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BJPsych open · 2025

Psychiatrists and non-psychiatrists' attitudes to psychotropic optimisation for people with intellectual disabilities and/or autism: cross-sectional comparison study.

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Tromans Samuel J, Deb Shoumitro, Mahmood Hassan, Triantafyllopoulou Paraskevi, Jamieson Tony, Gookey Gill, Bassett Paul, Malak Zayed, Sawhney Indermeet, Korb Laura, Adams Danielle, Sheehan Rory, Shankar Rohit

Аннотация

BACKGROUND: Off-licence psychotropic use in people with intellectual disability and/or autism, in the absence of psychiatric illness, is a major public health concern in England.

AIMS: To ascertain and compare views of psychiatrists and non-psychiatrists working with people with intellectual disability and/or autism on psychotropic medication optimisation for this population.

METHOD: A cross-sectional survey of 13 questions was disseminated online among psychiatrists and other health professionals working with people with intellectual disability and/or autism across England, using a non-discriminatory exponential snowballing technique leading to non-probability sampling. The questionnaire covered demographic characteristics, perceived barriers/benefits of psychotropic optimisation (including ethnicity) and views on implementation of a national medicine optimisation programme. Quantitative analysis used chi-squared, Mann-Whitney and unpaired t-tests, with significance taken as P < 0.05. Thematic analysis of free-text responses was undertaken with Braun and Clarke's methodology.

RESULTS: Of 219 respondents, significant differences in attitudes to most issues emerged between psychiatrists (n = 66) and non-psychiatrists (n = 149). Psychiatrists had less optimism of a successful national medication optimisation programme if commissioned, or achieving 50% reduction in psychotropic overprescribing and inappropriate psychotropic prescribing generally. Perceived barriers to reducing overmedication differed significantly between the psychiatrists and non-psychiatrists, Thematic analysis identified five themes (system issues, resources, medication challenges, family and carers, and training and alternatives/structure).

CONCLUSIONS: This is the first study to highlight important differences between psychiatrists and non-psychiatrists' attitudes to psychotropic optimisation despite respondents overall being broadly supportive of its need. A major finding is the hitherto unquantified concerns of patient ethnicity and its impact on psychotropic optimisation principles.