People with learning disabilities are often prescribed anti-psychotic medication, whether or not there has been a diagnosis of psychiatric disorder. There continues to be some concern about the evidence base to support this. The most recent Cochrane review which looked at the issue in relation to people with learning disabilities and schizophrenia found that there is a limited evidence base for their continued use in dual diagnosis.
The researchers in this audit were very aware of this limited evidence base, and set out to look at the prescribing practice of anti-psychotics in a Psychiatry Department in the north west of England, to identify whether such practice was in accordance with nationally recognised guidelines.
They collected data from every patient under the care of the department, (178) covering demographic information, the severity of learning disability, diagnoses and anti-psychotic drug use.
They also looked at standards of prescribing by looking at the indication of antipsychotic prescribing; reviews of medication; side effects documented and a range of physical health parameters (weight, blood pressure, blood glucose, lipids).
They found that 72%, or 126 of the patients were prescribed anti-psychotics, with 33% of these (42) being prescribed for challenging behaviour 72% had indication documented and nearly all had been reviewed (98%)
They did not however, find regular documentation of side effects, or measurement of physical parameters for the monitoring of metabolic syndrome.
As the researchers looked at all patients under the care of the department, this audit eliminates any possibility of sampling error or bias and shows that a significant number of people are receiving anti-psychotics for challenging behaviour. They suggest that the findings should be representative of the wider population of patients.
They conclude that the study confirms
- anti-psychotics in use to manage challenging behaviours
- lack of documentation of physical health and side effect monitoring.
They recommend regular monitoring of physical and side effects with careful documentation.
Antipsychotic prescribing in people with intellectual disabilities: a clinical audit, Griffiths H et al, in Advances in Mental Health and Intellectual Disabilities, 6, 4, 215 – 222
I believe more information should be available to the care givers who look after the day to day care of these people. The long term side effects of some of these drugs, especially the mood enhancers which are also prescribed for epilepsy, should be discussed openly with parents and carers.
My son has been on tegretol and lamotrogine for many years now, and has now been diagnosed with osteoporosis as well a low white blood cell count (neutropenia) which can leave him open to many infections. The irony of all this is because of my ignorance of the side effects of these drugs I allowed him to keep taking them even though his epilepsy had been controlled. My concern is that now he will be expected to take other possibly toxic drugs to rectify his bone loss. In fact the use of bisphosphonates for building bone mass has a list of side effects as long as your arm and some of them are quite frightening. If the medical profession are prescribing these drugs without explaining fully the long term effects these can have on the general health of their patients, then they should be ashamed of themselves.
Hi Pauline,
thanks for your comment. Your personal experience always sheds a really clear light on the research evidence. Your point about information about side effects is well made and it would certainly be good to see clearer and more easily understandable information about these.
john