ALT Persistent health inequalities over 20 years among adults with intellectual disabilities who display behaviours that challenge: evidence from English primary care records M Jagtiani, A Sadik, L Marston, S Deb, D Rai, B Perera, R Shankar, JA O’Connell, A Hassiotis Background Adults with intellectual disabilities who display behaviours that challenge (BtC) are more prone to poor health. Aims This study seeks to evidence the long-term health outcomes for those who display BtC. Method We conducted a longitudinal cohort study of adults with intellectual disabilities aged ≥18 years in England, using data fromthe Clinical Practice Research Datalink Aurum (January 2003 to December 2023) linked to Hospital Episode Statistics and Office for National Statistics. Main outcome measures were annual health checks, general practitioner referrals, emergency visits, out-patient attendance, in-patient admissions and mortality. Results Among 83 166 adults with intellectual disabilities (mean age 38.6 yea

ALT Antipsychotic discontinuation and reduction in people with schizophrenia and multiple-episode psychosis: the RADAR mixed-methods research programme including RCT by Joanna Moncrieff, Maria Long, Stefan Priebe, Johura Akther-Robertson, Thomas Barnes, George Bray, Ruth Cooper, Nadia Crellin, Katherine Darton, Nick Freemantle , Robert Freudenthal, Vasiliki Gkofa, Lisa Grünwald, Zoe Haime, Nadia Haynes, Robert Horne, Mark Horowitz, Rachael Hunter, Sonia Johnson, Lyn Kent, Glyn Lewis, Louise Marston, Nicola Morant, Vanessa Pinfold, Georgina Ramsay, Ruth Smith, Jacki Stansfeld, Tom Stockmann and Victoria Vickerstaff

ALT Abstract Background: Antipsychotic medication is beneficial for people with psychosis or schizophrenia in the short term, but the balance of risks and benefits in the long term is less clear. Many patients remain functionally impaired, experience significant and distressing side effects and physical health problems. Evidence in people with first episode psychosis suggests that social functioning may be improved for some patients following a gradual reduction or discontinuation of antipsychotics, but there is no evidence in people with recurrent conditions. Objectives: 1. To assess patients’ attitudes to long-term use of antipsychotic medication (work package 1a). 2. To develop a gradual strategy of antipsychotic reduction and discontinuation and to design a trial to assess its benefits and harms (work packages 1a and 1b). 3. To evaluate the antipsychotic reduction strategy in a randomised pilot trial (work package 2). 4. To conduct a full randomised trial (work package 3a) of the antip

ALT at 24 months, there was no significant difference between the two arms in costs (£5619; 95% confidence interval −£386 to £11,625) or quality-adjusted life-years (−0.035, 95% confidence interval −0.125 to 0.054). There were significantly fewer years of full capability in the supported reduction arm (−0.103, 95% confidence interval −0.191 to −0.015). Work package 3b – 26 patients were interviewed. Analysis indicated that patients experienced improvements in adverse effects, social functioning and sense of self. However, some experienced increased symptoms, challenging emotional intensity and relapse. For some patients, supported medication reduction provided an opportunity for learning and empowerment. Work package 3c – 15 clinicians provided feedback on their experiences. They felt that antipsychotic reduction had been beneficial for some but had led to negative outcomes for other patients. Some reported that the trial enabled more collaborative relationships with patients. Limitations: