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Are depot antipsychotics more coercive than tablets? The patient's perspective
M X Patel1, N de Zoysa, M Bernadt
1Division of Psychological Medicine, Institute of Psychiatry, King's College London, London, UK. m.patel@iop.kcl.ac.uk
Journal of Psychopharmacology (Oxford, England)
|March 24, 2009
Summary
Depot antipsychotics are perceived as more coercive than oral formulations by patients. Minimizing coercion through shared decision-making is crucial for improving treatment acceptance and reducing stigma.
Area of Science:
- Psychiatry
- Clinical Psychology
- Pharmacology
Background:
- Clinicians express concerns regarding depot antipsychotics, citing patient perceptions of stigma, coercion, and unacceptability.
- Understanding patient perspectives on coercion is vital for improving treatment adherence and therapeutic relationships.
Purpose of the Study:
- To investigate and compare patient perspectives on coercion associated with depot versus oral antipsychotic medications.
- To identify specific aspects of coercion experienced by patients on different antipsychotic formulations.
Main Methods:
- A cross-sectional study involving 72 participants with chronic mental illness on voluntary antipsychotic maintenance therapy.
- Utilized an adapted MacArthur Admission Experience (short form) to assess coercion related to oral and depot antipsychotics.
Main Results:
- Higher mean total coercion levels were reported for depot antipsychotics (4.39) compared to oral (2.80) (P = 0.027).
- Perceived coercion (2.52 vs 1.73) and negative pressures (1.17 vs 0.33) subscales were significantly higher for depot users.
- A significantly greater proportion of depot users (30%) felt pressured to take medication compared to oral users (2%) (P < 0.001).
Conclusions:
- Depot antipsychotics are perceived as more coercive than oral formulations, potentially contributing to treatment stigma.
- Minimizing the experience of coercion through shared decision-making is essential, irrespective of antipsychotic formulation.
- Ensuring patients have a voice in treatment decisions can improve acceptance and reduce negative perceptions of antipsychotic therapy.
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