Beyond psychopharmacology. Psychosocial strategies for getting the best results when switching antipsychotic medications.
Recent effectiveness studies have shown that over a year and a half, 3 of 4 study patients either stopped or changed their antipsychotic medication. This finding highlights the fact that psychopharmacologic treatments do not remain stable over the course of treatment. Our own interpretation is that these findings emphasize that medication decisions cannot be made outside the context of patients' beliefs, life goals, and social network. Especially important is understanding the underlying, often unspoken, hopes and goals that may motivate patients to try a new medication. For best outcomes when changing patient medications, physicians must translate unspoken patient thoughts and feelings into mutually agreed upon definable target symptoms before the switch. This process helps the patient become an active participant in the switching process and encourages patience and perseverance during the lag time before desired improvements may be seen. Concerns about the new medication are best addressed before the switch. Once the decision has been made to switch, the change must await patient psychological readiness to complete a full therapeutic trial of the new medication. The target goals established before the switch can be used to evaluate the success of the medication trial and to compare any improvements with those from the previous medication. It is also important to revisit the initial treatment goals to distinguish primary pharmacologic improvements from secondary psychologic reactions and challenges arising from those improvements.
Scheifler
Patricia L
PL
Partnership for Recovery, Sylacauga, AL 35150, USA. plscheifler@recovery.bz
Weiden
Peter J
PJ
D014150:Antipsychotic Agents / Q000627:therapeutic use*; D006801:Humans; D009042:Motivation; D010353:Patient Education as Topic; D010358:Patient Participation; D010361:Patients / Q000523:psychology*; D010817:Physician-Patient Relations; D012559:Schizophrenia / Q000188:drug therapy*
D014150:Antipsychotic Agents