Researchers warn 360,000 patients in the UK risk being ‘trapped’ on antipsychotics

Researchers are warning against the increasing use of antipsychotics, particularly in patients without ongoing psychiatrist review or physical health monitoring to detect early signs of heart disease and diabetes.

Antipsychotics are effective medications, but long-term use increases the risk of developing life limiting conditions and should be regularly monitored. A new study from researchers at the Universities of Liverpool, Glasgow, and Powys Teaching Health Board, found 1 in 69 adults in the UK are using antipsychotic medications long-term, yet more than half of them (56%) may not receive adequate health monitoring. They are therefore likely to miss opportunities to optimise or deprescribe antipsychotics by psychiatrists most capable of undertaking reviews and effectively become trapped on this medication.

Antipsychotics are licenced in the UK for the management of psychotic illnesses such as schizophrenia and bipolar disorder – conditions for which GPs receive funding to undertake annual physical health checks. However, 56% of antipsychotics are now being used long-term for patients with non-psychotic illnesses - such as depression, anxiety, personality disorder and in dementia -  conditions that are not funded for recall for physical health monitoring.

Virtually all antipsychotics are initiated by psychiatrists, who are the specialists in management of mental illness. However, the study also found that 48% of patients taking antipsychotics in primary care are no longer under psychiatrist care. It’s estimated approximately 360,000 patients across the UK are at risk of becoming ‘trapped’ on antipsychotics in primary care without psychiatrist review. Researchers suspect this is due to patients being discharged from pressured psychiatric clinics for GPs to manage, but GPs do not have the necessary training to know whether it is safe to change, reduce or stop antipsychotics.

Dr Alan Woodall, Honorary Clinical Senior Lecturer, Institute of Population Health, University of Liverpool and Clinical Lead for Integrated Care, Powys Teaching Health Board said: “Our study shows that more patients on antipsychotics are managed by GPs without ongoing psychiatrist review and are not on monitored disease registers. They are therefore less likely to undergo physical health monitoring, miss opportunities to optimise or deprescribe antipsychotics by psychiatrists most capable of undertaking reviews, and become effectively trapped on this medication. These trends pose risks for patients and need to be addressed urgently. We are calling for policy changes so that all patients on regular antipsychotics have funded physical health reviews by GPs and regular medication reviews by psychiatrists to ensure their care is optimised and they don’t find themselves stuck unnecessarily on these medications long-term.

Senior author, Professor Iain Buchan, W.H. Duncan Chair in Public Health Systems and Associate Pro Vice Chancellor for Innovation, University of Liverpool said: “This concerning trend in prescribing of antipsychotic medicines and lack of wrap-around care to mitigate the risks of common side effects is the latest in a series of analyses of NHS records from the Civic Health Innovation Labs (CHIL) and Mental Health Research for Innovation Centre (M-RIC).

“We are working with mental health service-users and carers to incorporate their experiences of living with combinations of conditions such as schizophrenia and obesity, high blood pressure, diabetes and heart disease that may be caused by antipsychotic medication. We are combining multiple perspectives on this problem to find innovative ways in which services might prevent the most serious side effects of antipsychotic medicines while maximising their benefits for patients.”

The paper, ‘Antipsychotic management in general practice: serial cross-sectional study (2011–2020)’ was published in the British Journal of General Practice. (DOI: https://doi.org/10.3399/BJGP.2024.0367).