.
go back to reference Byrne R, Davies L, A Morrison (2010) Priorities and preferences for the outcomes of treatment of psychosis: a service user perspective. Psychosis 2:210–217CrossRef Byrne R, Davies L, A Morrison (2010) Priorities and preferences for the outcomes of treatment of psychosis: a service user perspective. Psychosis 2:210–217CrossRef
15.
go back to reference McGorry P, Alvarez-Jimenez M, Killackey E (2013) Antipsychotic medication during the critical period following remission from first- episode psychosis: less is more. JAMA Psychiatry 70:898CrossRefPubMed McGorry P, Alvarez-Jimenez M, Killackey E (2013) Antipsychotic medication during the critical period following remission from first- episode psychosis: less is more. JAMA Psychiatry 70:898CrossRefPubMed
16.
go back to reference Breggin PR (2013) Psychiatric Drug Withdrawal: a guide for prescribers, therapists, patients and their families. Springer Publishing Company, New York Breggin PR (2013) Psychiatric Drug Withdrawal: a guide for prescribers, therapists, patients and their families. Springer Publishing Company, New York
17.
go back to reference Hall W (2012) The harm reduction guide to coming off psychiatric drugs, 2nd edn., The Icarus Project and Freedom Centre, USA Hall W (2012) The harm reduction guide to coming off psychiatric drugs, 2nd edn., The Icarus Project and Freedom Centre, USA
19.
go back to reference Geyt GL, Awenat Y, Tai S, Haddock G (2016) Personal accounts of discontinuing neuroleptic medication for psychosis. Qual Health Res 26:1–16 Geyt GL, Awenat Y, Tai S, Haddock G (2016) Personal accounts of discontinuing neuroleptic medication for psychosis. Qual Health Res 26:1–16
20.
go back to reference Salomon C, Hamilton B (2013) “All roads lead to medication?” Qualitative responses from an australian first- person survey of antipsychotic discontinuation. Psychiatr Rehabil J 36:160–165CrossRefPubMed Salomon C, Hamilton B (2013) “All roads lead to medication?” Qualitative responses from an australian first- person survey of antipsychotic discontinuation. Psychiatr Rehabil J 36:160–165CrossRefPubMed
21.
go back to reference Salomon C, Hamilton B, Elsom S (2014) Experiencing antipsychotic discontinuation: results from a survey of Australian consumers. J Psychiatr Ment Health Nurs 21:917CrossRefPubMed Salomon C, Hamilton B, Elsom S (2014) Experiencing antipsychotic discontinuation: results from a survey of Australian consumers. J Psychiatr Ment Health Nurs 21:917CrossRefPubMed
22.
go back to reference Jung E, Wiesjahn M, Wendt H, Bock T, Rief W, Lincoln TM (2016) Symptoms, functioning and coping strategies in individuals with schizophrenia spectrum disorders who do not take antipsychotic medication: a comparative interview study. Psychol Med 46:2179–2188CrossRefPubMed Jung E, Wiesjahn M, Wendt H, Bock T, Rief W, Lincoln TM (2016) Symptoms, functioning and coping strategies in individuals with schizophrenia spectrum disorders who do not take antipsychotic medication: a comparative interview study. Psychol Med 46:2179–2188CrossRefPubMed
23.
go back to reference Larsen-Barr MT (2016) Experiencing antipsychotic medication: from first prescriptions to attempted discontinuation. University of Auckland doctoral thesis, New Zealand Larsen-Barr MT (2016) Experiencing antipsychotic medication: from first prescriptions to attempted discontinuation. University of Auckland doctoral thesis, New Zealand
24.
go back to reference Read J, Cartwright C, Gibson K (2014) Adverse emotional and interpersonal effects reported by 1829 New Zealanders while taking antidepressants. Psychiatry Res 216:67–73CrossRefPubMed Read J, Cartwright C, Gibson K (2014) Adverse emotional and interpersonal effects reported by 1829 New Zealanders while taking antidepressants. Psychiatry Res 216:67–73CrossRefPubMed
25.
go back to reference Zipursky RB, Menezes NM, Streiner DL (2014) Risk of symptom recurrence with medication discontinuation in first-episode psychosis: a systematic review. Schizophr Res 152:408–414CrossRefPubMed Zipursky RB, Menezes NM, Streiner DL (2014) Risk of symptom recurrence with medication discontinuation in first-episode psychosis: a systematic review. Schizophr Res 152:408–414CrossRefPubMed
26.
go back to reference Gilbert PL, Harris MJ, McAdams LA, Jeste DV (1995) Neuroleptic withdrawal in schizophrenic patients: Review of the literature. Arch Gen Psychiatry 52:173–188CrossRefPubMed Gilbert PL, Harris MJ, McAdams LA, Jeste DV (1995) Neuroleptic withdrawal in schizophrenic patients: Review of the literature. Arch Gen Psychiatry 52:173–188CrossRefPubMed
27.
go back to reference Davidson L (2011) Recovery from psychosis: What’s love got to do with it? Psychosis–Psychol Soc Integr Approaches 3:105–114 Davidson L (2011) Recovery from psychosis: What’s love got to do with it? Psychosis–Psychol Soc Integr Approaches 3:105–114
28.
go back to reference Roe D, Goldblatt H, Baloush-Klienman V, Swarbrick M, Davidson L (2009) Why and how people decide to stop taking prescribed psychiatric medication: exploring the subjective process of choice. Psychiatr Rehabil J 33:38–46CrossRefPubMed Roe D, Goldblatt H, Baloush-Klienman V, Swarbrick M, Davidson L (2009) Why and how people decide to stop taking prescribed psychiatric medication: exploring the subjective process of choice. Psychiatr Rehabil J 33:38–46CrossRefPubMed
29.
go back to reference Gibson S, Brand S, Burt S, Boden Z, O Benson (2013) Understanding treatment non-adherence in schizophrenia and bipolar disorder: a survey of what service users do and why. BMC Psychiatry 13:153CrossRefPubMedPubMedCentral Gibson S, Brand S, Burt S, Boden Z, O Benson (2013) Understanding treatment non-adherence in schizophrenia and bipolar disorder: a survey of what service users do and why. BMC Psychiatry 13:153CrossRefPubMedPubMedCentral
30.
go back to reference Morrison AP, Hutton P, Shiers D, Turkington D (2012) Antipsychotics: is it time to introduce patient choice? Br J Psychiatry 201:83–84CrossRefPubMed Morrison AP, Hutton P, Shiers D, Turkington D (2012) Antipsychotics: is it time to introduce patient choice? Br J Psychiatry 201:83–84CrossRefPubMed
31.
go back to reference Bentall RP, Morrison AP (2002) More harm than good: the case against using anti-psychotic drugs to prevent severe mental illness. J Mental Health 11:351–356CrossRef Bentall RP, Morrison AP (2002) More harm than good: the case against using anti-psychotic drugs to prevent severe mental illness. J Mental Health 11:351–356CrossRef
32.
go back to reference del Barrio LR, Cyr C, Benisty L, Richard P (2013) Autonomous Medication Management (GAM): new perspectives on well-being, quality of life and psychiatric medication/Gestao Autonoma da Medicacao (GAM): novas perspectivas sobre bem-estar, qualidade de vida e medicacao psiquiatrica.(Author abstract), Ciencia & Saude Coletiva. 18 del Barrio LR, Cyr C, Benisty L, Richard P (2013) Autonomous Medication Management (GAM): new perspectives on well-being, quality of life and psychiatric medication/Gestao Autonoma da Medicacao (GAM): novas perspectivas sobre bem-estar, qualidade de vida e medicacao psiquiatrica.(Author abstract), Ciencia & Saude Coletiva. 18
33.
go back to reference The Health and Disability Commissioner (1996) The code of health and disability services consumers’ rights, Wellington The Health and Disability Commissioner (1996) The code of health and disability services consumers’ rights, Wellington
34.
go back to reference Irwin E, Mitchell L, Durkin L, Douieb B (1972) The need for a mental patients union (The Fish Pamphlet). Self-published, London, England Irwin E, Mitchell L, Durkin L, Douieb B (1972) The need for a mental patients union (The Fish Pamphlet). Self-published, London, England
36.
37.
go back to reference Gawith L, Abrams P (2006) Long journey to recovery for Kiwi consumers: recent developments in mental health policy and practice in New Zealand, Australian Psychologist, vol 41, pp 140–148 Gawith L, Abrams P (2006) Long journey to recovery for Kiwi consumers: recent developments in mental health policy and practice in New Zealand, Australian Psychologist, vol 41, pp 140–148
38.
Metadata
Title
Attempting to stop antipsychotic medication: success, supports, and efforts to cope
Authors
Miriam Larsen-Barr
Fred Seymour
John Read
Kerry Gibson
Publication date
01-07-2018
Publisher
Springer Berlin Heidelberg
Published in
Social Psychiatry and Psychiatric Epidemiology / Issue 7/2018
Print ISSN: 0933-7954
Electronic ISSN: 1433-9285
DOI
https://doi.org/10.1007/s00127-018-1518-x

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