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March 15, 2019 by Jone Bjornestad et al | Journal of Mental Health

Antipsychotic treatment – a systematic literature review and meta-analysis of qualitative studies

Jone Bjornestad, Kristina O. Lavik, Larry Davidson, Aslak Hjeltnes, Christian Moltu & Marius Veseth

Standardized clinical treatment guidelines recommend that individuals with psychosis be treated with antipsychotic medication in the acute phase as well as throughout the protracted phases of maintenance and recovery (APA, 2006; NICE, 2014). Antipsychotic medication has unequivocally proven effective in acute and short-term treatment (Bola, Kao, & Soydan, 2012; Lally et al., 2017; Leucht et al., 2017; Mackin & Thomas, 2011). Over the longer term, there are significant challenges related to this type of treatment.

First, a sizable share of those remitting after a first episode psychosis may be able to achieve a good long-term outcome with a very low dose or without antipsychotic drugs at all. Robust predictors for the early identification of these patients are still lacking, which may result in excessive use of antipsychotic medicine (Harrow, Jobe, Faull, & Yang, 2017; Moilanen et al., 2013; Murray et al., 2016; Wunderink, Nieboer, Wiersma, Sytema, & Nienhuis, 2013).

Second, severe side effects, particularly associated with long-term use, include grey matter volume decrease and lateral ventricular volume increase (Fusar-Poli et al., 2013; Moncrieff& Leo, 2010), diabetes (Rajkumar et al., 2017), metabolic syndrome (Vancampfort et al., 2015), and reduced subjective quality of life and functioning (Wunderink et al., 2013; Wykes et al., 2017).

Third, shared decision-making has become a stated priority in medical treatment in an attempt to reduce the use of compulsory treatment and increase subjective empowerment and adherence to treatments that are actively chosen (Leng, Clark, Brian, & Partridge, 2017). Hence, shared decision-making is a central part of the recovery paradigm (Alguera-Lara, Dowsey, Ride, Kinder, & Castle, 2017).

This perspective has emerged resulting from a growing body of evidence showing a gap between the realities of those who use, refuse, or are forced to take antipsychotic medication and professionals and researchers (Faulkner, 2015; Moncrieff, 2013). Nevertheless, and despite non-adherence to treatment recommendations continuing to be considered a sizeable public health problem (Kane, Kishimoto, & Correll, 2013), few studies have investigated the effects of shared decision-making in mental healthcare settings (Boychuk, Lysaght, & Stuart, 2018; Schauer, Everett, del Vecchio, & Anderson, 2007; Slade, 2017; Stovell, Morrison, Panayiotou, & Hutton, 2016).

Large scale, prospective long-term, double-blind, controlled studies using clearly defined samples in terms of illness type, severity, and duration evaluating treatment effect are lacking (Sohler et al., 2016). These types of studies are essential to reveal how antipsychotic treatment affects critical functioning throughout the course of illness (Rhee, Mohamed, & Rosenheck, 2018; Zipursky & Agid, 2015). Also, meta-analyses of qualitative studies are needed to systematically describe and summarize the growing empirical qualitative knowledge base on service users’ subjective perspectives on using antipsychotic drugs. Such studies are essential to inform large-scale trials with clinically relevant hypotheses, as well as to illuminate clinical implications for different sub-groups of individuals.

Full article (PDF)

Source: Journal of Mental Health

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