La déprescription des psychotropes représente un enjeu clinique et éthique majeur. Pourtant le rôle de la discipline infirmière, notamment en pratique avancée, dans ce processus reste peu décrit. Cette revue explore les contributions infirmières retrouvées dans la littérature.

Une revue de la portée a été conduite à partir des bases de données PubMed, CINAHL, Cochrane (2015–2025) ciblant déprescription, psychotropes, santé mentale, soins infirmiers, pratique avancée comprise. Nous avons inclus les articles mentionnant explicitement la discipline infirmière, en population adulte. Sur 44 articles identifiés, 8 ont été inclus après lecture intégrale.

Ces articles, majoritairement qualitatifs ou narratifs, portent sur les antipsychotiques (3), les antidépresseurs (2), les benzodiazépines (2) ou sur l’ensemble des psychotropes (1). Le rôle infirmier y est faiblement détaillé. Aucune étude ne propose de protocole de déprescription structuré, ni d’outil personnalisé. Les dimensions fréquemment abordées sont les représentations (patients, entourage, soignants), la coordination pluriprofessionnelle, l’accompagnement psychoéducatif.

Cette revue souligne l’absence d’outils concrets et de formalisation des contributions infirmières pour la déprescription. Elle met en évidence la nécessité d’un raisonnement clinique partagé, d’une coordination pluridisciplinaire renforcée et d’une temporalité ajustée au patient. Les résultats sont à interpréter avec prudence, du fait d’un corpus limité, d’une hétérogénéité des données et d’une faible transférabilité directe au modèle français.

La déprescription devrait être accessible aux personnes concernées lorsque ses bénéfices dépassent les risques. Il semble possible d’outiller cette démarche en incluant la pratique infirmière et les nouvelles prérogatives de la discipline.

Deprescribing refers to a process of optimizing pharmacological treatment for a given patient, with the aim of identifying the minimum effective dose, which may extend to treatment discontinuation when appropriate. In psychiatry, and particularly with regard to psychotropic medications, this approach represents a major clinical and ethical issue. On the one hand, it is driven by the need to involve people receiving psychotropic treatment and to respond to their requests; on the other hand, it aims to personalize treatment by better integrating the temporal dimension of psychiatric disorders, distinguishing between acute and maintenance phases, which involve different clinical objectives and risks. In contrast to treatment initiation, deprescribing remains far less formalized by scientific societies, clinical guidelines and educational frameworks. This scoping review explores the nursing contributions identified in the literature in relation to psychotropic deprescribing.

A scoping review was conducted using the PubMed, CINAHL and Cochrane databases, covering publications from 2015 to 2025. The search strategy targeted deprescribing, psychotropic medications, mental health, nursing care and advanced practice nursing. Articles were screened based on title, abstract and full-text screening. Studies explicitly referring to nursing involvement in adult psychiatric populations were included. Articles focusing on major neurocognitive disorders, non-psychiatric sleep disorders, non-psychotropic medications, child and adolescent psychiatry, or not mentioning nursing care were excluded. Qualitative, quantitative and mixed-methods studies were eligible. Out of 44 records initially identified, eight articles met the inclusion criteria after full-text review.

The included articles were predominantly qualitative or narrative in design, with only one mixed-methods study. The psychotropic drug classes addressed were antipsychotics, antidepressants and benzodiazepines. Study populations included adults with psychiatric disorders in general, as well as specific groups such as individuals with intellectual disabilities or older adults. Across the studies, nurses and Advanced Practice Nurses (APNs) were described as playing a contributory role in psychotropic deprescribing. Their involvement included clinical observation of adverse drug effects, monitoring of withdrawal or relapse symptoms, patient education, facilitation of shared decision-making, and coordination of care within interprofessional teams. When nurses practiced in advanced roles, they were directly involved in deprescribing strategies. Several obstacles were identified, including fear of relapse, difficulties in distinguishing withdrawal from relapse, limited time, lack of formalized protocols, insufficient training, and symbolic importance of psychotropic medications among patients, relatives and professionals. Conversely, facilitators included interprofessional collaboration, structured planning of dose reduction, availability of non-pharmacological alternatives, clear documentation in the patient medical record, and a sustained therapeutic alliance.

The predominantly qualitative nature of the reviewed studies highlights the importance of social representations among healthcare professionals and patients involved in psychotropic deprescribing. The literature describes a strong symbolic meaning of psychotropic medications in the representations held by patients, relatives, professionals and society. Non-pharmacological interventions, such as psychoeducation, supportive interviews, peer support and physical activity, are described as important components of deprescribing processes. These interventions help people anticipate and normalize withdrawal-related experiences and mobilize personal and social resources. The review underscores the importance of interprofessional collaboration, particularly between nurses, Advanced Practice Nurses, psychiatrists and pharmacists. However, most studies were conducted in hospital settings and rarely considered coordination with primary care or community-based nursing services. More generally, the lack of detailed clinical protocols and decision-support tools, as well as the limited use of psychometric assessments, could reduce the quality of nursing contributions to deprescribing. Within the articles included in this review, hyperbolic dose reduction strategies are rarely described and lack sufficient detail, despite growing interest in the broader literature. Taken together, these gaps make the practical implementation of deprescribing within nursing practice more difficult. These findings should be interpreted cautiously given the limited number of studies, data heterogeneity and limited transferability to the French healthcare context.

Deprescribing should be accessible to people receiving psychotropic treatment when its benefits outweigh its risks. This scoping review highlights the contribution of nursing practice, including advanced nursing roles, to psychotropic deprescribing processes. Research conducted within specific national healthcare contexts could help clarify how appropriate tools and organizational frameworks could be developed and validated to support psychotropic deprescribing in routine clinical practice.