ORCID

Abstract

BackgroundOff-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.AimsTo 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.MethodA 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.ResultsOf 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).ConclusionsThis 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.

Publication Date

2025-10-23

Publication Title

BJPsych Open

Volume

11

Issue

6

ISSN

2056-4724

Acceptance Date

2025-09-05

Deposit Date

2025-10-24

Funding

R. Shankar and S.J.T. are members of the BJPsych Open Editorial Board. They did not take part in the review or decision-making process of this paper. S.J.T., H.M., I.S., L.K. and R. Shankar are executive committee members of the Royal College of Psychiatrists’ Faculty of the Psychiatry of Intellectual Disability. S.J.T., D.A., R. Sheehan and R. Shankar have been involved in the development of the NHS England MindEd modules described in the paper. S.D. has been involved in the development of the SPECTROM module described in the paper. R. Shankar and S.D. has been involved in the Connect Behaviours tool described in the paper. MindEd, SPECTROM and Connect Behaviours are all non-commercial ventures. S.J.T. has received funding for projects related to intellectual disability and autism from the National Institute for Health and Care Research, Baily Thomas Charitable Fund, Wellcome Trust and Jazz Pharmaceuticals, and book royalties from Oxford University Press. R. Shankar has received institutional research, travel support and/or honorarium for talks and expert advisory boards from LivaNova, UCB, Eisai, Veriton Pharma, Bial, Angelini, UnEEG and Jazz/GW Pharma outside of the submitted work. He holds or has held competitive grants from various national grant bodies, including Innovate, Economic and Social Research Council, Engineering and Physical Sciences Research Council, National Institute for Health and Care Research, NHS Small Business Research Initiative and other funding bodies, including charities, all outside of this work. No other author has any conflict of interest.

Keywords

antipsychotic, autism, Intellectual disability, psychiatry, psychotropic

First Page

1

Last Page

11

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