title: Are depot antipsychotics more coercive than tablets? The patient's perspective.
abstract: Some clinicians consider depot antipsychotics to be stigmatising, coercive and unacceptable to patients. This cross-sectional study investigated patients' perspectives of coercion for depot and oral antipsychotics. In all, 72 participants with chronic mental illness on voluntary maintenance antipsychotic medication were interviewed for their views on oral and depot medication and experiences of coercion. The MacArthur Admission Experience (short form) was adapted to explore coercion regarding medication. Mean total coercion levels were higher for those on depot (depot: mean 4.39; oral: 2.80, P = 0.027), as were perceived coercion (2.52 vs 1.73, P = 0.041) and negative pressures subscales (1.17 vs 0.33, P = 0.009). No significant differences were found for the 'voice' subscale and affective reactions. Specifically, more participants on depot felt that people try to force them to take medication (30% vs 2%, P< 0.001). Depots were perceived as more coercive than oral antipsychotics. Greater perceived coercion may explain why some consider depots to be a more stigmatising form of treatment. Although forced medication is sometimes required, the experience of coercion should be minimised by giving patients a fair say in treatment decisions, regardless of formulation.
authors.affiliation: Division of Psychological Medicine, Institute of Psychiatry, King's College London, London, UK. m.patel@iop.kcl.ac.uk
authors.forename: M X
authors.initials: MX
authors.lastname: Patel
authors.forename: N
authors.initials: N
authors.lastname: de Zoysa
authors.forename: M
authors.initials: M
authors.lastname: Bernadt
authors.forename: J
authors.initials: J
authors.lastname: Bindman
authors.forename: A S
authors.initials: AS
authors.lastname: David
mesh_terms: D000293:Adolescent; D000328:Adult; D014150:Antipsychotic Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D003068:Coercion; D003430:Cross-Sectional Studies; D003692:Delayed-Action Preparations; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D008875:Middle Aged; D010817:Physician-Patient Relations; D012559:Schizophrenia / Q000188:drug therapy; D012938:Social Perception; D011795:Surveys and Questionnaires; D013607:Tablets; D055815:Young Adult
chemical_list: D014150:Antipsychotic Agents; D003692:Delayed-Action Preparations; D013607:Tablets