“I would prefer to be prescribing less”: Perceptions on antipsychotics and challenging behaviour

Abstract

Aims: Challenging behaviour in individuals with intellectual disabilities affects quality of life and often results in antipsychotic use, despite guidelines recommending non-drug approaches as the first line. This study explores healthcare team perspectives on managing challenging behaviour, barriers to reducing antipsychotic overprescription, and possible solutions. Methods: A cross-sectional qualitative study using thematic analysis of an online team discussion and survey. Findings were used to develop a driver diagram of proposed strategies. Results: Three themes were identified: (1) varied views on current prescribing practices, with concerns about overuse and limited awareness of guidance; (2) key barriers including staffing shortages, reluctance to reduce medication, poor communication, lack of structured reviews, and absence of outcome measures; and (3) proposed solutions such as family involvement, regular reviews, improved outcome tracking, staff education, and clear care pathways. Conclusion: Addressing system-level barriers through coordinated team-based approaches may reduce reliance on antipsychotics and improve care.

Keywords

intellectual disability challenging behavior antipsychotic prescribing multidisciplinary team barriers non-pharmacological interventions

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