Clinician perspectives on supporting adults with psychosis who wish to discontinue neuroleptic medication: qualitative analysis

Purpose: Research consistently demonstrates that service-users perceive limited choice in whether neuroleptic medication should be dis- continued. Clinicians identify barriers to making shared decisions around medication; however, little is known about how clinical decisions are made regarding whether to support service-users in discontinuing neuroleptic medication. This study examined clinicians’ perspectives on supporting adults who wish to discontinue neuroleptic medication.Materials and Methods: Grounded theory was used to investigate the views and perspectives of clinicians by individual in-depth interviews.Results and Conclusions: A theoretical model (Figure 1) was developed depicting a complex process of decision-making for clinicians working with service-users wishing to discontinue neuroleptics. Decision-making was influenced by clinicians’ personal and professional experiences, and underpinned by their assessment of risk factors and anticipated prognoses for service- users wishing to discontinue neuroleptics. This determined whether clinicians adopted a collaborative or coercive communication style with service-users. Decisions to support discontinuation elicited a range of anxieties in clinicians, leading to actions focused on harm reduction. Decisions about neuroleptic discontinuation are subjective and dependent on clinicians’ previous experiences and judgements regarding potential risk factors. The development of national guidelines, training, resources and support services are required for clinicians to be able to effectively support service-users to discontinue neuroleptic medication.