[Reduction and discontinuation of antipsychotic drugs in outpatient practice: perspectives of psychiatrists].

backgroundAntipsychotic medications (AP) are a central component in the treatment of psychotic disorders. The question arises how to balance long-term pharmacological treatment with the possibility of reduction or discontinuation (R&D). The German S3 guidelines for schizophrenia provide a general framework for R&D but concrete recommendations for practical implementation are still lacking.

objectiveThis qualitative study aims to explore the attitudes, challenges and reduction strategies of outpatient psychiatrists in Berlin and Brandenburg regarding the R&D of antipsychotics, in order to draw conclusions about the current state of care and potential gaps in service provision. MATERIAL AND

methodsIn this study 10 semi-structured interviews with outpatient psychiatrists and one focus group with psychiatrists were conducted. The data were analyzed using thematic analysis.

resultsThe participating psychiatrists predominantly favored an individualized and gradual approach to reducing antipsychotics. While some reported feeling confident and drew on their own clinical experience, others expressed considerable uncertainty and concern regarding the discontinuation process. This uncertainty was partly attributed to a perceived lack of specific guidance for practical implementation, which led to a sense of individual responsibility. Structural barriers, such as limited psychosocial support services and the lack of availability of finely graduated dosage forms, further hinder the implementation of effective reduction strategies. DISCUSSION: A clearer position in clinical guidelines, including more specific recommendations on R&D, could help reduce uncertainty among psychiatrists. Furthermore, enhanced psychosocial and psychotherapeutic support services would be necessary to enable a safe R&D process in outpatient settings.