Current Psychiatry Reviews - Volume 14, Issue 1, 2018

Background: The term “deprescribing” has been coined to describe a specific intervention designed to optimize the reduction or cessation of medications for which benefits no longer outweigh the risks. As a wider concept, it may also come to embody a shifting perspective in the management of chronic illnesses where multiple, changing factors add complexity and nuance to the risk/benefit calculations that underlie prescription. Despite a burgeoning literature in geriatric medicine and palliative and primary care, the term is only recently being introduced to psychiatry. Objective: This article seeks to raise the question of whether deprescribing may be useful as a construct, clinical intervention and novel field of research in the field of psychiatry. Method: A focused review of the literature is used to provide context and frame some arguments for and against the adoption of deprescribing concepts and practice in psychiatry at this time. Results: With both potential risks as well as benefits, the relative expertise in complex shared decision- making and psychosocial aspects of prescribing, mean the specialty of psychiatry has much to gain from and contribute to the field of deprescribing. Conclusion: Existing deprescribing guidelines may be adapted to guide initial implementation strategies in psychiatry. These should then undergo rigorous clinical trials to establish effectiveness and/or identify populations of most benefit. Further research is warranted to help guide decisionmaking around long-term psychotropic use.

Background: Deprescribing, or the active reduction or elimination of psychiatric medications, requires close collaboration between physician and patient. Purpose: This article outlines the use of shared decision making, peer support, and relapse prevention strategies as key elements of successful deprescribing in people with psychiatric disorders who are interested in decreasing or stopping psychiatric medications. Drawing from existing literature and a recovery oriented care perspective, specific recommendations to create appropriate contexts for deprescribing including collaborative relationships, social support and rehabilitation for example. Conclusion: Deprescribing as an intervention requires care coordination and preplanning to provide the best supports for the person in recovery.

Background: Medications can have a wide range of symbolically mediated effects on patients and these effects can be positive or negative. When medications serve conflicting countertherapeutic goals, action, including deprescribing, may be needed to ameliorate them. Method: Drawing on work with complex, treatment-refractory patients, we have identified strategies to inform and guide practitioners encountering meaning-based counter-therapeutic medication effects. Conclusion: These include the development of an overall diagnosis, a focus on the therapeutic alliance, addressing pathogenic meanings of medications and approaching deprescribing as an interpersonal process.

Background: Standard guidelines for the management of chronic psychoses recommend the rapid initiation of treatment with antipsychotic medications (APs) and often, indefinite continuation. Ongoing treatment with APs is based primarily on evidence from AP discontinuation studies, which have several crucial flaws. Due to this equivocal evidence for continued treatment with APs and owing to their serious side effects, there is a critical need for considering controlled reduction and/or discontinuation of APs in persons with chronic psychoses. Discussion and Conclusion: Deprescribing has been defined as the systematic process of medication reduction and or discontinuation when current or potential harms outweigh current or potential benefits, taking into account a patient's medical condition, functional status and their values and preferences. In this paper, we utilize the framework of deprescribing to answer the questions of why and how to reduce and/or discontinue treatment with APs. We first approach the complex issue of assessing the risk-benefit ratio of APs by examining the evidence for their continued benefit and their side effects. We emphasize deprescribing as a patient-centered process, using shared-decision making, psychosocial interventions and a flexible approach while prescribing. Finally, we present some of the limitations and challenges of using this approach in AP reduction and discontinuation.

Background: Caregivers of individuals with Eating Disorders (EDs) undergo significant caregiver burden and stress. Although the literature suggests that caregivers of eating disorders are significant supports in the client's recovery and relapse prevention, they receive limited research. Objective: This study explored the lived experience of caregivers of individuals with eating disorders. Method: Noblit and Hare's (1998) seven-step meta-ethnographic method was used to identify and consolidate the main themes across qualitative studies, which then supported the creation of a conceptual model of the caregiver experience. Results: Caregivers of individuals with eating disorders undergo a dynamic experience where three mutually influencing external factors of perceived barriers, healthcare experience and perceived support influence an internal reaction which then impacts the caregiver's output behaviors. Within their output behaviors, caregivers engage in two coexisting continuums of acceptance and coping. Demonstration of recognition, acknowledgement, personal growth, and hope indicate that caregivers have reached the final stages of acceptance and coping. Conclusion: Findings suggest that caregivers experience two simultaneous transformative learning processes of acceptance and coping. Numerous barriers such as stigma and difficulties accessing the healthcare system may slow these transformative learning processes. These findings revealed that both clinicians and social networks can become more effective in supporting ED caregivers.

Background: Pornography Use (PU) has been defined as the viewing of explicit materials in the form of pictures and videos, in which people are performing intercourse with clearly exposed and visible genitals. The prevalence of PU has increased dramatically among adolescents, partly attributed to the wide availability of such online material. Objective: The aim of this systematic literature review is to map the research interest in the field and to examine whether statistically significant results have emerged from the areas of research focus. Methods: To address these aims: a) the PRISMA guidelines are adopted and; b) an integrative conceptualization (derived from the merging of two widely accepted models of understanding of Internet use behaviours) was introduced to guide the synthesis of the findings. Results: In total, 57 studies were integrated into the present literature review. Findings were conceptualized/ classified into individual, contextual and activity factors related to PU in adolescence. In that context, individual associated factors, such as development, victimization, mental health and religiosity, appear to have primarily captivated research interest demonstrating significant relationships with adolescent PU. Conclusion: Results indicate that more research focus on contextual and activity related factors is required to improve the level of understanding of adolescent PU and to inform a more holistic conceptual framework of understanding of the phenomenon during adolescence that could potentially guide future research.