Patient Preference and Adherence (Feb 2022)
Antipsychotic-Related Stigma and the Impact on Treatment Choices: A Systematic Review and Framework Synthesis
Abstract
Michael Townsend,1 Kristin Pareja,2 Amy Buchanan-Hughes,3 Emma Worthington,4 David Pritchett,4 Malaak Brubaker,5 Christy Houle,6 Tenna Natascha Mose,6 Heidi Waters2 1Gateway Counseling Center, New York, NY, USA; 2Department of Global Value and Real World Evidence, Otsuka Pharmaceutical Development & Commercialization Inc, Princeton, NJ, USA; 3Evidence Development Division, Costello Medical Inc, Boston, MA, USA; 4Evidence Development Division, Costello Medical Consulting Ltd, Cambridge, UK; 5Department of US Medical Affairs, Otsuka Pharmaceutical Development & Commercialization Inc, Princeton, NJ, USA; 6Department of Value and Real World Evidence, Lundbeck Inc, Deerfield, IL, USACorrespondence: Michael Townsend, Email [email protected]: Antipsychotics are a class of medications primarily used to treat individuals with psychotic disorders. They have also been indicated for patients with other psychiatric conditions, such as post-traumatic stress disorder and major depressive disorder. Non-adherence is prominent amongst individuals prescribed antipsychotics, with medication-related self-stigma and social stigma identified as major factors. No previous reviews have focused on stigma associated specifically with antipsychotic medication. This systematic literature review aimed to synthesise evidence on the prevalence of stigmatising attitudes and behaviours related to antipsychotic treatment and understand their impact on antipsychotic treatment initiation and continuation.Methods: Two independent reviewers screened studies from databases, congress proceedings, ClinicalTrials.gov, and PsychU.org; relevant studies reported quantitative or qualitative data on antipsychotic-related stigma in adults with psychotic disorders, mood disorders, borderline personality disorder or anxiety disorders, or healthcare providers or caregivers of these patients, and any impact on treatment. Framework synthesis facilitated extraction and synthesis of relevant information; quantitative and qualitative data were coded and indexed against a pre-specified thematic framework by two independent reviewers.Results: Forty-five articles reporting on 40 unique studies were included; 22 reported quantitative data, 16 reported qualitative data, and two reported quantitative and qualitative data relating to antipsychotic-related stigma. Framework synthesis identified four themes: 1) impact of antipsychotic treatment on a) social stigma or b) self-stigma; 2) impact of side effects of antipsychotic treatment on a) social stigma or b) self-stigma; 3) impact of route of administration of antipsychotic treatment on stigma; 4) impact of stigma on the use of antipsychotics.Conclusion: This systematic literature review found that antipsychotic-related social and self-stigma is a factor in non-adherence to antipsychotics. Further research should examine stigma in a wider range of patients and the extent to which clinicians’ treatment decisions are impacted by the potential stigma associated with antipsychotic medications.Keywords: psychiatric condition, embarrassment, schizophrenia, psychosis, adherence, patient experience
