Author, as appears in the article.: Martínez-Hernáez Á; Pié-Balaguer A; Serrano-Miguel M; Morales-Sáez N; García-Santesmases A; Bekele D; Alegre-Agís E

Department: Antropologia, Filosofia i Treball Social

URV's Author/s: Alegre Agís, Elisa / Martinez Hernaez, Angel

Keywords: Therapeutic alliance Schizophrenia Qualitative research Psychosis Outcomes Mental health Experience Concordance Collaborative management of medication Coercion Catalonia Autonomous medication Antipsychotic medication qualitative research mental health concordance collaborative management of medication coercion catalonia antipsychotic medication

Abstract: © 2020 Elsevier Ltd 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.

Thematic Areas: Sociología Social sciences, biomedical Serviço social Saúde coletiva Public, environmental & occupational health Psychology Psicología Planejamento urbano e regional / demografia Odontología Nutrição Medicine (miscellaneous) Medicina ii Medicina i Interdisciplinar History and philosophy of science Historia y filosofía de la ciencia Health (social science) General o multidisciplinar General medicine Farmacia Enfermagem Educação física Economia Ciencias sociales Ciencias humanas Ciências biológicas i Ciências ambientais Ciência da computação Antropologia / arqueologia

ISSN: 02779536

Author's mail: elisa.alegre@urv.cat angel.martinez@urv.cat elisa.alegre@urv.cat

Author identifier: 0000-0003-3720-7163 0000-0002-5122-7075 0000-0003-3720-7163

Record's date: 2023-02-19

Papper version: info:eu-repo/semantics/publishedVersion

Link to the original source: https://www.sciencedirect.com/science/article/abs/pii/S0277953620300307

Licence document URL: http://repositori.urv.cat/ca/proteccio-de-dades/

Papper original source: Social Science & Medicine. 247 (112811): 112811-

APA: Martínez-Hernáez Á; Pié-Balaguer A; Serrano-Miguel M; Morales-Sáez N; García-Santesmases A; Bekele D; Alegre-Agís E (2020). The collaborative management of antipsychotic medication and its obstacles: A qualitative study. Social Science & Medicine, 247(112811), 112811-. DOI: 10.1016/j.socscimed.2020.112811

Article's DOI: 10.1016/j.socscimed.2020.112811

Entity: Universitat Rovira i Virgili

Journal publication year: 2020

Publication Type: Journal Publications