Abstract
Background: An issue throughout all areas of medicine, nonadherence to medications is particularly challenging in first-episode psychosis (FEP), where discontinuation of medications has been found to be one of the most reliable predictors of relapse after symptom remission (Haddad et al, 2014; Alvarez-Jimenez et al, 2012). And while medication factors and patient expectancies are frequently employed to understand challenges surrounding adherence, there are limits to their explanatory power.
Methods: Utilizing ethnographic methodologies, we collected and analyzed narratives of FEP clinic users in order to explore relationships between experiences of illness, contacts with the mental health system, and medication nonadherence. Data were composed of text materials relating to early intervention and first-episode psychosis and antipsychotic medications, longitudinal key informant interviews, and participant observation in a FEP clinic setting in Toronto, Canada. An interpretive thematic analysis of interview transcripts, field notes, and texts was subsequently undertaken, and emerging themes developed iteratively through multiple readings of the texts; the use of multiple coders, member checks, and the range of data sources enabled triangulation of the established themes.
Results: The imperative to consistently ingest or inject psychiatric medications can, at times, clash with the lived experience of those struggling to reorient a sense of self in the aftermath of a psychotic illness. Frictions exist between subjective meanings attached to experiences of psychosis and their biomedical framing, leading to ruptures in the clinical setting that are dramatized around medication use.
Conclusion: This pilot study demonstrates that a much broader scope of subjective and intersubjective experience is salient to issues surrounding medication use in first-episode psychosis. Moreover, meanings attached to medications are continually shifting, imbued with ambivalence, and overdetermined. As such, limiting analyses of antipsychotic adherence to medication-centric factors and cross-sectional methodologies fail to encapsulate the breadth of relevant meanings and experiences to medications and their mutable nature. These findings offer insights that may further facilitate engagement of individuals around medications and within first-episode services more broadly.