Using Medication to Manage Behaviour Problems among Adults with Intellecual Disability: Section 4 Guide to Using Psychotropic Medication to Manage Behaviour Problems among Adults with Intellectual Disability Technical Document (original) (raw)
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World psychiatry : official journal of the World Psychiatric Association (WPA), 2009
Psychotropic medications are used regularly to manage problem behaviours among people with intellectual disabilities. This causes concern because often these medications are used out of their licensed indications in this context. The WPA Section on Psychiatry of Intellectual Disability has recently developed an evidence and consensus-based international guide for practitioners for the use of psychotropic medications for problem behaviours among adults with intellectual disabilities. This guide advises on assessment of behaviours, producing a formulation, initiation of treatment, assessment of out-come and adverse effects, follow-up arrangements, and possibility of discontinuation of treatment.
The use of psychotropic medication in people with learning disability: Towards rational prescribing
Human Psychopharmacology: Clinical and Experimental, 1994
Between 20 per cent to 50 per cent of institutionalized people with a learning disability receive psychotropic medication. A similar or a slightly lower proportion of those who live in the community also receive these drugs. There is a decreasing rate of use of these drugs with the increasing age. The rate of psychotropic drug use seems to have declined in the last decade among the community-based population. The two main reasons for the use of these drugs are psychiatric illness and behaviour disorder. These drugs cause unacceptable sideeffects in a proportion of patients. Recent double-blind studies lend some support to the efficacy of zuclopenthixol in the treatment of behaviour disorder. Some drugs have been used on an experimental basis to treat behavioural problems with equivocal results. These include lithium carbonate, carbamazepine, sodium valproate, fluoxetine, buspirone, naloxone, naltrexone, dextroamphetamine, methylphenidate, fenfluramine, propranolol, nadolol, amantadine and midazolam. Non-drug dietary regimes, such as folk acid, vitamin B6, magnesium, and specific amino-acid rich diets have also been applied in the treatment of behavioural problems. Guidelines have been proposed for a common-sense rational approach to the use of psychotropic drugs in people with a learning disability. KEY woms-Learning disability, psychotropic medication.
Journal of Intellectual Disability Research, 2007
Background Psychopharmacological intervention in the management of behaviour problems in adults with intellectual disabilities (ID) has become a common treatment strategy. This has become a cause for concern, given that the evidence for its effectiveness is uncertain and most drugs are not licensed for this use.Methods A comprehensive systematic review of empirical research on the effectiveness of antipsychotic medication was conducted. Electronic and manual searches of literature were conducted. Stringent scientific methodology determined those primary trials that were worthy of inclusion.Results This review revealed one randomized controlled trial (RCT), one controlled, four uncontrolled prospective and three retrospective case series studies in adults. Additionally, two studies in both adults and children – one crossover RCT and one prospective controlled trial – were found.Conclusion Presently, there is RCT-based evidence for risperidone to be effective in both adults and children; however, this treatment carries a certain amount of risk associated with adverse effects. There is also evidence to support the use of other antipsychotics, primarily atypicals, but the evidence is based on noncontrolled case studies. There is currently not enough evidence available to recommend specific medication for specific behaviour problems. Before prescribing medication, clinicians should carry out a thorough assessment of behaviour, including its causes and consequences, and draw up a formulation providing the rationale for the prescribed intervention after considering all medication- and nonmedication-based management options.
Journal of intellectual disability research : JIDR, 2018
Problem behaviours (PBs) are a common cause for clinician contact in people with disorders of intellectual development and may be a common cause for the prescription of psychotropic medication. We aimed to use a large, multinational sample to define the prevalence of PBs, the associations with psychotropic medication use, and to assess for any potential 'diagnostic overshadowing' by the label of PBs in a population of people with disorders of intellectual development. A multinational, multi-setting, cross-sectional service evaluation and baseline audit was completed. Data were collected from UK hospitals, UK community settings, Sri Lanka and Hong Kong. A semi-structured questionnaire was completed by treating clinicians, capturing demographic details, prevalence rates of intellectual disability and psychotropic medication use, alongside psychiatric co-morbidity. A sample size of 358 was obtained, with 65% of included participants treated in an inpatient setting. Psychotropic...
Pharmacological management of challenging behavior of individuals with intellectual disability
Research in Developmental Disabilities, 2004
In many Westernized countries, including Australia, concerns about the use of psychotropic drugs to manage the challenging behavior of individuals with intellectual disability have resulted in the development of legislative and procedural controls. Although these constraints may limit indiscriminate use, employing medication remains a common practice. This study examined information about 873 individuals (566 males, 307 females) who were the subjects of reports to the Intellectual Disability Review Panel in March 2000 concerning the use of chemical restraint. A high proportion of people with intellectual disability were reported to have received drugs for purposes of behavioral restraint. The range of drugs was extensive, although those from the antipsychotic class were the most frequently reported. Many individuals concurrently received more than one type of drug or more than one drug from the same drug class. More males than females and more older than younger individuals were administered medication. A relationship between gender and age was apparent, with younger males but older females dominating. The use of drugs to mange the behavior of people with intellectual disability may at times be warranted. However, it is important that the extent and type of drug use, as well as the characteristics of those who are medicated, be subject to ongoing scrutiny.
British Journal of …, 2006
This paper describes the findings of a survey into prescribing of psychotropic medication with adults with learning disabilities in a British city. A self-completion questionnaire was sent to staff in dispersed housing and community learning disability teams to gather information about the number of people prescribed psychoactive medication, the type of medication prescribed, General Practitioner and Consultant Psychiatrist visits. The survey identified 55 people who were prescribed psychotropic medication. Of these, 89% were prescribed antipsychotic medication, whilst 47% were prescribed antidepressants. Forty-four per cent were prescribed more than one category of psychotropic medication, whilst 22% were prescribed more than one antipsychotic medication. Worryingly, a clear diagnosis was not provided in a large proportion of cases. The survey has informed a number of service developments, which are briefly described.