The meaning and management of neuroleptic medication: a study of patients with a diagnosis of schizophrenia
Introduction
The medical literature has portrayed non-adherence with prescribed medication as problematic because it is perceived to be a common cause of the failure of medical treatment, leading to an increase in the use of medical resources (Ley, 1992). Non-compliance is seen to create particular medical and social problems when the drugs concerned are neuroleptics (anti-psychotics) such as chlorpromazine or haloperidol. These drugs are commonly prescribed to patients diagnosed as suffering from schizophrenia in order to control or diminish positive psychotic symptoms such as hallucinations, delusions and ideas of persecution. These drugs are also used to tranquillise patients who are seen to be a danger to themselves or others and have little or no impact on the negative symptoms of psychosis, such as apathy or social withdrawal (Hirsch, 1986). Continuing and changing the dosage of this medication is the primary method of medically managing psychosis, even though the outcome literature indicates that the response to neuroleptics is highly variable1. Other means of management such as family and individual psychotherapy based on cognitive behavioural principles, though of proven efficacy, remain marginal to mainstream practice (Haddock and Slade, 1996). The failure of patients who are prescribed these medications to submit to medical authority by adhering to prescribed regimens is usually regarded as evidence of a lack of “insight” which is viewed as integral to the illness (Bartko et al., 1988). Moreover, failure to take neuroleptic drugs has been linked with frequent readmissions to hospital (Green, 1988). In social policy terms, non-compliance with neuroleptic medication has come to be seen as a threat to the legitimisation of de-institutionalisation and functioning of community mental health policies (Scheff, 1976; Scull, 1977; Rogers and Pilgrim, 1995). Despite the importance attributed to this form of medication taking, little attention has been paid to the patient meaning and management of these drugs or the way in which the specific context of mental health policy impinges on peoples medication practices. This paper is concerned with applying a patient-focused approach to understanding this issue using qualitative data derived from the personal accounts of people diagnosed as suffering from schizophrenia.
Section snippets
Mental health policy and neuroleptic medication taking
Within wider society, psychiatric patients “non-compliance” with neuroleptic medication has emerged as a significant social problem. Images of de-institutionalisation, often promoted via the media, have become synonymous with the creation of a new social problem, the occurrence of socially unacceptable behaviour by ex-psychiatric patients living in the community (Monahan, 1992). As neuroleptic medication has been accepted as a valid means of managing and controlling people who are viewed as a
Adherence to neuroleptic medication
Contrary to the assumption amongst some professional groups that non-compliance is worse amongst people with a diagnosis of schizophrenia, the literature suggests that adherence to neuroleptic medication is similar to groups of patients taking medication for other conditions. At least one third of medical patients do not adhere to medically prescribed drug regimens (Stockwell Morris and Schulz, 1992) and adherence rates with medications over a long period tend to converge at approximately 50% (
Method and sample
The larger research project from which these data are drawn endeavours to assess the effectiveness of two psychological interventions designed to enhance compliance with neuroleptic medication. One intervention is the current “gold standard” in which information is provided as suggested by “good” psychiatric practice. The other is a cognitive-behavioural model designed to work with patients' own definitions of their condition and which requires patients to self-monitor their most distressing
Symptom reduction vs side-effects
Respondents were asked what they viewed as the benefits and costs of taking neuroleptic medication. Three of the respondents reported no beneficial effects of taking medication. However, for most of the participants, continuation with prescribed medication stemmed from a recognition of the benefits that were gained from the medication and/or the personal costs associated with not complying with the regimen. Four people considered that preventing relapse and thus preventing hospitalisation was
Conclusion
In common with the findings of other studies of medication use for chronic illness, the self-regulation of neuroleptic drugs amongst those with a diagnosis of schizophrenia offers an example of how people attempt to retain or gain some personal control over a condition and its management. People were found to take medication and adopt other self care strategies in a way which helped them to manage a set of problems that they faced in their every day lives. For respondents in this study, taking
Acknowledgements
This study was funded by a grant from the Medical Research Council the North West NHSE and the Welsh Office. We are grateful for the helpful comments of John Monahan and David Pilgrim and for the suggestions of two anonymous referees.
References (41)
- et al.
Medication decision-making and management: A client centred model
Social Science and Medicine
(1996) Tonic fuel and food: social and symbolic aspects of the long-term use of psychotropic drugs
Social Science and Medicine
(1981)- Allsop, J. (1995) Health Policy and the NHS. Longman,...
- American Psychiatric Association (1994) Diagnostic and Statistical Manual for Mental Disorders, 4th ed. Author,...
Judging drugs: patients' conceptions of therapeutic efficacy in the treatment of arthritis
Human Organisation
(1980)- et al.
Clinical symptomatology and drug compliance in schizophrenic patients
Acta Psychiatrica Scandinavica
(1988) - Bentall, R. P., Day, J., Rogers, A., Healy, D. and Stevenson, R. C. (1996) Side effects of neuroleptic medication:...
- Blaxter, M. and Britten, N. (1996) Lay Beliefs about Drugs and Medicines and the Implications for Community Pharmacy....
- et al.
Tardive dyskinesia: Barriers to the professional recognition of iatrogenic disease
Journal of Health and Social Behaviour
(1986) - Busfield, J. (1986) Managing Madness. Hutchinson,...