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Title: The collaborative management of antipsychotic medication and its obstacles: A qualitative study
Author: Martinez-Hernaez, Angel  
Pié Balaguer, Asunción  
Serrano-Miguel, Mercedes  
Morales Sáez, Nicolás  
García-Santesmases Fernández, Andrea  
Bekele, Deborah  
Alegre Agís, Elisa  
Citation: Martínez-Hernáez, A. [Ángel], Pié Balaguer, A. [Asunción], Serrano-Miguel, M. [Mercedes], Morales-Sáez, N. [Nicolás], García-Santesmases Fernández, A. [Andrea], Bekele, D. [Deborah] & Alegre-Agís, E. [Elisa](2020). The collaborative management of antipsychotic medication and its obstacles: A qualitative study. Social Science & Medicine, 247(), 1-9. doi: 10.1016/j.socscimed.2020.112811
Abstract: Antipsychotic medication is the primary treatment for psychotic conditions such as schizophrenia and schizoaffective disorders; nevertheless, its administration is not free from conflicts. Despite taking their medication regularly, 25–50% of patients report no benefits or perceive this type of treatment as an imposition. Following in the footsteps of a previous initiative in Quebec (Canada), the Gestion Autonome de la Médication en Santé Mentale (GAM), this article ethnographically analyses the main obstacles to the collaborative management of antipsychotics in Catalonia (Spain) as a previous step for the implementation of this initiative in the Catalan mental healthcare network. We conducted in-depth interviews with patients (38), family caregivers (18) and mental health professionals (19), as well as ten focus groups, in two public mental health services, and patients’ and caregivers’ associations. Data were collected between February and December 2018. We detected three main obstacles to collaboration among participants. First, different understanding of the patient’s distress, either as deriving from the symptoms of the disorder (professionals) or the adverse effects of the medication (patients). Second, differences in the definition of (un)awareness of the disorder. Whereas professionals associated disorder awareness with treatment compliance, caregivers understood it as synonymous with self-care, and among patients “awareness of suffering” emerged as a comprehensive category of a set of discomforts (i.e., symptoms, adverse effects of medication, previous admissions, stigma). Third, discordant expectations regarding clinical communication that can be condensed in the differences in meaning between the Spanish words “trato” and “tratamiento”, where the first denotes having a pleasant manner and agreement, and the second handling and management. We conclude that these three obstacles pave the way for coercive practices and promote patients’ de-subjectivation, named here as the “total patient” effect. This study is the first GAM initiative in Europe.
Keywords: antipsychotic medication
collaborative management of medication
therapeutic alliance
mental health
qualitative research
Document type: info:eu-repo/semantics/article
Version: info:eu-repo/semantics/acceptedVersion
Issue Date: Feb-2020
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