How do you approach deprescribing psychiatric medications in elderly patients with polypharmacy concerns?

Briefly, I take 6 steps in my mind to tackle this carefully.

• Is prescribing really necessary? Can they try non-pharmacological management first?
• Carefully review the medical, surgical, and social history to avoid possible complications.
• Thorough medication reconciliation (including OTCs, herbals, CBD/THC) to avoid drug interactions.
• Doing a cognitive screening and testing their gait (Timed Up & Go).
• See if any of the current medications can be discontinued (gradually, of course).
• I make sure that the patient/caregivers understand and agree to the plan (I often type it quickly in a Word document and print it for them).