Perceptions of support staff with respect to discontinuation of long-term used antipsychotics for residential individuals with intellectual disability; a mixed method study

Abstract

Title Perceptions of support staff with respect to discontinuation of long-term used antipsychotics for residential individuals with intellectual disability; a mixed method study Background Antipsychotics are the most used psychotropic drugs by residential intellectually disabled individuals and have harmful side effects. There is limited evidence on the efficacy of antipsychotics on challenging behaviour. Discontinuation is possible for a part of residential individuals with intellectual disability and decreases some harmful side effects. In order to discontinue antipsychotics the cooperation of support staff is important. There is no knowledge on perceptions of support staff with respect to discontinuation of antipsychotic medication in persons with intellectual disability. Aim This study wants to gain insights in the perceptions of support staff about discontinuation of antipsychotics in residential individuals with intellectual disability. Method Four focus groups were conducted in this mixed methods study, followed by a survey with 29 Likert items. Results Support staff perceive antipsychotics as effective in decreasing anxiety, automutilation, agitation and aggression. Support staff perceives themselves as motivated to contribute to discontinuation of antipsychotics. A larger proportion of support staff believes reduction is possible compared with the proportion that believes that complete discontinuation is possible. A clear plan for the multidisciplinary team is perceived indispensable. Support staff has no perceived knowledge deficits on side effects of antipsychotics. Conclusion In this first study directed at the perceptions of support staff about discontinuation of antipsychotics a combination was found of a positive attitude toward contributing to discontinuation of antipsychotics on one hand and on the other hand the perceived efficacy of antipsychotics in reducing challenging behaviour and an expectation that discontinuation of antipsychotics is almost only possible in exceptional cases. Recommendations The development of a decision guide is recommended in order to contribute the use of tailor-made discontinuation or reduction plans.