Identifying people with psychotic illnesses who could discontinue antipsychotic medications without relapse and with maximum benefit: a scoping review

PI Title: Natalie Shoham

Lead member: QMUL

Why this study is needed:
Antipsychotic medications are the most common treatment for psychotic illnesses, like schizophrenia. Symptoms of these can include hearing voices, having unusual beliefs, and confused thinking patterns. Psychotic illnesses can negatively affect people’s ability to work and socialise. People with psychotic illnesses are also more likely to have physical health problems.
Antipsychotic medications (‘antipsychotics’) can work well to reduce the symptoms of these illnesses and prevent them from coming back. However, antipsychotics can also cause unpleasant effects like weight gain, diabetes, and feeling ‘slowed down’.
For this reason, many people prefer not to take antipsychotics, or to stop them when their symptoms are under control. This can however lead to the illness coming back, sometimes with serious consequences for people’s lives.
A recent trial looked at people with psychotic illnesses who had recovered, to see if it was better for them to stop antipsychotics. It found that people who gradually stopped antipsychotics were more likely to become unwell again than those who continued them. On the other hand, research has shown that around 1 in 5 people can stop antipsychotic medications without becoming unwell again. This means that some people probably stop medications who should not, whilst others continue when they don’t need to, and have side effects for longer than they need to. Often, the decision regarding whether to stop is left to General Practitioners (GPs) and people taking the medications themselves, because mental health teams do not normally keep seeing people once the mental illness is treated. This research project aims to help GPs to identify who might be able to stop antipsychotic medications without becoming unwell.

What we plan to do
We will search for all existing reports which describe the features of people who are more likely to be able to discontinue antipsychotic medications and remain well. We will then write a research paper summarising all this existing knowledge. We will include research based on large numbers of people, guidelines, and expert opinions. This is the first step, which will allow
us to see what is already known, and what we still need to explore in future research, to help us identify the people who should be offered a trial of stopping antipsychotics.

How we will report our findings
We will write these findings up in a research journal and present them at conferences like the British Journal of General Practitioner’s Research conference, alongside people who have taken antipsychotics. We will also publicise findings using infographics, podcasts and webinars via social media, and press releases. Our hope is that these findings will help patients and professionals to feel more confident in knowing when to consider stopping antipsychotic medications, and when not to.