Emotional experiences associated with entry into Clozapine treatment protocol reported by patients with Schizophrenia seen in a university specialized outpatient service: a clinical-qualitative study

• Grant number: 21/08084-5
• Support Opportunities: Scholarships in Brazil - Scientific Initiation
• Start date: October 01, 2021
• End date: March 31, 2023
• Field of knowledge: Health Sciences - Medicine - Psychiatry
• Principal Investigator: Egberto Ribeiro Turato
• Grantee: João Batista Alves dos Santos
• Host Institution: Faculdade de Ciências Médicas (FCM). Universidade Estadual de Campinas (UNICAMP). Campinas , SP, Brazil

Abstract

The psychological/emotional understanding of patients in the face of the protocol rigor of introducing new drugs is a permanent challenge for clinical professionals and was wrongly subordinate in scientific discussions. The contact with the universe of mental and cultural meanings allows confluence of languages and consequent desired and informed adherence by patients and the population to therapeutic and preventive measures. Schizophrenia is a serious, disabling psychiatric disorder that significantly reduces the patient's life expectancy. The literature reports that patients with schizophrenia have a reduced ability to maintain social relationships, sustain employment and live independently, showing that the correct understanding of the meanings hidden in their patients' statements is fundamental in establishing consonance and commitment essential in the treatment of the psychiatric disorder. Understanding the symbolic game of falling ill and caring is extremely important to have clinical success. Approximately 30% of patients with schizophrenia will not respond to the use of first and second-generation antipsychotics. The inability to respond to two different antipsychotics, at therapeutic doses, and for a sufficient duration, means that a person meets the criteria for resistance to treatment. The only medication with proven efficacy in this subset of patients with schizophrenia resistant to ERT treatment is clozapine. Among the side effects resulting from this medication are agranulocytosis, sedation, weight gain, constipation, hypersalivation, and rarely myocarditis and cardiomyopathy. Grunulocytopenia can be manifested by neutropenia or agranulocytosis. For this reason, it is necessary to perform frequent blood collection to monitor these blood cells, which is the trigger factor for this study. Objective: to explore and interpret emotional/symbolic meanings attributed to the protocol for introducing clozapine under specialized university outpatient follow-up. Participants and Method: (a) Sample constructed intentionally and sequentially, by referral from the physician in charge of the Psychiatry Clinic at HC-Unicamp; and closed by saturation of theoretical information. (b) The Clinical-Qualitative Method - a humanistic investigative approach developed for care settings will be used. Motto: "The Clinical-Qualitative Method (MCQ) is born from the Clinic and returns to the Clinic". (c) Use of the technique of the Semi-Directed Interview of Open Questions in Depth; in addition to free, complementary observations in the collection of the participants' statements. (d) Operationalization in the field is preceded by a phase of acculturation and setting to promote the insertion of the researcher in the chosen care setting, as well as in the language of future interviewees. (e) The treatment of the data will be done by the Clinical-Qualitative Content Analysis. Expected results: (a) published conclusions should contribute to a better understanding of the emotional representations of the problem on the part of readers of the scientific literature, thus improving the professional-patient relationship, allowing clear and effective guidance to patients and families, and therefore increasing adherence to individual clinical treatments and collective and preventive programs. (b) the immediate return of content interpretations to the local team should also benefit the outpatient population's treatments. (AU)