A Thesis submitted to The University of Arizona College of Medicine - Phoenix in partial fulfillment of the requirements for the Degree of Doctor of Medicine. / Neuroleptic medications are commonly administered in the emergency department but are known to induce extrapyramidal symptoms (EPS) in some patients; typically dystonia and akathisia. This systematic review will examine if adjunctive medications are efficacious when given in conjunction with neuroleptic medications to prevent these extrapyramidal symptoms. The Central, DARE, LILACS, PubMed, CINAHL, and OVID databases were searched for relevant articles between January 2014 and February 2016. Inclusion criteria required the article to be a randomized controlled trial; administer an anticholinergic medication given concurrently or just prior to treatment with medications with known extrapyramidal side effects; and be published in English. The initial search strategy yielded 1222 prospective articles of which 1208 were excluded by title and/or abstract. Fourteen articles were retrieved in full text and independently reviewed by each author. Seven 7 RCTs representing 645 patients were determined to be appropriate for analysis. Meta‐analysis of 5 studies found a significant effect (OR 0.4 with 95% CI 0.23‐0.71) for utilizing anticholinergic adjunct medications in the prevention of EPS for 60 minutes after administration. No reduction was found (OR 1.14 with 95% CI 0.01‐164) in EPS after 60 minutes in meta‐analysis of 2 studies with opposing results. Adjunctive anticholinergic medication was effective in reducing symptoms of dystonia (OR 0.13 with 95% CI 0.04‐0.43) but not in reducing symptoms of akathisia (OR 0.74 with 95% CI 0.27‐1.98). This systematic review found that anticholinergic adjuvant anticholinergic treatment reduced EPS induced by antipsychotic medications during 60 minutes after administration, with the greatest reduction in dystonic symptoms.

No description available.

The mechanisms by which antipsychotics (neuroleptics) produce their therapeutic effects in schizophrenia are largely unknown. Although neuroleptic efficacy is attributed to central dopamine D2 and/or serotonin 5-HT2 receptor antagonism, clinical improvements in schizophrenia are not seen until two or three weeks after daily neuroleptic administration. The mechanisms underlying the neuroleptic response must therefore occur downstream from initial receptor blockade and be a consequence of chronic neurotransmitter receptor blockade. The goal of the present study was to use neuroleptics with varied dopamine vs. serotonergic receptor blocking profiles to elucidate some of these intracellular post receptor mechanisms. Since the final steps of both dopamine and serotonin synthesis require the enzyme aromatic L-amino acid decarboxylase (AADC), the effects of neuroleptics on AADC gene (mRNA) expression were examined in PC12 cells and compared to their effects on the synthetic enzyme tyrosine hydroxylase (TH) and ' c-fos' (an early immediate gene [IEG]) mRNA. The neuroleptics examined did not significantly regulate AADC mRNA in PC12 cells, and only haloperidol upregulated TH and 'c-fos' mRNA. Later studies in rats showed that acute neuroleptic administration increased ' c-fos' mRNA, whereas the immunoreactivity of a related IEG (delta FosB) was increased upon chronic treatment. These studies and a subsequent dose response study demonstrated that upregulation of both 'c-fos' mRNA and delta FosB immunoreactivity was most prominent in dopaminergic projection areas including the striatum and nucleus accumbens. Because it has been suggested that neuroleptic treatment might prevent neurodegeneration in schizophrenia, the effects of neuroleptics on the mRNA expression of neuroprotective target genes of delta FosB were examined both ' in vivo' and 'in vitro'. These genes included brain-derived neurotrophic factor (BDNF), the neuroprotective enzyme superoxide dismutase (SOD), and the low affinity nerve growth factor receptor (p75). While dopamine D2 blockade unfavorably regulated BDNF and p75 mRNA, 5-HT 2 blockade either had no effect on or favorably regulated BDNF, SOD, and p75 mRNA. Thus, although little about the contribution of serotonergic blockade in the neuroleptic response was determined, dopaminergic blockade regulated IEG's and several of their target genes. Future studies will be needed to understand the role of 5-HT2 receptor blockade in the neuroleptic response.

Die Ergebnisse von Studien, die den Einfluss neuroleptischer Medikation auf kognitive Funktionen schizophrener Patienten untersuchten, waren bisher widersprüchlich. Ziel dieser Arbeit war die Prüfung, ob Beeinträchtigungen kognitiver Funktionen sowohl bei unbehandelten als auch mit konventionellen bzw. atypischen Neuroleptika behandelten schizophrenen Patienten im Vergleich zu gesunden Probanden nachweisbar sind. Es wurden 44 stationäre schizophrene Patienten und 51 gesunde Kontrollprobanden mit einer modifizierten, neuropsychologischen Testbatterie untersucht. Nach 8-11 Wochen erfolgte eine Wiederholungsmessung. Bei den schizophrenen Patienten konnte eine generalisierte kognitive Störung festgestellt werden. Der Vergleich des Behandlungseffektes der Atypika mit der Veränderung der Testleistung bei den gesunden Kontrollen bei Wiederholungsmessung ergab, dass der "Behandlungserfolg" durch die Atypika kleiner als die Verbesserung der kognitiven Defizite bei den gesunden Kontrollen bei Wiederholungsmessung ist. Die günstigen Effekte der Atypika auf die kognitiven Fähigkeiten bei schizophrenen Patienten sind demnach zwar vorhanden, aber im Vergleich zu den "Lerneffekten" bei gesunden Probanden eher klein. Weiterhin wurde eine Dosisabhängigkeit bestimmter kognitiver Funktionen (Perseveration, motorische Fähigkeiten) bei Patienten, die mit konventionellen Neuroleptika behandelt wurden, gefunden. Bei Atypika konnte dieser Zusammenhang nicht beobachtet werden. Atypische Neuroleptika könnten für schizophrene Patienten, die eine hohe Neuroleptikadosis benötigen, bezüglich kognitiver Funktionen besser verträglich sein. / The findings of studies investigating the effects of neuroleptics on the cognitive function in patients with schizophrenia have been inconsistent. The aim of this study was to investigate the effects of conventional and atypical neuroleptics on cognitive function in schizophrenic patients compared to drug-free patients and healthy controls. 44 schizophrenic in-patients and 51 healthy subjects were assessed with a modified neuropsychological test battery. After 8-11 weeks a repeat assessment was done. Patients with schizophrenia had generalized cognitive deficits. Comparing the treatment effect of atypical neuroleptics in patients with schizophrenia with the improvement of the test performance in the repeat assessment in healthy controls, it was found that the "treatment success" is less pronounced than the improvement after repeat assessment in healthy controls. This shows that there are positive effects of atypical neuroleptics on cognitive function, but compared to the "learning effects" of healthy controls it is small. Furthermore, it could be shown that some effects of conventional neuroleptics on cognitive function and psychomotor performance were dose-dependent. This effect was not observed with atypical neuroleptics. The main conclusions were that atypical neuroleptics are more acceptable also in higher dosage. Patients with a history of suboptimal response to conventional treatments may show cognitive benefits from atypical antipsychotic drugs.

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / Fluphenazine-induced orofacial dyskinesia (OD) is a putative animal model of tardive dyskinesia (TD) whose pathophysiology has been related to an increase in dopamine hypersensitivity and oxidative stress. Data from literature have shown that patients with TD present a decrease in dopamine transporter (DAT) expression. In a previously study, we have demonstrated that experimental animals presenting high intensity of vacuous chewing movements (VCM) induced by chronic treatment with haloperidol also presented a reduced dopamine uptake into striatum. Considering that one way to regulate DAT is through redox modulation, the first objective of the present study to determine if the chronic treatment with fluphenazine could induce an increase in oxidative stress index in brain regions (striatum and substantia nigra) and an alteration in levels of dopamine uptake in the striatum of rats treated acute and chronically with fluphenazine (Article 1). The fluphenazine treatment produced VCMs in the majority of the treated rats (87% after 24 weeks). Concomitant treatment with diphenyl diselenide decreased the prevalence of VCMs to 50%. Additionally, we separated the rats that developed (+VCM) or did not develop (-VCM) VCMs. We did not find any statistical differences among the groups when oxidative stress parameters were evaluated. Chronic fluphenazine treatment significantly decreased dopamine uptake. Concomitant treatment with diphenyl diselenide was not able to prevent this decrease in those rats that developed VCMs. Another objective of this work was to evaluate the role of dopamine (DA) and other monoamines and their metabolites on acute and chronic of OD induced by fluphenazine in rats (manuscript in preparation 1). The vacuous chewing movements (VCMs) or the levels of monoamines and its metabolites were quantified after 3 (acute) or 24 (chronic) weeks after beginning of treatment. The fluphenazine treatment produced VCMs in part of treated rats (50% after 3 weeks and about 85% after 24 weeks). There were not significant differences between the groups in monoamines levels neither in their metabolites in the striatum under acute fluphenazine treatment in +VCMs rats. However, we observed a trend to increase the levels of the DA metabolites, HVA (p=0.05) and DOPAC (p=0.06), after chronic treatment with fluphenazine. Our data suggest that an increase in DA metabolism could contribute to the maintenance of VCMs in rats. Moreover, development of VCMs seems not to be dependent of DA metabolism. Moreover, the use of diphenyl disselenide seems to be a promissory pharmacological therapy in the reduction of OD prevalence. / A discinesia orofacial (DO) induzida por flufenazina consiste num modelo de discinesia tardia (DT) cuja patofisiologia tem sido relacionada à hipersensibilidade dopaminérgica e ao estresse oxidativo. Dados da literatura demonstraram que pacientes com DT apresentam reduzida expressão do transportador de dopamina (TDA). Em um estudo prévio, nós demonstramos que animais experimentais que apresentam alta intensidade de movimentos de mascar no vazio (MMV) induzidos por tratamento crônico com haloperidol também apresentaram uma redução na captação de dopamina (DA) no estriado. Tendo em vista que uma das maneiras de reduzir a atividade dos TDA é via modulação redox, um primeiro objetivo deste estudo foi determinar se o tratamento crônico com flufenazina poderia induzir um aumento nos índices de estresse oxidativo em regiões cerebrais (estriado e substantia nigra) e quais os efeitos deste tratamento nos níveis de captação de DA no estriado de ratos tratados aguda e cronicamente com flufenazina (Artigo 1). O tratamento com flufenazina produziu MMV na maioria dos ratos tratados (87% após 24 semanas). O tratamento concomitante com disseleneto de difenila diminuiu a prevalência dos MMV para 50%. Além disso, separamos os animais que desenvolveram (+MMV) ou não desenvolveram (-MMV) MMV. Não encontramos nenhuma diferença estatística entre os grupos quando comparados parâmetros de estresse oxidativo. O tratamento crônico, mas não agudo, com flufenazina diminuiu significativamente a captação de DA nos animais que apresentaram MMV. O tratamento concomitante com disseleneto de difenila não foi capaz de prevenir esta redução naqueles ratos que desenvolveram MMV. Um outro objetivo deste trabalho foi avaliar a participação da DA, de outras monoaminas e de seus metabólitos no modelo agudo e crônico de DO induzida por flufenazina em ratos (manuscrito em preparação 1). O tratamento com flufenazina produziu MMV na maioria dos animais tratados (50% após 3 semanas e cerca de 85% após 24 semanas. Não houve diferença estatisticamente significativa entre os grupos controle e tratado com flufenazina agudamente com relação aos níveis de monoaminas e seus metabólitos no estriado de ratos apresentando MMV+. Observamos uma tendência a um aumento nos níveis dos metabólitos da DA, HVA (p=0.05) e DOPAC (p=0.06), após tratamento crônico com flufenazina. Em conjunto, estes resultados indicam que a redução no transporte de DA pode ser um possível mecanismo relacionado à manutenção da DO crônica em ratos. O metabolismo da DA parece ter participação na manutenção da DO, mas não no desenvolvimento. Além disso, o uso do disseleneto de difenila parece ser terapia farmacológica promissora para a redução da prevalência da DO.

Ce travail de neurobiologie intégrative porte sur l’étude des contrôles exercés par les récepteurs 5-HT2C au niveau du réseau des ganglions de la base, un groupe de structures sous-corticales impliquées dans le contrôle du comportement moteur. Les récepteurs 5-HT2C exercent trois modalités de contrôle sur les cellules des ganglions de la base comprenant les contrôles phasique, tonique et constitutif, ce dernier contrôle étant indépendant de la présence de la sérotonine (5-HT), le ligand endogène. A l’aide d’outils pharmacologiques appropriés (agoniste, antagoniste et agoniste inverse), nous avons étudié chez le rat les différents contrôles des récepteurs 5-HT2C sur un comportement moteur, les mouvements orofaciaux. Nous avons aussi étudié ces contrôles dans les ganglions de la base en mesurant l’expression du marqueur neuronal de changement d’activité cellulaire, le proto-oncogène c-Fos, et en utilisant des enregistrements extracellulaires unitaires de la fréquence basale ou évoquée par des stimulations corticales des structures de sortie du réseau, le noyau entopédonculaire (NEP) ou la substance noire pars reticulata (SNr). Mes données montrent que la stimulation du récepteur 5-HT2C ou le blocage de son activité constitutive entrainent une augmentation des mouvements orofaciaux anormaux. Les données anatomiques révèlent que les différents contrôles 5-HT2C s’expriment au niveau des structures d’entrées des ganglions de la base, le striatum et le noyau sous-thalamique (NST), avec une expression préférentielle de l’activité constitutive au niveau du striatum et du noyau accumbens (NAc). Le contrôle phasique et l’activité constitutive étendent leur influence vers les structures de sortie des ganglions de la base ce qui pourrait être associé à l’émergence des mouvements orofaciaux anormaux. Les contrôles 5-HT2C sont influencés par le niveau d’activité du réseau et notamment le niveau de transmission dopaminergique (DA). En effet, une lésion des neurones DA potentialise les réponses comportementales et électrophysiologiques induites par un agoniste 5-HT2C au niveau du NEP. La stimulation des récepteurs D2 entraîne des dyskinésies orofaciales et une augmentation des réponses électrophysiologiques de la voie cortico-sous-thalamo-nigrale et ces effets sont supprimés par des antagonistes 5-HT2C. Ce travail apporte des éléments concernant la distribution et la nature de divers contrôles exercés par les récepteurs 5-HT2C au sein des ganglions de la base. Il ouvre des perspectives thérapeutiques sur l’utilisation des antagonistes 5-HT2C dans la schizophrénie ou la maladie de Parkinson. Pour autant, ces contrôles sont complexes et une meilleure connaissance de leur rôle dans ces régions permettrait de mieux appréhender des thérapies éventuelles avec des agents 5-HT et/ou 5-HT2C. / This work of integrative neurobiology focuses on the study of the controls exerted by the 5-HT2C receptors in the basal ganglia, a group of subcortical structures involved in the control of motor behavior. 5-HT2C receptors exert three modalities of control over cells of the basal ganglia, including a phasic, tonic and a constitutive control, the latter one being independent of the presence of serotonin (5-HT), the endogenous ligand. Using appropriate pharmacological tools (agonist, antagonist and inverse agonist), we have studied in rats the different controls of 5-HT2C receptors on one motor behavior, the purposeless orofacial movements. We also have studied these controls in the basal ganglia by measuring the expression of the proto-oncogene c-Fos, a marker of change of neuronal activity by determining the firing rate, basal or evoked by cortical stimulations, of neurons located in the output structures, the entopeduncular nucleus (EPN) or the substantia nigra pars reticulata (SNr), using single unit extracellular recordings. My data showed that stimulation or the blockade of the constitutive activity of 5-HT2C receptor induced an increase in abnormal orofacial movements. Anatomical data indicated that the different 5-HT2C controls are expressed in the input structures of the basal ganglia, the striatum and the subthalamic nucleus (STN), with a preferential influence of the constitutive activity in the striatum and nucleus accumbens (NAc). In addition, the phasic control and the constitutive activity extended their control to the output structures of the basal ganglia which could be associated with the emergence of orofacial movements. 5-HT2C controls are influenced by the network activity, in particular the level of dopaminergic (DA) transmission. Indeed, a lesion of DA neurons potentiated behavioral and electrophysiological responses induced by a 5-HT2C agonist by acting in the EPN. The stimulation of D2 receptors induced oral dyskinesia and an increase in electrophysiological responses of the cortico-subthalamo-nigral pathway, and these effects were suppressed by selective 5-HT2C antagonists. This work brings up elements regarding the distribution and the nature of the diverse controls exerted by 5-HT2C receptors in the basal ganglia. It opens therapeutic perspectives for the use of 5-HT2C antagonists in the treatment of schizophrenia and Parkinson's disease. Nevertheless, these controls are complex and a better understanding of these controls in these regions would permit to apprehend possible treatments using 5-HT and/or 5-HT2C agents.

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / Haloperidol-induced orofacial dyskinesia (OD) is a putative animal model of tardive dyskinesia (TD) whose pathophysiology has been related to an increase in dopamine turnover, reduction in gabaergic neurotransmission and oxidative stress. Schizophrenic patients have been reported to eat a diet higher in fat than the general population and dietary fat intake can lead to an increase in oxidative stress in animal models. Thus, the first objective of this study was to determine if the association of high fat diet ingestion with prolonged haloperidol treatment could alter the OD and lead to oxidative stress in the rat brain (article 1). Haloperidol decanoate administration (38 mg/kg, which is equivalent 1mg/kg/day) monthly for a period of 6 months to rats fed previously with a HF diet caused an increase in OD. Furthermore, haloperidol caused an increase in the levels of lipid peroxidation in striatum and substantia nigra only in rats fed with the HF diet. Another objective of this work was to evaluate the effects of V. officinalis (1% administered in the drink water) in the animal model of OD induced by long-term treatment with haloperidol (article 2). V. officinalis has been widely used to treat insomnia since it posses GABAmimetic and antioxidant properties. Concomitant treatment with V. officinalis did not modify the intensity or prevalence of OD. We did not find any statistical differences among the groups when oxidative stress parameters were evaluated. On the other hand, haloperidol treatment significantly decreased [3H]-dopamine uptake in slices from striatum of rats, an effect unaltered by V. officinalis. The treatment with V. officinalis reduced the locomotor activity in the open field and increased the time spent on open arm in the plus maze test, confirming the anxiolitic effect of V. fficinalis. Taken together, these results indicate that a high fat diet caused a transitory increase in haloperidol-induced OD in rats and this, at least in part, can be related to the haloperidol-induced oxidative stress in brain structures. Our data also suggest that the reduction in dopamine transport can be a possible mechanism related to the maintenance of chronic OD in rats feeding NF diet. Finally, V. officinalis seems not to be efficacious in the reduction of OD in rats. / A discinesia orofacial (DO) induzida por haloperidol consiste num modelo de discinesia tardia (DT) cuja patofisiologia tem sido relacionada a um aumento na renovação de dopamina, à redução na neurotransmissão gabaérgica e ao estresse oxidativo. Existem relatos de que pacientes esquizofrênicos ingerem uma maior quantidade de gordura na dieta do que a população em geral e o aumento da ingestão de gordura pode levar a um aumento do estresse oxidativo em modelos animais. Assim, um primeiro objetivo deste estudo foi determinar se a associação de ingestão de dieta rica em gordura concomitante ao tratamento prolongado com haloperidol poderia alterar a DO e levar ao estresse oxidativo em cérebro de ratos (artigo 1). A administração de decanoato de haloperidol (38 mg/kg, equivalente a 1mg/kg/dia) mensalmente, por um período de 6 meses, a ratos previamente alimentados com dietas normolipídica (NL) e hiperlipídica (HL) causou um aumento na DO. Além disso, o haloperidol causou um aumento nos níveis de peroxidação lipídica em estriado e substantia nigra somente em ratos ingerindo dieta HL. Um outro objetivo deste trabalho foi avaliar os efeitos da V. officinalis (administrada na água de beber na proporção de 1mL de tintura de raíz para 100mL de água) no modelo animal de DO induzido por tratamento prolongado com haloperidol (artigo 2). A V. officinalis tem sido largamente utilizada para o tratamento de insônia possuindo propriedades GABA-miméticas e antioxidantes. O tratamento concomitante com V. officinalis não modificou a intensidade ou a prevalência da DO. Além disto, não encontramos nenhuma diferença estatística entre os grupos quando os parâmetros de estresse oxidativo foram avaliados. Por outro lado, o tratamento com haloperidol reduziu significativamente a captação de [3H]-dopamina em fatias de estriado de ratos, um efeito inalterado pela V. officinalis. O tratamento com V. officinalis reduziu a atividade locomotora no campo aberto e aumentou o tempo de permanência no braço aberto do labirinto em cruz elevado, o que confirma o efeito ansiolítico da V. officinalis. Em conjunto, estes resultados indicam que a dieta rica em gordura causou um aumento transitório da DO induzida por haloperidol em ratos o que pode, em parte, ser relacionado ao estresse oxidativo induzido por haloperidol em estruturas do cérebro envolvidas com a DO. Nossos dados também sugerem que a redução no transporte de dopamina pode ser um possível mecanismo relacionado à manutenção da DO crônica em ratos ingerindo dieta NL. Além disso, a V. officinalis parece não ser eficaz na redução da DO em ratos.

O cachorro-do-mato (Cerdocyon thous) é um canídeo neotropical que necessita ser contido por meios farmacológicos para a realização de certos procedimentos médicos e de manejo, em função de características comportamentais de defesa e grande susceptibilidade ao estresse. A combinação de seis protocolos (tiletamina-zolazepam-xilazina-atropina e azaperone; dextrocetamina-diazepam-xilazina-atropina e azaperone; cetamina racêmica-diazepam-xilazina-atropina e azaperone; tiletamina-zolazepam-detomidina-atropina e azaperone; dextrocetamina-diazepam-detomidina-atropina e azaperone; cetamina racêmica-diazepam-detomidina-atropina e azaperone) foram administradas, por via intramuscular, a dez cachorros-do-mato (nove machos e uma fêmea) com pesos médio 5,85 ± 0,83 kg, para possibilitar a realização de procedimentos de que incluíam marcação, exame físico, colheita de amostras de sangue, colheita de medula óssea e outros procedimentos pouco invasivos de moderada duração em Cerdocyon thous de cativeiro. Após a verificação dos pesos de cada cachorro-do-mato, a dose individual de cada uma das drogas foi calculada por meio de extrapolação alométrica interespecífica. O método proposto mostrou-se plenamente adequado à contenção farmacológica de exemplares de Cerdocyon thous que necessitem ser submetidos a procedimentos medianamente dolorosos ou incômodos, como exame físico e colheita de sangue e medula óssea. Não é indicado, porém, para procedimentos cirúrgicos. / The Crab-eating Fox (Cerdocyon thous) is a neotropical carnivorous that requires chemical restraint for handling due to its susceptibility to stress and characteristics of defensive behavior. Ten Crab-eating Fox (9 males and 1 female) weighing 5.85 ± 0.83 kg were given the combination of six protocols (tiletamine-zolazepam-xylazine-atropine and azaperone; dextroketamine-diazepam-xylazine-atropine and azaperone; racemic ketamine-diazepam-xylazine-atropine and azaperone; tiletamine-zolazepam-detomidine-atropine and azaperone; dextroketamina-diazepam-detomidine-atropine and azaperone; racemic ketamine-diazepam-detomidine-atropine and azaperone) by i.m. injection during field procedures that included identification, physical examination, blood sampling, bone marrow harvesting and other mildly invasive procedures of moderate duration in Cerdocyon thous of captivity. After checking the weights of each Crab-eating Fox, the individual dose of each drug was calculated by means of interspecific allometric extrapolation. The proposed method was safe for both the animal and the human personnel and it is recommended for routine management and stressful but not painful medical procedures like physical examination, measuring, sexing, and bone marrow and blood collection in Cerdocyon thous. / Tese (Doutorado)

No description available.

Cette recherche aborde la médication psychiatrique à partir du point de vue des usagers. Des entrevues en profondeur ont été réalisées auprès de dix personnes utilisatrices en provenance d’une ressource communautaire et alternative en santé mentale. Les répondants éprouvent ou ont éprouvé des problèmes importants de santé mentale. La majorité des usagers de notre échantillon consomme des neuroleptiques. Les participants sélectionnés ont cheminé avec l’approche de la gestion autonome de la médication en santé mentale (GAM). La GAM constitue un terrain fertile, car l’approche favorise la réflexion critique, la diversité de pratiques autour de la médication psychotrope. Un état des connaissances portant sur l’expérience subjective de la médication est présenté. Les effets de la médication sur les personnes et leur contexte de vie ainsi que les aspects symboliques ont été analysés. Parmi les effets majeurs de la médication, on compte : l’effet de « gel », la grande fatigue, les difficultés d’attribution, le désir d’arrêt et les effets paradoxaux. La médication peut avoir des effets positifs ou négatifs sur l’entourage, le travail, les études ou autres implications sociales. Le rapport des usagers relatif à la médication a évolué vers un usage planifié, modulé et moindre. À cet effet, les dix usagers sont passés d’une phase de « novice » à une « d’expert ». Les résultats de cette recherche indiquent que la notion d’observance au traitement doit être revisitée et la notion d’efficacité élargie. Cette étude qualitative démontre que les versants « intérieurs » de la médication, l’expérience subjective et l’intersubjectif apportent une perspective plutôt rare, mais riche, du médicament en tant qu’objet social. / This research looks at psychiatric medication from the perspective of service users. In-depth interviews were conducted with 10 service users from a community-based, alternative mental health resource. The respondents experience or have experienced serious mental health problems. The majority of service users in our sample take neuroleptics. Selected participants followed the mental-health approach known as GAM: Gaining Autonomy & Medication Management. GAM provides a perfect ground, since this approach encourages critical thinking and promotes diverse practices around psychotropic medication. Current knowledge around the subjective experience of medication is presented. The effects of medication on people and their life contexts are analyzed, as well as their symbolic aspects. Among the main effects of medication are: the “anaesthetizing” effect, intense fatigue, difficulties of attribution, the desire to quit and paradoxical effects. Medication can have positive or negative effects on one’s circle of family and friends, work, studies or other social commitments. The relationship between service users and their medication has evolved toward a planned, adapted and reduced use. In this sense, the 10 service users went from a “novice” phase to that of “expert”. Results from this research show that the notion of treatment compliance must be revisited, and the concept of efficiency, broadened. This research shows that the “interior” dimensions of medication, the subjective experience and intersubjectivity provide rare and rich insights into medication as a social object.