Neuroleptic medication discontinuation: A systematic review of the relationship between therapeutic alliance and neuroleptic adherence and a qualitative exploration of clinicians’ perspectives towards neuroleptic discontinuation

  • Nicola Forsberg

Student thesis: Doctor of Clinical Psychology


This thesis aimed to explore neuroleptic medication discontinuation, with particular focus on aspects relevant to clinicians. Papers 1 and 2 have been prepared for submission to journals and are in line with journal requirements. To ensure consistency throughout this thesis some minor formatting and stylistic changes have been made. Paper 1 is a systematic review aiming to examine and synthesise evidence on the relationship between the therapeutic alliance and neuroleptic medication adherence in individuals with experience of psychosis. Eighteen empirical papers were identified for inclusion in this review, seventeen of which reported positive associations between therapeutic alliance and neuroleptic adherence. However, further research using high quality designs and advanced statistical methods are required before it is possible to conclude the true extent and potential mediators of the relationship between alliance and adherence. Paper 2 utilised grounded theory method to examine clinicians’ perspectives of decision-making concerning neuroleptic medication discontinuation. Twelve in-depth interviews were completed with Psychiatrists and Mental Health Nurses and a theoretical model was developed depicting a complex process of decision-making for clinicians working with service-users wishing to discontinue neuroleptics. The process of making decisions about neuroleptic discontinuation was found to be subjective and dependent on clinicians’ previous experiences and judgements regarding potential risk factors. The clinical and research implications are discussed with reference to existing literature. Paper 3 provides a critical appraisal and reflective account of papers 1 and 2 and was not written for publication. This includes evaluation of the research area, methodological decisions, strengths and weaknesses, implications for future research and practice and personal reflections of the research process.
Date of Award31 Dec 2018
Original languageEnglish
Awarding Institution
  • The University of Manchester
SupervisorGillian Haddock (Supervisor), Yvonne Awenat (Supervisor) & Sara Tai (Supervisor)


  • decision making
  • staff
  • psychiatrist
  • non-adherence
  • antipsychotic medication
  • concordance
  • therapeutic relationship
  • Schizophrenia

Cite this