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Thinking About Medication GroupRob Allison,
Maggie Stronach, Ceri Owen, Ruth Lambley
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Aims of presentation

• Brief outline some literature regarding
  medication
• Describe a Thinking about Medication group in
  York
• Personal experiences related to medication and
  the group

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Disclaimer.!!!
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Disclaimer.!!!
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The dominant approach

• The dominant approach in psychiatry is a
  biological one (Bentall, 2009)
• The main tool for psychosis-related problems is
  medication (Bentall, 2009 Coleman, 2004 NICE,
  2009), usually prescribed indefinitely (Whitaker,
  2004)

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The harm done

• side effects including neuroleptic malignant
  syndrome, Parkinsonian symptoms, tardive
  dyskinesia, blindness, fatal blood clots, heat
  stroke, swollen breasts, leaking breasts,
  impotence, obesity, sexual dysfunction, blood
  disorders, painful skin rashes, diarrhoea,
  nausea, forgetfulness, seizures, diabetes,
  increased risk of suicide, early death
• Lewander, 1994 Keefe et al, 1999
• Arana, 2000 Kane Freeman, 1994
• Glazer, 2000a Glazer, 2000b)

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The harm done

• MRI studies antipsychotics cause atrophy of the
  cerebral cortex and an enlargement of the basal
  ganglia (Gur et al, 1998 Chakos et al, 1994
  Madsen et al, 1998) (cited in Whitaker, 2004)
• the drugs cause changes in the brain associated
  with a worsening of the very symptoms the drugs
  are supposed to alleviate (Whitaker, 2004, p.8)

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The power of belief.. (Kirsch, 2009)

• Expectancy of improvement
• The strong therapeutic response to
• antidepressant medication is almost
• as strong to placebo
• Statistically significant but not clinically
  meaningful
• the dirty little secret many have long been
  unimpressed by the magnitude of the differences
  observed between treatments and controls, what
  some of our colleagues refer to as the dirty
  little secret in the pharmaceutical literature
  (Hollon, DeRubeis, Shelton Weiss, 2002)

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Despite evidence, prescriptions increase!

• Evidence consistently shows that maintaining
  patients on antipsychotics produces poor
  long-term outcomes and 40 of those diagnosed
  would do better if they were never exposed to
  them or gradually withdrew from them (Whitaker,
  2004)
• Maintenance Antipsychotic Therapy Is the Cure
  Worse than the Disease? concluded that an
  attempt should be made to determine the
  feasibility of drug discontinuance in every
  patient (Gardos Cole, 1977)
• Research since then confirm the wisdom of this
  advice
• But in spite of this, antipsychotics are been
  prescribed more and more and to a larger group of
  patients.

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Medication on the increase

• Prescriptions (UK)
• 1988-2001, issued prescriptions (generally)
  increased by 56
• 19922002, issues prescriptions for
  antidepressants increasing by 243
• (NICE, 2004)
• 19982008, 48 increase in prescriptions for
  antipsychotic medication
• (Information Centre for Health and Social Care
  (2008),
• cited in Moncrieff, 2011)
• 20062010, 43 increase in prescriptions for
  selective serotonin re-uptake inhibitors (most
  commonly prescribed group of anti-depressants) to
  nearly 23m a year (NHS Prescription Services)
  http//www.bbc.co.uk/news/health-12986314
  (accessed 7th April, 2011)

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Medication for profit?

• The pharmaceutical industry is the most
  profitable in the world (Bentall, 2009, p.197) -
  global market for antipsychotic medication is
  approx 15 billion per year (Lewis Lieberman,
  2008)
• By 2002, the combined profits for the top 10 (of
  Fortune 500 top 500 highest gross revenues of
  American public corporations ) was more than the
  profits of all the other 490 companies put
  together!! (Law, 2006, cited in Bentall, 2009,
  p.198)

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MIND study

• Several studies indicate non-adherence for
  medication range from 30-50 (Tacchi Scott,
  2005)
• In a MIND study, it was found that 70 of people
  who were prescribed psychiatric medication felt
  pressured to take it, with a similar proportion
  also feeling powerless or passive about taking
  them (MIND, 2005)
• 18 found the medication to be mainly helpful BUT
  21 found them unhelpful, with the remaining 71
  somewhere in the middle
• 60 stopped taking their medication because of
  the adverse effects
• 25 tried to come off their medication against
  medical advice, with nearly half not telling
  their doctor at all due to fear of opposition
• It was also found that even when doctors were
  involved, they were not always helpful

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Mental health service disengaging from people

• The power-imbalance influences the way services
  are delivered and perceived
• Many people experiencing mental distress distance
  themselves from mental health practitioners in
  order to take control and either come off or
  reduce their medication
• Coleman (2004) reports that it was only after
  leaving mental health services was he was able to
  feel empowered to take control of his own
  recovery, which he suggests has been a similar
  experience for many others

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Mental health service disengaging from people

• Rather than discuss with mental health
  professionals, many people will instead attempt
  to alter their medication and, effectively, take
  control of their medication without the
  involvement of mental health professionals
• Implies that mental health services struggle to
  engage with people when they most need it
• Implies that mental health services, at times,
  work against people rather than work with people
• This is particularly concerning given the
  difficulty in reducing psychiatric medication and
  the adverse effects of withdrawal (Moncrieff,
  2006)

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The way antipsychotic medication is used

• (But) the real problem with antipsychotics is
  not their effectiveness, but the way that they
  are used
• (Bentall, 2009, p.222)
• Moncrieff (2007/2009) - alternative model of
  drug action, disease-centred model to a
  drug-centred model
• It is the consequences of being in these altered
  states that amount to the therapeutic effects of
  the drug (Moncrieff, 2007/2009)

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Thinking About Medication Group

• Background Research has shown that people
  frequently want more information about
  psychiatric drugs and benefit from the
  opportunity to talk about issues related to them.
  
• The group is based on a similar group run by Guy
  Holmes (Clinical Psychologist with a special
  interest in Psychiatric medication) in
  Shrewsbury, and a group run by Rufus may and Adam
  Jhuragoo in Hebden Bridge called Coming-Off.com.
• Aim Help people access information about drugs
  they maybe taking or considering. Provide a space
  to talk through experiences, exchange views and
  give and receive support. Provide access to
  expertise from other sources. To explore pros and
  cons of taking medication and explore alternative
  coping strategies.

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Thinking About Medication Group

• Whos involved Two people with experience of
  taking Psychiatric medication, who have been part
  of the steering group. Rob Allison Mental Health
  Nurse Lecturer, Karen Flowerdew, Consultant
  Clinical Psychologist, Andy Elmslie Consultant
  Psychiatrist, Sarah Smith Pharmacist and Maggie
  Stronach Mental Health Nurse.
• Pilot run we ran a pilot in early 2011, planned
  12 sessions with timetabled agenda, open group,
  rotating facilitators

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Thinking About Medication Group

• Agenda
• Intros, suggestions/content for sessions
• Repeat last session, reflection
•  Research in different psychiatric medication
•  Recovery, relating to medication
•  Illicit/non-prescribed drugs
•  Psychological therapies alternatives to
  medication
•  Open session
• Pros cons of psychiatric medication,
  withdrawals, etc
• Practical issues related to medication,
  empowerment
•  Complimentary therapies
•  Reflections - what have people got from the
  group?
•  Evaluations, plans for future
•  

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Thinking About Medication Group

• What did people want from the group?
• We provided self-help materials, some brought
  different information to the group, some wanted
  to come off their medication, some wanted
  information about side effects, some talked about
  how much they valued their medication, some
  wanted support and advice regarding how they
  could talk to their psychiatrist regarding their
  medication and have more influence over their
  prescribing, some wanted tips about how to safely
  reduce their medication
• What worked well and not so well?
• Good initial turnout. Better advertising hence
  the conference.
• Worked better when less structured sessions.
• Constant rotating of facilitators confusing, feel
  would work better with couple core facilitators,
  allow more flow between sessions.

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Thinking About Medication Group

• Future plans
• Conference on 2/3/2012 with speakers including,
  Phil Thomas, Rachel Waddingham, Guy Holmes
• Group to restart at Sycamore House from Weds 14th
  march 2012, and every Wednesday, self referral,
  group open to all who take or considering taking
  psychiatric medication.

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Patients (and carers if appropriate) should be
informed of the benefits and side-effects
profiles of antipsychotics and be involved in the
choice of antipsychotic NICE schizophrenia
guidelines.
www.adbusters.org
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An illustration of my feelings about being given
chlorpromazine when Id asked for something not
sedating so I can keep up with my postgraduate
study.
www.bonkersinstitute.org
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Side effects are even more frightening when you
cant anticipate them and dont understand what
is happening. Having concerns dismissed is
unhelpful.
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www.plos.org
Flickr / Kheel Centre
Whose data? OUR DATA!
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www.choiceandmedication.org
Patient decision aids because informed consent
is important.
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