Neuroleptic medication in psychosis: A systematic review of client reasons for adherence and non-adherence and a qualitative exploration of service-user perceptions of the role of significant others in neuroleptic discontinuation.

Abstract

Thesis AbstractThe University of ManchesterCandidate: Miriam WadeA Thesis submitted to The University of Manchester for the degree of Clinical Psychology Doctorate in the Faculty of Biology, Medicine and Health.Neuroleptic medication in psychosis: A systematic review of client reasons for adherence and non-adherence and a qualitative exploration of service-user perceptions of the role of significant others in neuroleptic discontinuation.December 2016This thesis investigates neuroleptic discontinuation in people with experience of psychosis. The thesis comprises three independent papers. Papers one and two have been prepared for, and submitted to journals in accordance with the relevant journal guidelines. Paper one is a systematic literature review which seeks to synthesise studies exploring reasons for neuroleptic adherence and non-adherence from the perspective of the service-user. A comprehensive search of relevant databases resulted in the identification of 21 eligible studies which were reviewed. The studies included qualitative, quantitative and mixed method approaches, thus narrative synthesis techniques were employed. Results indicated several key themes of 'reasons' for neuroleptic adherence and non-adherence including medication efficacy, relationships with other people, economic issues, side-effects, compatibility with personal beliefs, stigma, fear and coercion. Findings were largely consistent across studies.Paper two is a qualitative study which sought to examine service-user perceptions of the role that other people play in neuroleptic discontinuation. Twelve participants were interviewed and a grounded theory approach was adopted to analyse transcribed interview data. Eight categories were identified including own and other's views on discontinuation and recovery; feelings of powerlessness; battling to be heard; covert discontinuation; support needs and responses of other people. Findings suggest that discontinuation is a complex process in which service-users attempt to negotiate their own desires for neuroleptic use with those of significant others, including mental health professionals, family and friends. A preliminary grounded theory model is presented and discussed in relation to pertinent clinical implications. These include the need for a holistic approach to recovery and greater service-user choice in treatment decisions.Paper three presents a critical reflection of the research conducted in Papers one and two and is not intended for publication. In the paper, research decisions are discussed and the strengths and weaknesses of both the systematic review and the empirical study are considered. Personal and professional implications of the research are identified and discussed.

Date of Award	1 Aug 2017
Original language	English
Awarding Institution	The University of Manchester
Supervisor	Gillian Haddock (Supervisor) & Sara Tai (Supervisor)