title: Becoming adherent to antipsychotics: a qualitative study of treatment-experienced schizophrenia patients.
abstract: OBJECTIVE
  Discontinuation of antipsychotic medication is a pervasive clinical problem in the treatment of patients suffering from psychosis. The aim of this study was to complement a largely quantitative body of research by focusing on patients' perspectives on the topic.
  
  
  METHODS
  In-depth semistructured interviews were conducted with 20 persons who have schizophrenia spectrum disorders. Narratives were elicited on illness and medication use and emphasized key turning points, such as periods of nonadherence and illness relapses.
  
  
  RESULTS
  Respondents had extensive experience with antipsychotic treatment (15±12 years of treatment). Nineteen (95%) reported at least one extended period of nonadherence. A complex picture of medication use or refusal emerged from patients' descriptions. An array of external factors influenced initiation of medication and treatment maintenance: pressure from family or clinicians, secondary benefits from initiating and maintaining treatment, and a variety of coercive measures. Moreover, personal factors transcended rational models in deciding whether to take medication; patients' responses stressed the importance of trust, emotional reactions, and subjective experiences with medication and stigma.
  
  
  CONCLUSIONS
  These findings call into question the validity of a purely voluntaristic model of the use of antipsychotic medication. Its use was part of a long and painful fight with a debilitating disorder, and off-medication periods were essential parts of a learning process.
authors.affiliation: Department of Psychiatry, University of Montreal, Montreal, C.P. 6128 succursale Centre-ville, Montréal, Québec H3C 3J7, Canada. constantin.tranulis@gmail.com
authors.forename: Constantin
authors.initials: C
authors.lastname: Tranulis
authors.forename: Donald
authors.initials: D
authors.lastname: Goff
authors.forename: David C
authors.initials: DC
authors.lastname: Henderson
authors.forename: Oliver
authors.initials: O
authors.lastname: Freudenreich
mesh_terms: D000328:Adult; D014150:Antipsychotic Agents / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D055118:Medication Adherence / Q000523:psychology*; D011569:Psychiatric Status Rating Scales; D011618:Psychotic Disorders / Q000188:drug therapy / Q000523:psychology; D012559:Schizophrenia / Q000188:drug therapy*; D012565:Schizophrenic Psychology; D012649:Self Concept; D013240:Stereotyping
chemical_list: D014150:Antipsychotic Agents