Pharmacists’ perspectives on deprescribing psychotropic medicines in people with intellectual disabilities

Introduction: Psychotropic medicines are sometimes inappropriately prescribed for individuals with intellectual disabilities without a clinical diagnosis of a mental illness, increasing risks of side effects and poor physical health. This study aims to understand how attitudes, training, experience, and work settings are associated with pharmacist confidence in deprescribing psychotropic medicines and to identify enablers and barriers to the psychotropic deprescribing process in people with intellectual disabilities. Methods: An online survey collected data from 64 pharmacists who reviewed psychotropic medication for individuals with intellectual disabilities between July and December 2022. Linear regression examined the relationship between pharmacist confidence and chosen predictors of attitudes, non medical prescriber status, and working in primary or secondary care. Content analysis applied to free-text data identified enablers and barriers of the psychotropic deprescribing process. Results: Positive attitudes and working in secondary care were associated with greater deprescribing confidence. Enablers included stakeholder support, good communication, specialist interventions, education, and regular medication reviews. Barriers were lack of support, resources and education, poor communication, and fear of negative consequences. Conclusion: Pharmacists’ positive attitudes towards deprescribing were associated with increased confidence. Successfully deprescribing psychotropic medications, while aiming to improve health outcomes, requires the active support and collaboration of all stakeholders. This support is important as deprescribing interventions may carry potential risks such as discontinuation symptoms and the return of previously managed symptoms.