Opinion Piece: The case for establishing a minimal medication alternative for psychosis and schizophrenia

ABSTRACT

The development of severe mental health conditions is strongly linked to our environments, particularly experiences of trauma and adversity. However treatments for severe mental health conditions are often primarily biomedical, centred around medication. For people diagnosed with schizophrenia or psychosis, this is antipsychotic medication. Although antipsychotics have been found to reduce symptoms and risk of relapse, some patients derive little benefit from these drugs, and they can lead to severe adverse effects. Subsequently, a high proportion of people do not want to take antipsychotics and request an alternative. Yet in the UK and in many countries there are currently no guidelines for stopping antipsychotics or formal treatment alternatives, despite such alternatives being available in some countries. For example, in Norway and Vermont (USA), in response to pressure from service user organisations, governments have mandated the establishment of “minimal medication” services. We examine whether everyone with a psychotic condition needs long-term antipsychotic treatment and evidence for alternative models of care. We recommend that healthcare providers should be encouraged to develop a psychosocial treatment package for people with psychosis or schizophrenia that provides a realistic possibility of minimising antipsychotic exposure.

KEYWORDS:

• Psychosis
• schizophrenia
• minimal medication
• psychosocial treatments
• antipsychotic reduction or discontinuation
• alternative treatments

Disclosure statement

JM is the Chief Investigator of the RADAR Study (Research into Antipsychotic Discontinuation and Reduction, NIHR Programme Grant). RC previously worked as a senior (postdoctoral) researcher on the RADAR study. TC is an associate investigator on the RADAR study. JPM is an honorary research fellow on the RADAR study. JR reports no conflicts of interest.

Notes

1. We use “antipsychotic” instead of “neuroleptic”, We recognise the issue with “antipsychotic” as it implies that they are modifying an underlying pathology. However, we use this term as it is the most recognisable.