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

## TL;DR

This study compares attitudes of psychiatrists and non-psychiatrists in England on optimizing psychotropic medication for people with intellectual disabilities and/or autism.

## Contribution

It is the first study to quantify differences in attitudes and highlight concerns about patient ethnicity in psychotropic optimization.

## Key findings

- Psychiatrists were less optimistic about the success of a national medication optimization program.
- Barriers to reducing overmedication differed significantly between psychiatrists and non-psychiatrists.
- Patient ethnicity emerged as a key concern in psychotropic optimization that had not been previously quantified.

## Abstract

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.

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.

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.

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).

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.