Perceived Experience of the clozapine Treatment Protocol: A Qualitative Study of Reports by Brazilian Patients With Schizophrenia Treated in a University Outpatient Service Specializing in Psychiatry.

introductionUnderstanding the meanings people attribute to observed events and lived experiences is to unveil their symbolic universe, thus allowing us to help them better manage their emotions, reactions, and relationships, particularly in clinical settings. Patients with schizophrenia resistant to treatment with first- and second-generation antipsychotics respond well to clozapine; however, this medication presents agranulocytosis as an important side effect. Consequently, the medication protocol requires frequent blood draws to monitor any effects on blood cells. Investigating patients' perceived emotional experiences of this procedure triggered our study.

objectiveTo interpret emotional and/or symbolic meanings attributed by patients with schizophrenia to the clozapine treatment protocol during follow-up at a university outpatient service specializing in psychiatry.

methodA clinical-qualitative study was conducted based on Turato's design. Data were collected by means of in-depth semi-directed interviews with open-ended questions conducted in-person with participants using clozapine. Sampling followed Fontanella's theoretical information saturation criterion. Data were explored by Faria-Schutzer's clinical-qualitative content analysis (CQCA), employing psychodynamic concepts from Medical Psychology.

resultsAnalysis of nine interviews resulted in four categories: (1) the frequent blood collections foreseen by the protocol seem to have little impact on patient's symbolization and treatment adherence; (2) "I come here to stay alive": the frequent blood collections foreseen by the protocol seem to have a good impact on patient's treatment adherence; (3) Reframing a psychiatric illness: the protocol reinforces the embodiment of a medical diagnosis. DISCUSSION: Faced with a socially and psychologically non-silent mental disorder, management of schizophrenic symptoms seems to suppress patient symbolization of the blood count collection protocol and the risk of agranulocytosis. Moreover, the protocol appears to promote safety and favor treatment adherence, as well as to provide a greater level of social integration by inserting patients into the health system dynamics.

conclusionDespite the repetitive experience of blood collection for rigorous effect control, such a ritual does not seem to bring about symbolizations "more charged" than the chronicity of the disease itself. Therefore, patients benefit from the frequent blood collections, as it secures them from possible social isolation by promoting social interaction. These benefits can help patients to develop new meanings for their life condition.