La déprescription en psychiatrie est un sujet complexe en raison du risque de rechute, de l’hétérogénéité clinique des troubles et de leur évolution au long cours. En l’absence de recommandations précises, surtout en France, les données restent limitées. L’objectif de cette étude est d’explorer les pratiques et représentations des psychiatres concernant la déprescription des antipsychotiques. Une étude descriptive multicentrique a été réalisée à l’aide d’un questionnaire en ligne auprès de psychiatres exerçant en milieu hospitalier ou en exercice mixte (hospitalier et libéral ou intra- et extra-hospitalier). L’outil comportait un cas clinique fictif d’un patient présentant un trouble du spectre de la schizophrénie stabilisé et des questions relatives sur les pratiques et représentations liées à la déprescription. Les données ont été analysées à l’aide de statistiques descriptives. Un total de 140 psychiatres ont complété le questionnaire. Concernant le cas clinique, 91 % étaient favorables à la déprescription, le justifiant par la stabilité clinique (93 %) et l’absence de symptômes positifs (85 %). Le principal frein à la déprescription identifié était le risque de rechute (100 %). Dans leur pratique, 85 % des psychiatres avaient déjà déprescrit, chez des patients stables cliniquement, ayant présenté un épisode isolé ou en cas de plaintes d’effets indésirables. Les psychiatres plus jeunes valorisaient davantage l’implication des proches et la mise en place d’un plan de crise. Les psychiatres exerçant en milieu mixte se montraient plus attentifs à l’altération du fonctionnement social et aux effets indésirables rapportés par les patients. La déprescription des antipsychotiques suscite un intérêt croissant en psychiatrie. Elle repose sur une approche individualisée intégrant les critères cliniques, la volonté du patient et un suivi renforcé.

Deprescribing involves carefully identifying medications that could potentially be discontinued, taking into account the patient's overall clinical status, treatment goals, and adherence. In psychiatry, deprescription is particularly challenging. Psychotropic medications, especially antipsychotics, are often prescribed long-term, and stopping them raises specific clinical concerns. The risk of relapse, the heterogeneity of psychiatric disorders, and their progression over time are all critical factors in deprescribing decisions. Furthermore, the lack of clear guidelines on how to taper or discontinue antipsychotics, particularly in France, remains a significant barrier to implementating deprescription in practice. This study aims to examine the practices and perceptions of psychiatrists in France concerning the deprescription of antipsychotics, to identify the arguments supporting or opposing this approach, and to capture their clinical experiences with a practice that remains poorly documented. A multicenter descriptive study was conducted using an online questionnaire among psychiatrists practicing in hospital settings or in mixed practice (hospital-based and private practice, or intra- and extra-hospital). The survey included a fictitious clinical case of a patient with a stabilized schizophrenia spectrum disorder and questions on practices and perceptions related to deprescribing. Data were analyzed using descriptive statistics. The questionnaire was distributed by email via mailing lists of professional healthcare networks. Participation in the questionnaire was anonymous and voluntary. A total of 140 psychiatrists completed the questionnaire. In the clinical cases, 91% favored deprescribing, mainly justified by clinical stability (93%) and the absence of positive symptoms (85%). The main obstacle identified was the risk of relapse (100%). In their practice, 85% of psychiatrists had already engaged in deprescribing, most often in clinically stable patients after an isolated episode or in cases of adverse effects. Younger psychiatrists placed greater emphasis on involving relatives and implementating a crisis plan, while those in mixed practice were more attentive to impaired social functioning and adverse effects reported by patients. Deprescribing antipsychotics is a topic of growing interest in psychiatry, frequently discussed at conferences but sometimes controversial. Several studies have explored the feasibility of deprescribing these medications. This process requires an individualized approach, based on a medical decision that considers the patient's clinical context and a careful benefit-risk assessment. The use of hypothetical clinical cases has proven useful to establish a common framework for exploring deprescribing strategies. Clinical stability and absence of positive symptoms are the primary factors determining the feasibility of deprescription, while success also depends on the patient's environment and care context. Psychiatrists highlighted the importance of enhanced follow-up, a stable living situation, and a strong therapeutic alliance to reduce relapse risk. Practitioners in mixed care settings reported more frequent opportunities to deprescribe compared with those in exclusively inpatient settings, where care is mainly acute. Our results show heterogeneous deprescribing practices, reflecting the lack of standardized guidelines on tapering or discontinuation procedures. Optimal tapering duration varies individually; while some patients tolerate rapid reductions, hyperbolic tapering is generally better tolerated and minimizes withdrawal symptoms. When considering a patient's request, psychiatrists must balance respecting patient preferences with professional responsibility regarding relapse risk, a concern particularly noted among younger psychiatrists. Medico-legal risk was rarely cited, suggesting other factors dominate deprescribing decisions. Overall, deprescribing represents a move toward personalized psychiatric care, guided by clinical criteria, patient preferences, and the presence of long-term adverse effects. Training prescribers in gradual dose-reduction strategies and raising awareness of withdrawal risks may enhance the safety of antipsychotic deprescription and address current gaps in pharmacological knowledge.