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Saturday, April 1, 2023

Promoting better use of psychotropic drugs in mental health

Antipsychotic medication is the primary treatment for psychotic disorders such as schizophrenia. However, 25 to 50% of people with the disease say they are not satisfied with the medications they usually take. This fact is due to the side effects and risks…

Antipsychotic medication is the primary treatment for psychotic disorders such as schizophrenia. However, 25 to 50% of people with the disease say they are not satisfied with the medications they usually take. This fact is due to the side effects and health risks of the drug, such as weight gain, risk of metabolic syndrome or effects on self-esteem, among others. There are other factors as well: The social connotations associated with these types of drugs, such as stigma or discrimination. Antipsychotics have also been shown to be useful in relieving positive symptoms of psychosis, such as hallucinations and delusions, but they do not work as well in relieving negative symptoms such as apathy or loss of motivation. All this set of factors hinders the therapeutic alliance, which is understood as the collaborative link between the patient and the therapist. Now, an investigation coordinated by the URV highlights the existence of other mechanisms for the participation and co-responsibility of users with regard to their treatment. As a result of this research, the Guide to Collaborative Management of Medication in Mental Health has been produced.

The device, the result of research carried out by the MARC (Medical Anthropology Research Center) research group of URV in collaboration with a UOC research group, has been developed over a period of more than three years. The aim of the study is to investigate the perceptions and subjective experiences associated with the consumption of psychotropic drugs in Catalonia, especially antipsychotics, as well as their impact on quality of life and daily life of consumers. The research aims to implement inclusive and sustainable health policies in the field of mental health and is based on interviews, questionnaires and discussion groups with users of psychotropic drugs, caregivers and professionals. It is an ethnographic, qualitative and observational study, with no diagnostic or pharmacological procedures involved.

The guide is focused on people who have experienced mental suffering and received psychotropic drugs as a therapeutic measure., It is intended to be useful material for generating dialogue and debate on this type of treatment. The tool also aims to enhance the participation and decision-making capacity of the person who consumes psychoactive drugs, especially antipsychotics, by facilitating access to all necessary information about the drugs and their alternatives, as This type of consumer is, in general, at risk of exclusion and with little personal autonomy. In this guide, co-authored by a research team, mental health professionals, users and caregivers, you can find information about drugs and their side effects, experiences or brief first-person accounts, and tools to create a workspace In which drugs can be discussed for mental health.

A central and innovative aspect of this guide are the questions for reflection which are presented to the reader to develop an opinion and personal position regarding medicine. “What do I feel when I feel bad?”, “How do I recognize it?” or “What are my favorite daily activities?” some of them are.

From Canada to Brazil and ending in Catalonia

Collaborative Medication Management (GCM) is an initiative developed in Quebec in the early 1990s in collaboration with civil society and, above all, users of mental health services and their advocates. In recent years, this experience has received an exponential boost, moving to Brazil under the framework of L’Alliance Internationale de Recherche Universités – Communautés, Sant Mentale et Citoyenneté (ARUCI-SMC). In Brazil, the project has been deployed in public universities in the states of São Paulo, Rio Grande do Sul and Rio de Janeiro.

The project, which has now landed on URV, has made an in-depth analysis of these GCM experiences in the areas in which they have been carried out. In addition, a study of the management of drugs in Catalonia is carried out, in order to analyze the barriers that exist in the collaborative management of drugs and the spaces for the co-production of shared solutions between users, professionals and caregivers.

Finally, this GCM guide has been prepared in book format, adapted to the social and cultural reality of Catalonia. These are not drug guides, but tools for daily and reflective work by the users themselves.,

research continuity

The research findings highlighted the existence of three main barriers to collaboration between participants (users, physicians and family caregivers). First, they understood the concept of discomfort differently, attributing it to symptoms of a disorder in the case of practitioners and to adverse effects of the drug in the case of users. Second, there were differences in how the level of awareness of the disorder was defined. Professionals associated awareness of the disorder with treatment compliance, caregivers understood it as synonymous with self-care, and the idea of ​​”pain awareness” arose among patients, as a category In a broad sense, it includes discomfort, experiences of marginalization and stigma, as well as adverse effects of biomedical treatments.

Finally he also outlined Conflicting expectations regarding clinical communication, These terms are condensed in the difference in meaning between «treatment» and «treatment», where the first refers to an intersubjective treaty by patients and the recognition of the other as a subject, and the second, an intervention that is carried out more on an object (disease) than on the subject (patient). These constraints facilitate coercive behaviors and the subjectivity of patients, which are precisely the areas in which the guide seeks to influence in order to generate the opposite: autonomy, empowerment of those affected, and clinical practices of shared decisions.

Various institutions have participated in the research, such as the Badalona II Adult Mental Health Center, Nu Barris Adult Mental Health Center, Catalonia Mental Health Federation, La Muralla, Exec SCCL Cooperative, Radio Nicosia Sociocultural Association, Catalan Mental Health Congress (FCCSM) and Cypress Inclusive Leisure Association.

The forecast is that the study will continue through a proof of concept — that is, a proof of concept that is performed with the aim of verifying that the concept or theory is viable — or a clinical trial, confirms the research team. .

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