Re-starting the conversation: improving shared decision making in antipsychotic prescribing

Shared Decision-Making (SDM) is one of the key components of patient-centred care. People diagnosed with schizophrenia/psychosis still face significant barriers to achieving this, particularly when it comes to antipsychotic medication prescribing. These barriers include issues such as stigma, feelings of coercion and lack of information. Clinicians also describe barriers to achieving SDM in antipsychotic prescribing, including a lack of training and support. In this viewpoint article, we provide a summary of these barriers from the perspectives of both service users and clinicians based. We suggest that, to make a practical first step towards achieving SDM, the conversation around antipsychotic prescribing needs to be re-started. However, the onus to do this should not be placed solely on the shoulders of Service Users. More research is needed to address this issue

Experiences of taking neuroleptic medication and impacts on symptoms, sense of self and agency: a systematic review and thematic synthesis of qualitative data

Purpose: Neuroleptic (antipsychotic) drugs reduce psychotic symptoms, but how they achieve these effects and how the drugs’ effects are experienced by people who take them are less well understood. The present study describes a synthesis of qualitative data about mental and behavioural alterations associated with taking neuroleptics and how these interact with symptoms of psychosis and people’s sense of self and agency. Methods: Nine databases were searched to identify qualitative literature concerning experiences of taking neuroleptic medication. A thematic synthesis was conducted. Results: Neuroleptics were commonly experienced as producing a distinctive state of lethargy, cognitive slowing, emotional blunting and reduced motivation, which impaired functioning but also had beneficial effects on symptoms of psychosis and some other symptoms (e.g. insomnia). For some people, symptom reduction helped restore a sense of normality and autonomy, but others experienced a loss of important aspects of their personality. Across studies, many people adopted a passive stance towards long-term medication, expressing a sense of resignation, endurance or loss of autonomy. Conclusions: Neuroleptic drugs modify cognition, emotions and motivation. These effects may be associated with reducing the intensity and impact of symptoms, but also affect people’s sense of self and agency. Understanding how the effects of neuroleptics are experienced by those who take them is important in developing a more collaborative approach to drug treatment in psychosis and schizophreni

An analysis of views about supported reduction or discontinuation of antipsychotic treatment among people with schizophrenia and other psychotic disorders

BACKGROUND: Antipsychotic medication can reduce psychotic symptoms and risk of relapse in people with schizophrenia and related disorders, but it is not always effective and adverse effects can be significant. We know little of patients' views about continuing or discontinuing antipsychotic treatment. AIMS: To explore the views of people with schizophrenia and other psychotic disorders about continuing their antipsychotic medication or attempting to reduce or discontinue this medication with clinical support. METHODS: We collected quantitative and qualitative data by conducting semi-structured interviews in London, UK. Factors predicting a desire to discontinue medication were explored. Content analysis of qualitative data was undertaken. RESULTS: We interviewed 269 participants. 33% (95% CI, 27 to 39%) were content with taking long-term antipsychotic medication. Others reported they took it reluctantly (19%), accepted it on a temporary basis (24%) or actively disliked it (18%). 31% (95% CI, 25 to 37%) said they would like to try to stop medication with professional support, and 45% (95% CI, 39 to 51%) wanted the opportunity to reduce medication. People who wanted to discontinue had more negative attitudes towards the medication but were otherwise similar to other participants. Wanting to stop or reduce medication was motivated mainly by adverse effects and health concerns. Professional support was identified as potentially helpful to achieve reduction. CONCLUSIONS: This large study reveals that patients are commonly unhappy about the idea of taking antipsychotics on a continuing or life-long basis. Professional support for people who want to try to reduce or stop medication is valued

An analysis of views about supported reduction or discontinuation of antipsychotic treatment among people with schizophrenia and other psychotic disorders

Background Antipsychotic medication can reduce psychotic symptoms and risk of relapse in people with schizophrenia and related disorders, but it is not always effective and adverse effects can be significant. We know little of patients’ views about continuing or discontinuing antipsychotic treatment. Aims To explore the views of people with schizophrenia and other psychotic disorders about continuing their antipsychotic medication or attempting to reduce or discontinue this medication with clinical support. Methods We collected quantitative and qualitative data by conducting semi-structured interviews in London, UK. Factors predicting a desire to discontinue medication were explored. Content analysis of qualitative data was undertaken. Results We interviewed 269 participants. 33% (95% CI, 27 to 39%) were content with taking long-term antipsychotic medication. Others reported they took it reluctantly (19%), accepted it on a temporary basis (24%) or actively disliked it (18%). 31% (95% CI, 25 to 37%) said they would like to try to stop medication with professional support, and 45% (95% CI, 39 to 51%) wanted the opportunity to reduce medication. People who wanted to discontinue had more negative attitudes towards the medication but were otherwise similar to other participants. Wanting to stop or reduce medication was motivated mainly by adverse effects and health concerns. Professional support was identified as potentially helpful to achieve reduction. Conclusions This large study reveals that patients are commonly unhappy about the idea of taking antipsychotics on a continuing or life-long basis. Professional support for people who want to try to reduce or stop medication is valued

Behaviour change strategies for reducing blood pressure-related disease burden: findings from a global implementation research programme

Background: The Global Alliance for Chronic Diseases comprises the majority of the world’s public researchfunding agencies. It is focussed on implementation research to tackle the burden of chronic diseases inlow- and middle-income countries and amongst vulnerable populations in high-income countries. In itsinaugural research call, 15 projects were funded, focussing on lowering blood pressure-related diseaseburden. In this study, we describe a reflexive mapping exercise to identify the behaviour change strategiesundertaken in each of these projects.Methods: Using the Behaviour Change Wheel framework, each team rated the capability, opportunity andmotivation of the various actors who were integral to each project (e.g. community members, non-physicianhealth workers and doctors in projects focussed on service delivery). Teams then mapped the interventionsthey were implementing and determined the principal policy categories in which those interventions wereoperating. Guidance was provided on the use of Behaviour Change Wheel to support consistency inresponses across teams. Ratings were iteratively discussed and refined at several group meetings.Results: There was marked variation in the perceived capabilities, opportunities and motivation of the variousactors who were being targeted for behaviour change strategies. Despite this variation, there was a highdegree of synergy in interventions functions with most teams utilising complex interventions involvingeducation, training, enablement, environmental restructuring and persuasion oriented strategies. Similar policycategories were also targeted across teams particularly in the areas of guidelines, communication/marketingand service provision with few teams focussing on fiscal measures, regulation and legislation.Conclusions: The large variation in preparedness to change behaviour amongst the principal actors across theseprojects suggests that the interventions themselves will be variably taken up, despite the similarity in approaches taken.The findings highlight the importance of contextual factors in driving success and failure of research programmes.Forthcoming outcome and process evaluations from each project will build on this exploratory work and provide agreater understanding of factors that might influence scale-up of intervention strategies

Health, education, and social care provision after diagnosis of childhood visual disability

Aim: To investigate the health, education, and social care provision for children newly diagnosed with visual disability.Method: This was a national prospective study, the British Childhood Visual Impairment and Blindness Study 2 (BCVIS2), ascertaining new diagnoses of visual impairment or severe visual impairment and blindness (SVIBL), or equivalent vi-sion. Data collection was performed by managing clinicians up to 1-year follow-up, and included health and developmental needs, and health, education, and social care provision.Results: BCVIS2 identified 784 children newly diagnosed with visual impairment/SVIBL (313 with visual impairment, 471 with SVIBL). Most children had associated systemic disorders (559 [71%], 167 [54%] with visual impairment, and 392 [84%] with SVIBL). Care from multidisciplinary teams was provided for 549 children (70%). Two-thirds (515) had not received an Education, Health, and Care Plan (EHCP). Fewer children with visual impairment had seen a specialist teacher (SVIBL 35%, visual impairment 28%, χ2p < 0.001), or had an EHCP (11% vs 7%, χ2p < 0 . 01).Interpretation: Families need additional support from managing clinicians to access recommended complex interventions such as the use of multidisciplinary teams and educational support. This need is pressing, as the population of children with visual impairment/SVIBL is expected to grow in size and complexity.This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited

Body-Induced Blindness: Public Access Files

Supplementary Material for our manuscript, "Blinded by bodies: Elevated eating disorder symptomatology is associated with increased attentional priority for thin bodies