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Mental health professionals’ views and experiences of antipsychotic reduction and discontinuation

Mental health professionals’ views and experiences of antipsychotic reduction and discontinuation

Cooper, Ruth E. ORCID: 0000-0002-9735-4731, Hanratty, Éanna, Morant, Nicola ORCID: 0000-0003-4022-8133 and Moncrieff, Joanna (2019) Mental health professionals’ views and experiences of antipsychotic reduction and discontinuation. PLoS ONE, 14 (6):e0218711. ISSN 1932-6203 (Online) (doi:https://doi.org/10.1371/journal.pone.0218711)

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Abstract

Background:
The widely established treatment for psychosis is long-term antipsychotic medication. However, many people stop taking this treatment, and request other options. There are also growing concerns about adverse effects, but currently no professional guidelines to support reducing or stopping these drugs. The views and experiences of individual mental health professionals around reducing and stopping antipsychotics are therefore crucial in treatment decisions.

Methods:
We conducted 7 focus groups with prescribing psychiatrists and other members of community-based statutory mental health services in London. Participants discussed their views about, experiences, and processes of antipsychotic reduction and discontinuation. Data were analysed using thematic analysis.

Results:
Participants acknowledged that antipsychotics can have severe adverse effects. They were generally supportive of trying to reduce these drugs to the lowest effective dose, although stopping antipsychotics was less acceptable. Prior experiences of adverse events after reduction or discontinuation meant that both were approached with caution. Reduction was also reported to be hampered by organisational and knowledge barriers. Lack of resources, pressure to discharge, and poor continuity of care were seen as organisational barriers. Knowledge barriers included inadequate evidence about who might be best suited to reduction, and lack of guidance about how this could be done safely. This meant that reduction was often prompted by patients, and sometimes actively discouraged, and stability with maintenance treatment was often favoured.

Conclusions:
Concerns about risk and other barriers means that clinicians are often reluctant to implement reduction or discontinuation of antipsychotic medication. In order to increase the treatment options available to service users, more research and guidance on how to minimise the risks of antipsychotic reduction and discontinuation is required to enable clinicians to engage more constructively with service users requests, offering people more choice and control in managing their mental health condition.

Item Type: Article
Additional Information: © 2019 Cooper et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Uncontrolled Keywords: Antipsychotics, reduction and discontinuation, focus groups
Subjects: B Philosophy. Psychology. Religion > BF Psychology
Faculty / Department / Research Group: Faculty of Education, Health & Human Sciences
Faculty of Education, Health & Human Sciences > Department of Psychology, Social Work & Counselling
Last Modified: 20 May 2021 09:55
Selected for GREAT 2016: None
Selected for GREAT 2017: None
Selected for GREAT 2018: None
Selected for GREAT 2019: None
Selected for REF2021: None
URI: http://gala.gre.ac.uk/id/eprint/32755

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