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Concern over psychotropic prescribing for learning disability patients

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People with learning disabilities are being regularly treated with psychotropic drugs normally only used to treat patients with severe mental illness, according to a new study.

The research published today in the BMJ found 70% of prescriptions for antipsychotic medication are given to those without a record of severe mental illness.

The findings suggest that people with intellectual disabilities are being inappropriately treated with psychotropic drugs.

Concern has existed for many years that psychotropic drugs in general - and antipsychotics in particular which have been developed to treat schizophrenia and bipolar disorder- are overused in people with intellectual disability.

“We have shown that adults with intellectual disability are treated with psychotropic drugs at a rate far exceeding that of recorded mental illness”

UCL research authors

A team of researchers based at University College London set out to describe rates of recorded mental illness, challenging behaviour, and use of psychotropic drugs in people with intellectual disability in UK primary care.

They said that the findings “highlight the need for an improved evidence base for use of drugs and optimisation of drug treatment in people with intellectual disability”.

The study found that psychotropic drugs are being used to manage other presentations, such as challenging behaviour, rather than for mental illness.

The researchers analysed data from 571 UK general practices and identified 33,016 people with a record of intellectual disability.

Of 9,135 participants treated with antipsychotic drugs by the end of the study period, 6,503 (71%) did not have a record of severe mental illness.

“More work is clearly needed as prescribing often seemsto be contrary to the evidence base and clinical guidelines of good practice”

UCL research authors

Of the 11,915 with a record of challenging behaviour, 5,562 (47%) had received antipsychotic drugs, whereas only 1,561 (13%) had a record of severe mental illness.

The study also found that new prescriptions for antipsychotics were significantly more common in older people and in those with a record of challenging behaviour, autism, dementia, and epilepsy, as well as mental illness.

People with a record of challenging behaviour were more than twice as likely to receive a prescription for antipsychotics.

“Psychotropic drugs are an important element in the management of specific psychiatric conditions. However, we have shown that adults with intellectual disability are treated with psychotropic drugs at a rate far exceeding that of recorded mental illness,” concluded the study authors.

“Although the prescription of antipsychotic drugs has declined over the past 15 years, more work is clearly needed as prescribing often seemsto be contrary to the evidence base and clinical guidelines of good practice,” they added.

Earlier this summer, NHS England committed to “rapid and sustained” action against the over-prescribing of psychotropic drugs for people with learning disabilities.

This followed research which found a high level of their inappropriate use, particularly in primary care settings.

Studies by Public Health England and the Care Quality Commission found medication was often being given in the absence of the patient having any symptoms indicating the relevant condition and also as a way to manage challenging behaviour.



  • 4 Comments

Readers' comments (4)

  • The return of the licquid cosh!

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  • The return of the liquid cosh!

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  • The overuse of these drugs for those with dementia or learning disability is a menace and any nurse/carer should check out and EMPLOY behaviour management and compassion before approaching a doctor with the problem. What other reaction beyond a prescription would you expect from a doctor? It's just bad nursing and bad doctoring. Primitive!

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  • Absolutely! And why on earth do they start dementia patients on maximum dose then reduce, rather than do it the other way round? My friend, who has vascular dementia - admittedly with an overlying psychosis - has nearly died twice in the past year following prescription of massive doses of antipsychotics which were then withdrawn when everyone panicked about the appalling side effects.

    By dint of making a complete nuisance of myself with her GP and the staff of the psychogeriatric unit where she's currently detained, I've now succeeded in getting two small reductions of the latest antipsychotic in the past six months. It breaks my heart to see her going through such agonising physical symptoms after each reduction, but this terrible drug has already deprived her of the use of one hand and both legs, and I feel we're in a race against time to save her dominant hand.

    I fail to understand why a frail 80-year-old woman with a BMI of 16 and relatively minor behavioural problems should be put straight onto a dose that would be prescribed for a powerfully-built man with acute schizophrenia.

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