I studied your post carefully.
This is actually a complicated situation. How? The issues:
1 - Who diagnosed what and when.
2 - What is the patient’s consent status at present - and has it changed from any material times in 1 above.
3 - Closely connected to 1 & 2 is who prescribed what and when.
4 - A ‘new psychiatrist’ acting in accordance with GMC expectations (from 31 pieces of quasi-legislation at the GMC) will be burdened with the above. I’ve been there in similar situations many times before.
5 - Patient apparently not attending the OP appointment.
6 - Psychiatrist has declared that he does not treat autism (for reasons unknown). [Unclear when that was said or by what means of communication - I do not need to know.]
7 - There are three declared diagnoses
a) primary is autism,
b) secondary unspecified non-organic psychosis
c) anxiety disorder.
8 - It is unclear what antipsychotic medication is prescribed, whether one, several or including or excluding a depot.
Should the psychiatrist have some input in gradually discontinuing the medication or write to the GP with regard to this, as he is still providing repeat prescriptions, even thought the psychiatrist has signed the patient off.
The question (without a question mark) may appear simple and perhaps it may be expected that there is a simple answer. There is no simple answer.
The following is opinion on similar such cases where I have been involved or witness to - NOT ADVICE even if so construed.
Prescribing specific issues:
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All practising psychiatrists normally being licenced medical doctors - registered with the GMC - ought to address 1, 2 & 3 before and during decision-making about prescribing. See: //investigativepsychiatry.com/2024/09/04/core-list-of-key-standards-and-knowledge/
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A psychiatrist in the captioned situation will normally have primary responsibility (and most) for prescribed psychotropic meds - even if prescribed by a previous psychiatrist or psychiatrists.
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Capacity and consent - always to be considered before reaching for the ‘proverbial pen’. Though the Mental Capacity Act (2005) states that ‘everybody’ should be presumed to be of capacity for ‘everything’, we should all know that in mental health circles no one should assume a patients to be of capacity to decide about specific medications.
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Whether one or more medications are unlicenced prescribing; as defined in para 103 - 109 of GMC prescribing standards (freely available) online. Capacity/consent - even more important if there is such prescribing.
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A doctor can refuse to treat a medical condition (which would include autism) if they are not competent to do so and if attempting to do so would foreseeably (in law) result in an act of negligence (in the law of Tort). Why? Because the GMC directs all doctors to ‘obey the law’ (which does not mean ‘just statute’). Caution: I am not defending ‘a psychiatrist’- I am stating a general position with a reference to the GMC.
Diagnostic-specific issues
Notice I did not say diagnosis-specific issues. Diagnostics is often conflated with diagnosis.
1 - ‘Unspecified’: The word appears 106 times in ICD-10 and 775 times in ICD-11. Thus the diagnostic system has given a wide privilege to anyone making diagnoses - not just psychiatrists. But with great power ought to come great responsibility and restraint.
2 - The reality of my experience over 30 years is as follows:
a) loads of psychiatrists use ‘unspecified’ categories to justify some treatment activity.
b) I have never once in 30 years found cogent documentation for the use of ‘unspecified’ categories.
c) this means something to me. It may mean nothing at all in the national context.
Caution: I imply nothing about ‘a psychiatrist’ or any group of psychiatrists. I am simply stating my factual experience. I have no hard evidence on what ‘psychiatrists’ as a group do nationally.
3 - It is the usual - again based on my experience - for anxiety disorder to be diagnosed ‘at the drop of a hat’ and pills to follow. I am yet to see robust documentation of the rationale for such diagnoses; referenced against diagnostic criteria.
4 - I have seen too many patients with autism, polydiagnosed and then ‘poly-pharmacied’. I think something must be wrong with that - because I have seen too many patients ‘wronged’ in that way. The GMC is totally unaware of what’s going on. Why? Because they are not an inspectorate of their standards (different to the CQC). They sit there waiting for complaints to land in their laps. Caution: I am not making a specific statement about ‘a psychiatrist’ and I do not mean to incite GMC action upon any doctor.
5 - Probability of unspecified psychosis and unlicenced medication in any patient of unknown (undeclared) capacity status is possibly one for exploration.
Actions
I wondered what course of action, if any, needs to be taken.
I said I am not giving advice - and that is behaviour and cognition ruled by the GMC - irrespective of what ‘other doctors’ may do.
What I can say is that information and shared experience is power. All such cases require a thorough medication review. ‘Everybody’ believes that they know what medication review means. But not everybody ‘actually knows’ what it means. //investigativepsychiatry.com/2023/05/15/medication-reviews/