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Symptoms, functioning and coping strategies in individuals with schizophrenia spectrum disorders who do not take antipsychotic medication: a comparative interview study

Published online by Cambridge University Press:  07 June 2016

E. Jung ,
M. Wiesjahn ,
H. Wendt ,
T. Bock ,
W. Rief  and
T. M. Lincoln
E. Jung
Affiliation:
Department of Psychology, Division of Clinical Psychology and Psychotherapy, Philipps-University Marburg, Marburg, Germany
M. Wiesjahn
Affiliation:
Department of Psychology, Division of Clinical Psychology and Psychotherapy, Philipps-University Marburg, Marburg, Germany
H. Wendt
Affiliation:
Department of Clinical Psychology and Psychotherapy, Institute of Psychology, University of Hamburg, Hamburg, Germany
T. Bock
Affiliation:
Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
W. Rief
Affiliation:
Department of Psychology, Division of Clinical Psychology and Psychotherapy, Philipps-University Marburg, Marburg, Germany
T. M. Lincoln*
Affiliation:
Department of Clinical Psychology and Psychotherapy, Institute of Psychology, University of Hamburg, Hamburg, Germany
*
*Address for correspondence: T. M. Lincoln, Department of Clinical Psychology and Psychotherapy, Institute of Psychology, University of Hamburg, von-Melle-Park 5, Hamburg, Germany. (Email: [email protected]; [email protected])
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Abstract

Background

A considerable proportion of people with schizophrenia spectrum disorders do not take antipsychotic medication but seem to be functioning well. However, little is known about this group. To test the assumption that absence of medication is compensated for by more effective coping and increased social support, this study compared symptoms, functioning, coping strategies and social support in non-medicated and medicated individuals with schizophrenia spectrum disorders.

Method

In all, 48 participants with a DSM-IV schizophrenia spectrum disorder who were taking (n = 25) or not taking antipsychotic medication (n = 23) were included. Assessment consisted of self-ratings of symptoms, symptom-related distress and social support combined with a semi-structured interview that assessed general and social functioning, subjective evaluation of symptoms and coping strategies.

Results

Symptom severity and distress did not differ between the groups. However, the non-medicated participants had significantly higher levels of general functioning than medicated participants and a longer duration of being non-medicated was significantly associated with a higher level of general functioning. In contrast to the hypotheses, not taking medication was not associated with more effective coping strategies or with higher levels of social support. Medicated participants more frequently reported the use of professional help as a coping strategy.

Conclusions

Our results corroborate previous studies finding improved functioning in individuals with schizophrenia spectrum disorders who do not take medication compared with those who take medication, but do not support the notion that this difference is explicable by better coping or higher levels of social support. Alternative explanations and avenues for research are discussed.

Keywords

Antipsychotic medicationcopingfunctioningnon-medicated patientsschizophrenia
Type
Original Articles
Information
Psychological Medicine , Volume 46 , Issue 10 , July 2016 , pp. 2179 - 2188
Copyright
Copyright © Cambridge University Press 2016 

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References

Ascher-Svanum, H, Faries, D, Zhu, B, Ernst, FR, Swartz, MS, Swanson, JW (2006). Medication adherence and long-term functional outcomes in the treatment of schizophrenia in usual care. Journal of Clinical Psychiatry 67, 453–460.CrossRefGoogle ScholarPubMed
Barnes, TR; Schizophrenia Consensus Group of British Association for Psychopharmacology (2011). Evidence-based guidelines for the pharmacological treatment of schizophrenia: recommendations from the British Association for Psychopharmacology. Journal of Psychopharmacology (Oxford, England) 25, 567–620.CrossRefGoogle ScholarPubMed
Buchanan, RW, Kreyenbuhl, J, Kelly, DL, Noel, JM, Boggs, DL, Fischer, BA, Himelhoch, S, Fang, B, Peterson, E, Aquino, PR, Keller, W; Schizophrenia Patient Outcomes Research Team (PORT) (2010). The 2009 schizophrenia PORT psychopharmacological treatment recommendations and summary statements. Schizophrenia Bulletin 36, 71–93.CrossRefGoogle ScholarPubMed
Cohen, J (1992). Statistical power analysis. Current Directions in Psychological Science 1, 98–101.CrossRefGoogle Scholar
Connor, KM, Davidson, JRT (2003). Development of a new resilience scale: the Connor–Davidson Resilience Scale (CD-RISC). Depression and Anxiety 18, 76–82.CrossRefGoogle ScholarPubMed
Daumit, GL, Goff, DC, Meyer, JM, Davis, VG, Nasrallah, HA, McEvoy, JP, Rosenheck, R, Davis, SM, Hsiao, JK, Stroup, TS, Lieberman, JA (2008). Antipsychotic effects on estimated 10-year coronary heart disease risk in the CATIE schizophrenia study. Schizophrenia Research 105, 175–187.CrossRefGoogle ScholarPubMed
Erickson, DH, Beiser, M, Iacono, WG (1998). Social support predicts 5-year outcome in first-episode schizophrenia. Journal of Abnormal Psychology 107, 681–685.CrossRefGoogle ScholarPubMed
Fahrenberg, J, Myrtek, M, Pawlik, K, Perrez, M (2007). Ambulatory assessment-monitoring behavior in daily life settings: a behavioral–scientific challenge for psychology. European Journal of Psychological Assessment 23, 206–213.Google Scholar
Field, A (2009). Discovering Statistics using SPSS, 2nd edn. Sage: London.Google Scholar
Fydrich, T, Sommer, G, Tydecks, S, Brähler, E (2009). Fragebogen zur sozialen Unterstützung (F-SozU): Normierung der Kurzform (K-14) [Social Support Questionnaire (F-SozU): standardization of short form (K-14)]. Zeitschrift Für Medizienische Psychologie 18, 43–48.Google Scholar
Goodman, SH, Sewell, DR, Cooley, EL, Leavitt, N (1993). Assessing levels of adaptive functioning: the Role Functioning Scale. Community Mental Health Journal 29, 119–131.CrossRefGoogle ScholarPubMed
Harrison, G, Hopper, K, Craig, T, Laska, E, Siegel, C, Wanderling, J, Dube, CK, Ganev, K, Giel, R, an der Heiden, W, Holmberg, SK, Janca, A, Lee, PWH, Leòn, CA, Malhotra, S, Marsella, AJ, Nakane, Y, Sartorius, N, Shen, Y, Skoda, C, Thara, R, Tsirkin, SJ, Varma, VK, Walsh, D, Wiersma, D (2001). Recovery from psychotic illness: a 15- and 25-year international follow-up study. British Journal of Psychiatry : The Journal of Mental Science 178, 506–517.Google Scholar
Harrow, M, Jobe, TH (2007). Factors involved in outcome and recovery in schizophrenia patients not on antipsychotic medications: a 15-year multifollow-up study. Journal of Nervous and Mental Disease 195, 406–414.CrossRefGoogle Scholar
Harrow, M, Jobe, TH (2013). Does long-term treatment of schizophrenia with antipsychotic medications facilitate recovery? Schizophrenia Bulletin 39, 962–965.CrossRefGoogle ScholarPubMed
Harrow, M, Jobe, TH, Faull, RN (2012). Do all schizophrenia patients need antipsychotic treatment continuously throughout their lifetime? A 20-year longitudinal study. Psychological Medicine 42, 2145–2155.CrossRefGoogle Scholar
Ho, BC, Andreasen, NC, Ziebell, S, Pierson, R, Magnotta, V (2011). Long-term antipsychotic treatment and brain volumes. Archives of General Psychiatry 68, 128–137.Google Scholar
Konings, M, Bak, M, Hanssen, M, van Os, J, Krabbendam, L (2006). Validity and reliability of the CAPE: a self-report instrument for the measurement of psychotic experiences in the general population. Acta Psychiatrica Scandinavica 114, 55–61.CrossRefGoogle Scholar
Lacro, JP, Dunn, LB, Dolder, CR, Leckband, SG, Jeste, DV (2002). Prevalence of and risk for medication nonadherence in patients with schizophrenia: a comprehensive review of recent literature. Journal of Clinical Psychiatry 63, 892–909.Google Scholar
Lee, PW, Lieh-Mak, F, Yu, KK, Spinks, JA (1993). Coping strategies of schizophrenic patients and their relationship to outcome. British Journal of Psychiatry 163, 177–182.CrossRefGoogle ScholarPubMed
Leucht, S, Abraham, D, Kissling, W (1999). Efficacy and extrapyramidal side-effects of the new antipsychotics olanzapine, quetiapine, risperidone, and sertindole compared to conventional antipsychotics and placebo. A meta-analysis of randomized controlled trials. Schizophrenia Research 35, 51–68.CrossRefGoogle ScholarPubMed
Leucht, S, Engel, R, Davis, J (2009). How effective are second-generation antipsychotic drugs? A meta-analysis of placebo-controlled trials. Molecular Psychiatry 14, 429–447.Google Scholar
Leucht, S, Tardy, M, Komossa, K, Heres, S, Kissling, W, Salanti, G, Davis, JM (2012). Antipsychotic drugs versus placebo for relapse prevention in schizophrenia: a systematic review and meta-analysis. Lancet 379, 2063–2071.Google Scholar
Lewander, T (1994). Neuroleptics and the neuroleptic-induced deficit syndrome. Acta Psychiatrica Scandinavica. Supplementum 380, 8–13.CrossRefGoogle ScholarPubMed
Lieberman, J, Stroup, T, McEvoy, J, Schwartz, M, Rosenheck, R, Perkins, D, Keefe, RSE, Davis, SM, Davis, CE, Lebowitz, BD, Severe, J, Hsiao, J (2005). Effectiveness of antipsychotic drugs in patients with chronic schizophrenia. New England Journal of Medicine 353, 1209–1223.CrossRefGoogle ScholarPubMed
Lincoln, TM, Peter, N, Schäfer, M, Moritz, S (2009). Impact of stress on paranoia: an experimental investigation of moderators and mediators. Psychological Medicine 39, 1129–1139.Google Scholar
Lincoln, TM, Ziegler, M, Mehl, S, Kesting, ML, Lüllmann, E, Westermann, S, Rief, W (2012). Moving from efficacy to effectiveness in cognitive behavioral therapy for psychosis: a randomized clinical practice trial. Journal of Consulting and Clinical Psychology 80, 674–686.Google Scholar
McNally, SE, Goldberg, JO (1997). Natural cognitive coping strategies in schizophrenia. British Journal of Medical Psychology 70, 159–167.Google Scholar
Moilanen, J, Haapea, M, Miettunen, J, Jääskeläinen, E, Veijola, J, Isohanni, M, Koponen, H (2013). Characteristics of subjects with schizophrenia spectrum disorder with and without antipsychotic medication – a 10-year follow-up of the Northern Finland 1966 Birth Cohort study. European Psychiatry 28, 53–58.CrossRefGoogle ScholarPubMed
Moritz, S, Hünsche, A, Lincoln, TM (2014). Nonadherence to antipsychotics in schizophrenia: the role of positive attitudes towards positive symptoms. European Neuropsychopharmacology 24, 1745–1752.Google Scholar
Newcomer, JW (2007). Antipsychotic medications: metabolic and cardiovascular risk. Journal of Clinical Psychiatry 68, 8–13.Google Scholar
Newcomer, JW, Haupt, DW (2006). The metabolic effects of antipsychotic medications. Canadian Journal of Psychiatry. Revue Canadienne de Psychiatrie 51, 480–491.CrossRefGoogle ScholarPubMed
Norman, RMG, Malla, AK, Manchanda, R, Harricharan, R, Takhar, J, Northcott, S (2005). Social support and three-year symptom and admission outcomes for first episode psychosis. Schizophrenia Research 80, 227–234.CrossRefGoogle ScholarPubMed
Phillips, LJ, Francey, SM, Edwards, J, McMurray, N (2009). Strategies used by psychotic individuals to cope with life stress and symptoms of illness: a systematic review. Anxiety, Stress and Coping 22, 371–410.Google Scholar
Ray, WA, Chung, CP, Murray, KT, Hall, K, Stein, CM (2009). Atypical antipsychotic drugs and the risk of sudden cardiac death. New England Journal of Medicine 360, 225–235.Google Scholar
Rückl, S, Büche, L, Gentner, NC, Heyne, J, Von Bock, A, Barthel, A, Vedder, H, Bürgy, M, Kronmüller, KT (2012). Heidelberg Coping Scales for Delusions: psychometric evaluation of an expert rating instrument. Psychopathology 45, 244–251.Google Scholar
Sass, H, Wittchen, HU, Zaudig, M, Houben, I (2003). Diagnostisches und Statistisches Manual Psychischer Störungen (DSM-IV-TR) [Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR)]. Hogrefe: Göttingen.Google Scholar
Schwartz, RC (2007). Concurrent validity of the Global Assessment of Functioning Scale for clients with schizophrenia. Psychological Reports 100, 571–574.CrossRefGoogle ScholarPubMed
Torgalsboern, A-K (2012). Sustaining full recover in schizophrenia after 15 years: does resilience matter? Clinical Schizophrenia and Related Psychoses 5, 193–200.Google Scholar
Viguera, AC, Baldessarini, RJ, Hegarty, JD, van Kammen, DP, Tohen, M (1997). Clinical risk following abrupt and gradual withdrawal of maintenance neuroleptic treatment. Archives of General Psychiatry 54, 49–55.CrossRefGoogle ScholarPubMed
Weiden, PJ, Miller, AL (2001). Which side effects really matter? Screening for common and distressing side effects of antipsychotic medications. Journal of Psychiatric Practice 7, 41–47.Google Scholar
Whitaker, R (2004). The case against antipsychotic drugs: a 50-year record of doing more harm than good. Medical Hypotheses 62, 5–13.CrossRefGoogle ScholarPubMed
Wiesjahn, M, Jung, E, Lamster, F, Rief, W, Lincoln, TM (2014). Explaining attitudes and adherence to antipsychotic medication: the development of a process model. Schizophrenia Research and Treatment 2014, 341545.Google Scholar
Wittchen, HU, Zaudig, M, Fydrich, T (1997). Strukturiertes Klinisches Interview für DSM-IV [Structured Clinical Interview for DSM–IV]. Hogrefe: Göttingen.Google Scholar
Wunderink, L, Nieboer, RM, Wiersma, D, Sytema, S, Nienhuis, FJ (2013). Recovery in remitted first-episode psychosis at 7 years of follow-up of an early dose reduction/discontinuation or maintenance treatment strategy: long-term follow-up of a 2-year randomized clinical trial. JAMA Psychiatry 70, 913–920.Google Scholar