The examined patient group was quite heavily burdened by mental disorders: more than one-half had a disease and treatment history of more than five years, and nine out of ten used more than one type of psychoactive drug. The discrepancy between the number of patients who used antipsychotic drugs (n = 67) and the number of patients diagnosed with psychosis (n = 25) is due to the fact that this group of drugs is also used for treatment of manic disorders and in smaller doses as a tranquilising medication, usually less than 0.5 defined daily doses. A total of 63 patients reported to have good, very good or extremely good benefit from psychoactive drugs. A total of 52 patients nevertheless wanted an option for drug-free treatment.
Among patients who were also taking medication for somatic disorders we expected to find a higher acceptance for the use of psychoactive drugs. This was not so, however. One-half (49 %) of this group would want an option for drug-free treatment.
The public debate on psychoactive drugs is not of recent date, but has become more vocal in recent years. Antipsychotic and antidepressant drugs in particular have received a negative focus. The criticism is associated with inadequate evidence of efficacy, long-term adverse effects (6) and that antipsychotics are claimed to sustain symptoms of psychosis (7).
Many patients are treated with psychoactive drugs for many years, often with multiple drugs and with uncertain effect (8). However, in light of clinical experience it is difficult to envisage treatment of serious psychoses and manic conditions entirely without the use of antipsychotic drugs; this view is supported by historical experience from the time prior to the introduction of antipsychotic drugs in the 1950s. In the prevailing guidelines for treatment of psychosis disorders, drugs still occupy a key position (9). The paradoxical clinical experience is that patients with conditions for which there is best evidence that drugs are effective – psychoses and manic conditions – tend to have the greatest reservations regarding the use of medication.
The relatively high number of patients who would want a drug-free option if it were available may be an expression of disappointment, since many of them continued to struggle with persistent symptoms or unpleasant adverse effects. It could also be an expression of a wish to avoid the daily reminder of the disorder that the drug intake may represent. An alternative interpretation is that many of the patients had an insufficient understanding of their own need for preventive treatment or treatment as such. On the other hand, we may wonder why far more patients would not want a drug-free option, since the health authorities have backed the establishment of such treatment programmes.
One strength of the study is that it is based on a patient sample that had personal experience of relatively severe mental disorders, where all commonly used psychoactive drugs were used in the treatment. Another advantage is that persons with user experience have participated in the project group, including the discussion and implementation of patient interviews.
The reason for using a hospitalisation period of at least one week as an inclusion criterion was that the study also identified the benefits to the patients of therapeutic interventions other than drugs. When compared to background variables from the 2016 national study of patient experiences in mental health care (10), our patient sample is reasonably representative of hospitalised Norwegian psychiatric patients in terms of sex, age, diagnoses and disease burden.
For the key question in this study, 'would you want a drug-free treatment programme if this were available?', only two response alternatives were given: yes or no. This may represent a methodological weakness, because the response alternatives fail to leave sufficient room for nuances and doubts. The patients were asked during hospitalisation, i.e. during an active stage of the disorder, where we may assume that the need for alleviation and drugs is at its highest. It is therefore possible that the proportion that would have favoured a drug-free option might have been larger during a less intense phase of the disorder.
The reasons for the patients' views on the use of drugs have not been identified, and this ought to be followed up through a qualitative study.