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Some clinicians consider depot antipsychotics to be stigmatising, coercive and unacceptable to patients. This cross-sectional study investigated patients' perspectives of coercion for depot and oral antipsychotics. In all, 72 participants with chronic mental illness on voluntary maintenance antipsychotic medication were interviewed for their views on oral and depot medication and experiences of coercion. The MacArthur Admission Experience (short form) was adapted to explore coercion regarding medication. Mean total coercion levels were higher for those on depot (depot: mean 4.39; oral: 2.80, P = 0.027), as were perceived coercion (2.52 vs 1.73, P = 0.041) and negative pressures subscales (1.17 vs 0.33, P = 0.009). No significant differences were found for the 'voice' subscale and affective reactions. Specifically, more participants on depot felt that people try to force them to take medication (30% vs 2%, P< 0.001). Depots were perceived as more coercive than oral antipsychotics. Greater perceived coercion may explain why some consider depots to be a more stigmatising form of treatment. Although forced medication is sometimes required, the experience of coercion should be minimised by giving patients a fair say in treatment decisions, regardless of formulation.

Some clinicians believe that antipsychotic depot injections are unacceptable to patients. This cross-sectional study investigated patients' attitudes regarding antipsychotics, and included within-participant comparisons. Two hundred and twenty-two out-patients with schizophrenia/schizoaffective disorder completed the Drug Attitude Inventory (DAI-10), scales on insight, side effects and treatment preferences. Formulation preference was associated with current medication formulation: depots were preferred by 43% (33/76) on depot vs 6% (8/146) on orals (P < 0.001). Attitudes (DAI scores) regarding current formulation were influenced by illness duration, extrapyramidal symptoms and insight but not by formulation (depot vs oral). For those with experience of both formulations, participants currently on tablets scored depots less favourably than oral (4.27 vs 6.89, P < 0.001); those on depot did not differentiate. When voluntary patients on maintenance antipsychotics are asked about their attitudes to their current medication, those on depot respond similarly to those on oral. However, when asked to state a preference for formulation (depot vs oral), patients tend to favour their current formulation. Whatever leads some to switch from depot to oral, leaves a lasting negative impression of the depot and this may limit uptake of newer depots.

Background: Antipsychotic depot medications improve medication adherence by reducing covert nonadherence, but some clinicians believe that they are unacceptable to patients. This cross-sectional study investigated patients' perspectives on factors influencing adherence to antipsychotics, from both those taking depots and those taking tablets in ongoing voluntary outpatient care. The study is novel in also encompassing such factors as injection phobia and perceived coercion regarding medication in relation to self-reported adherence., Method: Seventy-three patients with schizophrenia/schizoaffective disorder (ICD-10 criteria) completed structured clinical interviews that included the Rating of Medication Influences (ROMI) scale as well as instruments that assessed patients' functioning, psychopathology, insight, extrapyramidal symptoms, quality of life, needle anxiety, experience of coercion, and beliefs about medication., Results: Participants taking depot (vs. oral) medication had higher ROMI noncompliance mean scores (15.7 vs. 14.4, p = .019). Predictive factors for influences on noncompliance included certain beliefs regarding medication (concern and overuse) but not extrapyramidal symptoms. There were no differences between the 2 formulation groups on the ROMI compliance subscale. Further predictive factors associated with influences on compliance included perceived necessity., Conclusions: Previously, side effects were considered to be a reason for nonadherence to depot more than for oral medications, but our findings do not support this. Rather, beliefs and attitudes are more important than side effects in predicting self-reported adherence and influencing factors thereof. Prescribing a depot medication to enhance relapse prevention will not in itself ensure adherence and therefore must also be accompanied by discussion regarding adherence and associated personal benefits., (Copyright 2008 Physicians Postgraduate Press, Inc.)

Utilization of long-acting antipsychotic injections (depots) shows wide regional variation. In many countries, community psychiatric nurses (CPNs) administer depots but their concerns and attitudes regarding these drugs are seldom considered. We aimed to investigate attitudes and knowledge towards depots in a cross-sectional survey of CPNs in London, and compare them with those of psychiatrists obtained in a previous study. Three subscales of a depot attitude/knowledge questionnaire were used with additional items which referred to aspects of the CPN role. Participants were 70 CPNs who attended an academic meeting. Most CPNs reported that they were involved in treatment decisions (78%) although some CPNs seldom asked their patients about side effects (19%) and felt that they did not have sufficient time for consultations (23%) or training (23%). Several CPNs believed that depots are old fashioned (34%) and stigmatizing (44%). Compared to psychiatrists, CPNs believed more that depots compromised patient autonomy (28%, P = 0.003) and were coercive (42%, P < 0.001). Familiarity with depots and their knowledge of side effects were positively associated with favourable attitudes. CPNs have several strongly endorsed attitudes towards depot medication. Interprofessional group differences also exist which may undermine the treatment process. Training/refresher courses about depots should highlight systematic treatment decision-making and side effect monitoring which, in turn, may improve professionals' attitudes, knowledge and clinical monitoring of depots.